No quick solutions for problems with long-term care

For advocates for improvements to care for seniors, the COVID-19 crisis has put into stark relief many of the shortcomings in the system, leading to widespread outbreaks, hospitalizations and deaths among the residents of many long-term care facilities – some 69 per cent of COVID-19 deaths in the country were among residents of such homes, well above the international average of about 41 per cent.

Chronic underfunding, understaffing, poor pay and aging facilities were all issues before the pandemic struck. Some critics have been warning about the issues for years, though they may not resort to “I told you so” under the circumstances. What they’d like to see is action taken to improve the lot of long-term care residents today and post-pandemic, preparations that would serve residents well during the next pandemic.

Such issues are at the center of ongoing community rallies organized by the Ontario Health Coalition, for instance, and are likely to be discussed in relation to Chartwell’s plans to sell off some of its long-term care homes, including one in Elmira.

The debate focuses on non-profit versus for-profit long-term care homes, where there’s a noted difference in the quality of care. A recent University of Waterloo study, for instance, found facilities owned by private equity firms and large chains have the highest mortality rates.

The study found that nursing homes with the highest profit margins have the lowest quality as financialized ownership and are even more aggressive in seeking to extract value from care homes and the people who live and work in them.

In the pandemic, that some facilities fared much better than others during the first wave suggests that those that were better prepared and/or reacted quickly are a model for the kind of improvements advocates want to see.

Critics argue that longstanding shortcomings in the longterm care sector didn’t mean the pandemic had to be the crisis it became in some facilities. The pre-existing conditions, however, made the sector ripe pickings for the spread of the virus, with Stolee noting that the first wave saw most of the attention focused on preventing the hospitals from being overwhelmed by the pandemic.

As those with chronic or not-easily diagnosed symptoms are often aware, our healthcare system isn’t as responsive as in the case of an acute illness, whether a broken bone or something in the vein of a heart attack or stroke. Or, as we’ve seen lately, mobilizing ICU beds to deal with those stricken down by COVID-19.

The situation is even worse when it comes to the diseases of aging, for which we have few remedies. The system isn’t set up very well to deal with the likes of dementia and care for the elderly, who are often seen as on a one-way path through the healthcare experience.

There’s currently a divide between efforts to keep seniors in their homes with some level of support, long-term care facilities and hospitalization, with the system always looking to avoid having beds taken up by those suffering from chronic diseases of aging. That’s a situation that’s only going to take up more resources, as a report from the Canadian Medical Association estimates the cost and demand for elder care will nearly double by 2031, for instance.

What remains to be seen is what more the upcoming commission will recommend to counter the longstanding problems. Money will be at the heart of the matter – as with all precarious work, low wages, poor benefits and insecure hours lead to vacancies, low morale and staff turnover. Reversing those conditions will be costly, ultimately leading to higher costs to residents and their families, in all likelihood ... if the industry goes down that road.

Included in the mix will be the division between for-profit and non-profit homes, with many fingers already pointing to the discrepancies in the number of cases and fatalities in for-profit facilities. In the end, the issue will be politicized.