Elder care reform must start with skills training

By Sarah Watts-Rynard

When it comes to tragedy, the human instinct is to assign blame. In the case of pandemic-induced deaths in Canada’s long-term care facilities, there are no end of culprits: governments for regulatory and oversight failures, owners and managers for poor employment practices, workers for abandoning their posts. Regardless of the direction the finger is pointing, the reality is that the senior population is growing, the cost of high-quality elder care is sky-rocketing and demographics dictate that the need for long-term care is here to stay.

Part of the solution starts with a highly skilled workforce that can rely on well-developed training pathways both before and throughout their careers.

Elder care is a segment of the healthcare system few want to think about. Most Canadians put off long-term care for their aging relatives until health, mobility and/or cognitive issues make it necessary. Even then, family becomes an integral part of the care-taking team in sometimes crowded and often understaffed conditions. The situation in many long-term care homes was ripe for a COVID-19 wake-up call.

Responding to that call requires a new cross-country emphasis on high-quality applied learning that combines knowledge and know-how, incorporating concrete training on subjects like sanitation, food safety and infection prevention with human skills such as empathy, patience and optimism.  

Today, an unregulated workforce provides as much as 80 per cent of direct care to nursing home residents and there is no national standard for training. According to 2018-19 data collected by the Canadian Institute of Health Information, more than 54 per cent of the population in long-term care is over the age of 85, 44 per cent have reduced physical function and more than 80 per cent suffer moderate to severe cognitive loss. This reality suggests it is not merely a matter of deploying more people to work in long-term care or calling in the military to offer emergency support.  Rather, the appropriate response is one that ensures the workforce is well-equipped for roles that are both physically and mentally demanding.

This is a space where Canada’s polytechnics are ahead of the curve, offering everything from entry-level training to professional development and applied research in the elder care sector.  It is time to make high-quality training a requirement of occupations in long-term care.

As in all healthcare occupations, theory-based training alone is not sufficient.  Polytechnic elder care programs are heavily weighted toward hands-on, practical training and simulationHigh-tech laboratories have been set up to simulate a variety of long-term care settings – from hospital-style wards to private rooms and apartments.  Walking into one of these spaces feels like a visit with your grandmother.

Real-life scenarios are built into the polytechnic training environment, with situations that draw learners into the realities of working with physically and cognitively impaired adults. Learners are required to wear personal protective gear and are tasked to interact with high-tech mannequins that speak, breathe and can be programmed to simulate very human scenarios. This approach embraces the technology and equipment of the modern healthcare sector, but goes further, focusing on how to support human beings.

But even realistic scenario-driven teaching cannot fully capture the skills development process.  A large majority of polytechnic programs include a work placement as a mandatory requirement of graduation. Elder care students need opportunities to put their skills into practice, building both competence and confidence.

In other words, a well-prepared and highly trained workforce is no simple matter. 

It is time for regulators to make quality training mandatory across the full spectrum of healthcare professions, including long-term care. While the COVID-19 pandemic shines a light on understaffed and overwhelmed conditions in some of Canada’s long-term care homes, considerations and solutions must build on what we know works. Well-trained, well-compensated and well-supported healthcare workers are better able to respond to the demands of a stressful work environment. The elderly population deserves nothing less.

But polytechnics can’t do it alone. Solutions must include new investments from governments in hands-on learning for the long-term care sector.

It is critical to get learners back to the classroom, safely, during COVID-19. This may well require that institutions rethink class sizes, scheduling, space utilization and cleaning processes.  There’s also the need for improved training equipment and spaces that often go too long between upgrades.

Realistically, none of this comes without a cost.

Equally, long-term care homes must be supported in their efforts to provide supervised, professional clinical placements. Elder care – a field dominated by women – tends to rely on unpaid work terms. In Budget 2019, the federal government invested $798.2 million over five years in work-integrated learning, but little of it will flow to placements in the “caring economy.” 

The pandemic serves to draw new attention to this oversight.

Finally, initial training and ongoing professional development should be required across the sector for workers in both private and public long-term care facilities.  Given the very real stresses of the job, quality care for seniors relies on our capacity to support frontline workers. This will undoubtedly require a new approach to funding high-quality long-term care.

The time for blame has long passed. The opportunity for action lays ahead. Let’s not miss the chance to do it right, particularly given that long-term care may well be something many of will experience firsthand at some point in the future.

Sarah Watts-Rynard is CEO of Polytechnics Canada, a national association of the country’s leading polytechnic institutions. Polytechnic education is industry-driven and hands-on, actively preparing graduates for the world of work.