If we are lucky! – Some thoughts on the care of seniors

If we are lucky, we are all going to get old one day. We will be called seniors at age 65, or perhaps even at age 55. Membership in this group cuts across all races, genders, creeds, sexual orientations and linguistic or ethnic identities. If we are really lucky our leaders will have solved a lot of the problems facing this group today. If we are not, then perhaps our good fortunes will have run out as we navigate the difficult road to the end of our life journey.

The Canadian Medical Association initiated the “Demand a Plan” campaign for a National Seniors Strategy not long ago. The federal government appointed an amazing advocate in Honourable Filomena Tassi as Minister for Seniors in 2018. Our strong provincial and local leaders in every party talked incessantly about needing more beds in long term care homes for the aging population in 2018 election campaigns. Advocacy groups across the country are currently clamouring for changes and greater funding allocations for the care of seniors.

And the problem is only going to get worse. Statistics Canada estimates that a full quarter of Canadians will be seniors by 2036. The Conference Board of Canada estimated 2.4 million Canadians will need continuing care by 2026, a 71% increase since 2011. A CD Howe paper quoted by the CMA in 2016, projects that the cost of long term care will triple from about 69 billion in 2014 to about 188 billion in 2050.

In response to this growing demographic, entrepreneurs have seen an opportunity. A big opportunity. And big business is doing well on the backs of our old people. Very well indeed!

Who can fail to notice the luxurious residences going up in every part of the country? Who can miss the slick advertisements on television about the amazing lifestyles available in these “Homes”? Who does not love hearing about the excellent care, the compassionate workers, the standards of excellence these multi million dollar businesses are claiming to provide for aging loved ones we must plan for?

November 5, 2018 rates reported in Long Term Care Overview/ Ontario.ca are $1,848.73 for a basic room, $2,228.63 for a semi-Private room and $2,640.78 for a private room. “Cost of Retirement Homes in Ontario” by ComfortLife in 2018 reports the average cost for Assisted Living Care in Ottawa including housekeeping,dressing,all ADL’s at $4500 a month and up. Memory Care in a Retirement Home in Toronto including meals, housekeeping, bathing, medication administration is $6500 a month and up. It goes on to say that the average retirement home cost in Ontario was $3,204 in 2013 with additional costs for certain care and hospitality services. In addition, in my experience, people with resources often bring in extra assistance to ensure their loved one has even the most basic regular care expected by most of us such as shaving, mouth care, cleaning of hearing aids and glasses, or guaranteed feeding help.

Old folk, and helping them journey on out of life to the inevitable, has become a new frontier for moneymakers. Business people run these corporations and business people are recruited to manage the residences. Profits is the goal of business ventures, not people. Meeting the demands and expectations of the shareholders becomes the priority for a great annual report, not meeting the needs of the consumers of service. And that, dear politicians and the public who elect them, is at the heart of many of the very big and frequent problems residents in these Retirement Residences and Long Term Care Homes experience today.

W5’s Sandie Rinaldo hosted a three part series recently entitled “ Crisis in Care.” Horrific stories of abuse and neglect were reported. Lawsuits against Canada’s three biggest for- profit long term care chains were covered.

CBC News reported in a study entitled ”Long Term Care Workers demand mandatory staff-to-patient ratios-Sudbury”, heartbreaking accounts of how, despite herculean efforts and complete dedication, staff across the province are forced to leave residents in unchanged diapers, skip residents scheduled biweekly showers or baths, and wake, wash, toilet, dress and wheel each elderly or infirm person to the breakfast table in under seven minutes flat!

Elizabeth Payne writes in the Ottawa Citizen on January 4, 2019 that ‘ Long-Term care homes want end to mandatory inspections.’ Given that these inspections have found all kinds of evidence of neglect, abuse, mishandling of medications and failures to report incidents, requests to eliminate them in the name of efficiency and the burden on staff to comply is most alarming! What is actually needed is more accountability, but with much more funding and much more frontline staff.

Budgets set by the provincial government are $142.47 per day, per resident which includes $8.33 per day for all meals, snacks and beverages, an amount less than that allotted for a person incarcerated in our prison system. These figures come from a report entitled “This is Long Term Care- 2016” by the Ontario Long Term Care Association, and I thought it might have been a misprint when I read that “unspent funds” are to be returned to the government!

Our leaders in Ontario are very much aware of the problems in elder care and went to great effort a short while ago to ensure Long Term Care Homes comply with legislation and regulations in implementing the Long Term Care Home Quality Inspection Program. It was designed to protect our vulnerable elderly and disabled with all kinds of inspection protocols, certifications, structured interviews, record keeping requirements and the like. Transparency was sought. A better way was envisaged.

And yet somehow the checks and balances designed to ensure safe and quality care does not seem to be doing the job.

A recently retired nurse out of Long Term Care said to me, "My husband and I will never go to a LTCH. We will travel first to Europe for an exit injection.” When I dug deeper for a reason, she responded, "Because I worked in one!”

A resident living in an Ontario Long Term Care Home, whom I befriended last year said to me, “We would like some of these managers to enter a Long Term Care Home incognito for just one weekend, live in a wheelchair and see how the policies, procedures and deficiencies in staff affect our lives so dreadfully! Do they know how it feels to be put to bed at 9:30 in the evening and not to be gotten up until after 9 in the morning despite the discomfort in a body having to lie there.”

When I saw white plaster dust on the floor in her room, I assumed it was there due to her colliding wheelchair. She corrected my interpretation with, "My frustration and pain living here gets taken out on the wall!”

Indeed, she scratches the plaster off the wallboard with her fingernails.

A physically disabled, but very bright senior Long Term Care Home resident I saw in a local hospital last spring, whose passion is reading and using her computer, told me she lacked bifocal corrective lenses for over 5 months despite 6 requests to management in charge of her residence for help to replace her broken glasses, and 3 trips by Para Transpo to nearby opticians who all lacked capacity to assess a person confined to a wheelchair. When she finally got assessed at the 7 month mark and obtained a prescription, she could not have it filled because she had to save $250 at the rate of $50 per month, in order to purchase them from the supplier chosen by the manager.

These kinds of studies, reports and stories from my own experience are extremely disturbing. Senior Canadians have contributed to our country as workers, partners and parents. Many have continued in their golden years to contribute as long as possible in volunteer work, and helping their neighbours and families. At the end they deserve good care, safety and activities that make their sprint to the finish line as happy as possible. We need to find a way to be sure that happens for every one of them and every one of us when our turn comes.

A few suggestions come to mind for the people with the power to make the changes.

Get the profit motive out of the care of the elderly. If there are profits to be made in this area let our government make it and reinvest it back into the care needs of the elderly who must pay. Make people, not profits the focus.

Hire compassionate, highly educated social workers whose first attribute is integrity, to be the Executive Directors of every Long Term Care Home, not business people. These managers should have training and experience with the elderly so their lens will be on the people they serve in the residences, not marketing, expenditures on superficial, showy residence attributes, and profits.

Fund the staffing for the front line care of the elderly in Long Term Care Homes at a ratio equivalent to that we demand for our children, five to one. Anyone who has cared for an elderly loved one knows full well the time it takes to bathe, shave, groom, toilet, change, dress, medicate, feed, talk to and listen to one, is at least, if not more than that required to care for a small child. Add in the potential of the elderly person having some dementia or behaviour problems and the time, skill and patience needed escalates even more. There is no question that a front line staffing ratio of five to one makes sense, and would allow quality care to be a genuinely realistic possibility if implemented.

Support and encourage our young people to enter the health care field as PSW’s and RPN’s by paying them what they are worth. Surely an experienced, trained, competent caretaker of the elderly should be earning a living wage equivalent of workers who are bus drivers, hospital orderlies, pet groomers or school administrators? Why do we feel comfortable exploiting mostly women, often immigrant women, or less academically inclined women, by paying them only slightly over minimum wage to perform a desperately needed and difficult job? We often force them to work in two part time jobs to get 40 plus hours per week, giving them no benefits or paid vacations, and overloading them with unbelievable caseloads of sometimes 15 residents, the bulk of whom are full care, high needs persons. We also expect them to cover for their absent coworkers because managers do not or cannot find replacement workers, and then turn around and complain when problems surface that absolutely no one could likely handle any better. What can we be thinking?

Consider the mole approach, the incognito resident approach or the “Mystery Shopper” approach to accountability and discovering problems in Long Term Care Homes If such persons were randomly placed as residents for extended periods they would gain the trust of workers, families and other residents who would share their problems in an open, transparent way, as the fear of reprisal and retaliation is often much too prevalent for this kind of information to be gotten in traditional inspection programs. Any way to get this population to talk, which could guarantee anonymity and confidentiality would also be helpful, as these factors are absolutely major in getting the real truth in any bureaucracy or work environment.

This getting old thing is not for sissies it is said. If we are lucky, we will all get old. If we are luckier, our leaders will think wisely about the care of our seniors and be excellent at their jobs.