Hot! Situation Critical Part 4 [Nursing Homes]

simcoe.com/news – Attention has turned to making the nursing home a desirable option for the frail elderly, instead of a dreaded “institution of last resort,” as the Canadian Health Care Association put it in a 2009 report on how to refocus long-term care. – Fourth in a four-part series
Jun 24, 2010.   Mike Adler and Rob O’Flanagan, STAFF

ONTARIO – The answer to gridlock across Ontario’s long-term care system is an injection of new money, elder advocates say.

For nursing-home operators, a top priority is the fulfillment of a long-standing promise from the province to fund more staff.

Ontario’s Health Quality Council, a watchdog agency, sees more assisted-living homes as a potential pressure relief valve for overwhelmed nursing homes.

For thousands of Ontario families battling the system’s long waiting lists and cumbersome bureaucracy, any relief measure would do.

“I think the first thing that is needed are more homes,” Denise Riekstins of Toronto  wrote in a typical e-mail response during research for Metroland’s special report.

“The waiting lists are ridiculous, especially for newer homes. I also think that more thought should go into how to improve home care, maybe make it more affordable, so the person can stay in their home as along as possible. Institutional homes are certainly not like home.”

Health Minister Deb Matthews says quality improvements are taking hold now in all nursing homes, with a focus on reducing traditional health risks such as falls and bed sores.

Efforts to make more home care available as an alternative are in progress under a $1.1-billion program created in 2007. More short-stay beds are being created, to help reduce the number of seniors placed permanently in long-term care.

Such “restorative” beds, as Matthews calls them, allow elderly people with short-term needs to be placed temporarily in nursing-home beds to regain their health, and then go home.

But what exactly has to happen to produce real change?

“I think more time,” Matthews said. “I mean, it does take time to change a system.”

In the meantime, attention has turned to making the nursing home a more palatable choice for the frail elderly, instead of a dreaded “institution of last resort,” as the Canadian Health Care Association put it in a 2009 report on long-term care.

Christina Bisanz, CEO of the Ontario Long Term Care Association, believes in a conversion that would see nursing homes become a “hub” for all types of care.

With the right kind of planning, she says, Ontario’s existing 625 homes could feature day programs for the frail elderly who have dementia or chronic diseases, “to help them to live in the community as long as possible.”

Bisanz said nursing homes can become “more than just the residence where 24-7 care is given.”

In some Ontario long-term care homes, that’s already happening.

At Shalom Village in Hamilton, residents pump iron to help maintain functional mobility.

Shalom’s health-club concept was originally regarded skeptically by potential funding bodies, said Pat Morden, the home’s chief executive. A long-term care home is traditionally viewed as a place of restful care. That’s changing.

“They barely get in, but they’re down there lifting weights. And you see the difference,” she said.

Experts in the field of gerontology say such workouts help prevent falls and other debilitating mishaps, and can also improve cognitive ability. Benefits flow to the home and the resident.

Attitudes about what long-term care settings should be like and what services they should offer are changing rapidly. Researchers are looking at ways to incorporate brain-benefiting music classes and computer games, and body-strengthening practices such as yoga and tai chi, into daily routines to make the final years of life more rewarding, positive and healthier.

“If we can help people to remain as cognitively well as possible and as physically active as possible, even if they’re in a long-term care setting, that still could have benefits not only for the individual, but on the caregivers,” said Pat Spadafora, director of Sheridan Elder Research Centre, part of the Sheridan Institute of Technology and Advanced Learning.

Under the motto From Lab to Life, the centre forms collaborative research projects in the long-term care field, studying the impact of innovative dance programs aimed at improving mobility, or computer-gaming programs that encourage cognitive health.

“If the individual can improve their balance, for example, through our dance program,” Spadafora explained, “and their flexibility and their range of motion and their muscular endurance, then maybe they won’t need as much physical support from the caregiver to help them get in and out of bed.”

At Shalom Village, Morden has witnessed the capacity of activities such as music to reactivate mind and spirit. One resident who had a musical background but was debilitated by Parkinson’s and dementia began to participate in the home’s long-standing drum circle.

He hadn’t spoken for two years.

“He was in the drum circle and he was drumming, and he was sobbing,” Morden said. “He just sobbed and sobbed. And then gradually he took over the leadership of the drum circle. That’s the magic, to find those moments for people, at some level.”

Alexa Roggeveen, Sheridan Elder Research Centre’s research co-ordinator, said a recent project, funded by Colleges Ontario Network for Industry Innovation, in conjunction with RBJ Schlegel Villages (a nursing-home operator), studied the openness of residents in retirement and long-term care environments to using brain-fitness software and games on a regular basis.

The technology has potential, especially for an aging population that is increasingly computer and Internet savvy, Roggeveen said. Older adults want to keep learning, and the advances in computer science can be incorporated into recreational activities — things such as games nights — to enhance brain function.

“People want opportunities to do these sorts of things. They don’t want to sit in a room and let their brains atrophy.”

Demands on long-term care in Ontario are mounting as the population ages, and as a more affluent and informed population demands better care and more services.

Expectations of long-term care have steadily increased in recent decades, said Dominic Ventresca, director of seniors services for Niagara, who oversees eight municipally run homes.

Residents who grew up during the Depression were content with “a bed and a meal,” and an occasional visit from a doctor or nurse, Ventresca said.

Ontarians now expect care that is above that base level, Ventresca and others said, with a greater selection of meals and activities, and more timely service — not just having nursing or personal support available, but having it delivered in a timely way, such as more frequent changing of diapers and other incontinence products.

The Eden Alternative, an international long-term care organization, set out to transform the traditional hospital-based settings of care homes into flourishing human habitats.

Its philosophy and beliefs have taken hold around the world, including in Canada, said Kathleen Burnett, the group’s international co-ordinator.

“Eden is a continuous-improvement process,” said Burnett. “It’s part of a culture-change movement in long-term care.”

Eden Alternative used to be based on incorporating plants, animals and children into long-term care environments. But the movement has evolved beyond that.

“We want to pull away from the medical model … the hospital model of care,” she said. “The primary focus currently of everything that goes on in long-term care is based on illness, injury, diagnosis. The drivers are basically the nursing department.”

In contrast, in the human habitat of Eden, she said, the individual drives the home environment.

“People don’t go to an Eden Home to die, they go there to live,” she said. “And that is a complete turnaround from what we are currently seeing in Ontario.”

In an Eden Alternative home, “the elders make most of the decisions,” Burnett said. “It’s about the team working together to benefit all members in that household.”

Morden and others believe long-term care residents deserve to live life to the fullest.

“To their families and the people who love them, they are their history, their parents. These people are loved, and their people who love them want to see them respected, not in pain, having joy.”

Gerry Phillips, Ontario minister responsible for seniors, said municipalities can help improve daily life for older citizens, through, for example, providing “kneeling buses” (with suspensions that can be lowered to accommodate a wheelchair ramp) or different uses of community centres and parks.

When people look at towns and cities, he said, they see — and rightly so — some “very youth-oriented” features such as hockey rinks and child care. The province is eager to help municipalities become more “age-friendly,” he said.

The province is also encouraging development of technology — from high-tech push-button devices to summon help or monitor health, to low-tech kitchen sinks people in wheelchairs can use — that could help seniors stay home longer. As demand for senior-friendly devices grows, Phillips said, costs should go down.

In a decade, the first of the baby boom generation will hit 75. By 2036, the number of Ontarians 75 and over will rise to 2.2 million, from 850,000 today.

Seniors will outnumber children in the future, and one might expect that a scramble to build as many new nursing homes as possible would be under way.

But that’s not what the province is doing, contrary to what some experts on the elderly advise. Indeed, the focus is on aging in place.

Ontario elder advocate Doris Grinspun said Scandinavia incorporates the elderly into day-to-day life, and embraces them as vibrant members of the community.

Every senior in Denmark gets a phone call at 75.

“Happy Birthday!” says the nurse on the line. “We’d like to discuss how to help you stay in your house as long as you want.”

Grinspun, cochair of the Elder Health Coalition, an adviser to the province of Ontario since 2004, said “we haven’t made enough progress” on helping seniors age gracefully at home, and there’s no time to waste.

In many places, small steps and shifts in attitude are inching toward a future where it’s intended that most Ontarians won’t need a nursing-home bed, no matter how long they live.

Long-term care in Ontario is undergoing “total renovations,” and elder advocates Concerned Friends of Ontario Citizens in Care Facilities said it is pleased with the province’s new patient-centred direction, said Phyllis Hymmen, the group’s president.

“There’s a lot of encouraging things happening,” she said, adding people are still afraid of what the future may be like, “but increasingly less so.”

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A number of groups are voicing opinions on what should be done to create better ways of caring for the next generation of the frail elderly.

Elder Health Coalition
Governments need an Elder Health Strategy and must make seniors a priority for programs and support networks allowing them to stay healthy and independent.
(No website: the coalition represents 30 groups advising the province on care for older persons)

Concerned Friends of Ontario Citizens in Care Facilities
concernedfriends.ca
There needs to be enough of everything — enough beds, enough staff. The industry needs to attract more people, particularly physicians, to this challenging field.

Alzheimer Society of Ontario

alzheimerontario.org
Issues posed by dementia must be addressed through specialized training, better-designed nursing and group homes, overcoming stigma and making dementia a national priority.

Ontario Health Quality Council
ohqc.com
Building assisted-living homes and communities creates nursing-home vacancies. Improve long-term care resident satisfaction through better staff attention and morale, activities and a homelike environment.

Canadian Association of Retired Persons
carp.ca
Family caregivers should get support, including the right to time off work, training and respite. Home-care services must be more reliable.

Ontario Long Term Care Association

oltca.com
Ensure the long-term care sector can use new technology and innovation to improve residents’ lives and deliver proper care to people wherever they are.

Ontario Hospital Association
oha.com
Help people better understand care options, properly plan and resource future services they will need, and continue to focus on improving quality of patient lives.

Ontario Association of Non-Profit Homes and Services
oanhss.org
Senior care, wherever it is delivered, must meet a consistent minimum standard. In nursing homes, staffing levels must be increased to handle residents’ greater needs.

PSW Canada
pswcanada.com
The ratio of patients to personal support workers must change so PSWs have more time to spend with residents, and PSW training should be standardized.

Canadian Medical Association
cmaj.ca
Canadians must plan for the effects of retiring baby boomers on health care, and deal with the current scarcity of long-term care and home-care services.

Canadian Union of Public Employees, Ontario Division
cupe.on.ca
Ontario needs meaningful rules and laws to hold service providers accountable for how they’re spending public money on seniors, including guaranteed levels of care.

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