Close your eyes and imagine what a best-in-class LTC system looks like… then build it

Posted on April 25, 2020 in Child & Family Policy Context

Source: — Authors: – Business

The evidence is mounting that perhaps the biggest factor in shutting down our $2.5-trillion economy is the appalling toll that COVID-19 has taken among senior citizens in long-term care facilities (LTC).

And the continued escalation of COVID-19 cases among seniors and staff in LTC facilities, even as we are bending the curve in the general population, delays the reopening of our economy.

Close to half of the 1,974 deaths Canada has suffered from COVID-19 are linked to LTCs. That is a conservative estimate. Careful measurement of COVID-19’s impact in LTCs has barely started.

Regarding the overall COVID-19 death toll, LTC outbreaks are “driving severe outcomes in Canada,” Theresa Tam, Canada’s chief public health officer, has said. “That is absolutely a key feature of this epidemic.”

That is the great reckoning from our chronic neglect of those who built our country. It is also our opportunity to start over, and build the world’s best eldercare system.

We need to get on with it soon, as the population of elderly Canadians grows, and ahead of the inevitable next epidemics, our having failed to act on what we learned from the SARS, MERS, swine flu (H1N1) and Ebola outbreaks.

Close your eyes and imagine what a best-in-class LTC system looks like.

It has fewer and larger LTC facilities. We have too many now — more than 2,600 nursing homes, assisted-living centres and other seniors’ facilities in Quebec alone — making their proper government oversight impossible.

The new LTC system remains provincially regulated, respecting that the Constitution vests provinces with health care authority. But it now conforms with inviolable federal standards, as Medicare does.

Among those new standards is a proper ratio of personal support workers (PSWs) to residents, as with regulated daycare centres, recognizing that widespread LTC staff shortages have contributed substantially to the fatality toll.

Another is that provinces maintain a stockpile of personal protective equipment (PPE), drawn upon to provide PPE to all staff of an LTC facility at the first sign of an outbreak.

A key factor in the rapid spread of COVID-19 is the even more severe shortage of PPE in LTC facilities than in hospitals.

Each resident of the new LTC system has his or her own room, with a personal washroom. No more two to four residents per room, with mere drapes to “protect” against outbreak spread.

With adequate test kits on hand, the identification of a single infected resident triggers the immediate testing of every resident and staff member of the facility.

A seniors home resident laid low by a contagious condition is transferred to the facility’s isolation ward, which is equipped with a respirator.

The affected resident is treated by the facility’s full-time physician and by members of a new provincial corps of specialists in geriatric health care.

The isolation wards relieve pressure on acute-care hospitals, the most expensive form of health care, and reduce to days from weeks the amount of time an LTC facility is in total lockdown.

That, in turn, minimizes the anxiety suffered by families with a loved one in an LTC facility in lockdown.

Since an LTC facility is only as good as its PSWs, the balance of this article is about them.

PSWs are the principal human contact for residents of LTC facilities.

Like all who work in the nursing field, PSWs are usually the first to detect signs of trouble in a patient’s health.

With rare exceptions, the PSW has the most nuanced knowledge of the residents in her care, and the strongest bond of trust and friendship with them.

Yet PSWs toil in a low-income ghetto with few equals in its shoddy treatment of people providing an essential service.

In the new system, PSWs are paid a minimum of 20 per cent more than their current wages.

That alone will not provide PSWs a decent living income. So, the new system also provides PSWs with paid sick days, pensions, continual retraining, and advancement opportunities, as other employers do in attracting and retaining talent.

In the current system, PSWs hold entry-level jobs. Turnover is high, as PSWs quit for better jobs in other fields.

Effectively, then, we currently entrust the care of our elders to temps. As we do lawn care.

The abrupt disappearance of a trusted PSW is traumatizing for a resident. It is a health setback that can take several months to overcome.

The new system gives PSWs reason to think of their work as a career, not a way station to something better.

In the new LTC system, PSWs are prohibited from working in multiple locations. That widespread practice, rooted in PSWs’ low pay, is believed to have caused much of the COVID-19 spread. It has been suspended in B.C., Ontario and Quebec. It needs to be permanently banned across Canada.

PSWs experience a great deal of death. So, in the new system, they are given semi-annual psychological assessments and provided psychiatric counselling as needed.

The new LTC system provides on-site affordable housing and daycare for PSWs and the facility’s entire staff. That includes orderlies and cleaning and security staff, who also work in the low-income ghetto.

Starting in the 1960s, Ontario built a sprawling network of community colleges from scratch.

That was expensive, and worth every penny. By comparison, a new LTC system is a modest financial proposition.

Capital costs are reasonable, since we are retrofitting existing large facilities, building some new ones, and closing hundreds of obsolescent properties that house as few as 18 seniors.

And operating costs, funded from existing LTC budgets, will be lower per resident. A system of fewer and larger facilities yields greater buying power for supplies, reduces duplication, lowers inspection costs, and cuts power bills with more energy-efficient buildings.

So, the money is there to take proper care of our elders. Given the now-evident consequences of failing to do so, there should be tremendous pressure on governments to get moving on this project. It upgrades eldercare and helps solve the crises of income inequality and unaffordable housing.

Here’s where you come in.

When was the last federal, provincial or municipal election fought on eldercare?

This is the time to make eldercare an issue, with rallies, town-hall meetings and website forums.

It is crucial that we show up.

That includes visiting our beloved relatives and friends at LTC facilities.

During my mother’s four years of care at a superb Scarborough LTC facility, I was usually the only visitor for a population of more than 250 residents.

PSWs are more successful in their treatment of a resident who is anticipating a loved one’s visit, and for several days after your visit.

Some of our challenges are daunting, climate crisis for instance.

This one is comparatively straightforward.

It calls on us merely to rally and rebuild — and to visit.


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This entry was posted on Saturday, April 25th, 2020 at 10:34 am and is filed under Child & Family Policy Context. You can follow any responses to this entry through the RSS 2.0 feed. You can skip to the end and leave a response. Pinging is currently not allowed.

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