Social Policy in Ontario

Nursing homes don’t have to be grim, depressing places

Posted on January 15, 2016 in Child & Family Delivery System

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TheStar.com – Opinion/Commentary – International research team headed by York professor reimagines institutional long term care as humane, dignified option
Jan 15 2016.   By: Carol Goar, Star Columnist

The harder the Ontario government beats the drum for home care, the more worried York University sociologist Pat Armstrong becomes.  “We’re kidding ourselves if we think we can care for everybody at home. There will always be people who need 24-hour nursing care. We can’t neglect them.”

Currently 76,000 vulnerable seniors live in nursing homes. Thousands more are on regional waiting lists. Hospitals consider them “bed blockers.” Private retirement residences aren’t equipped to meet their needs. Their families can’t take care of them or get enough home care to keep them clean, safe and stable.

“I think we see nursing homes as a symbol of failure — failure of the individuals to care for themselves, of families to care for older people, of the medical system to cure them,” Armstrong said. “It’s something we don’t want to think about because we intend to avoid such places when we grow old.”

That attitude has led to underfunding, understaffing, low wages and high turnover in nursing homes. Care providers don’t have time to listen to residents, respond to their needs, help them eat, talk to them or alleviate their boredom. Food service workers lock the dining room between meals. Clothes vanish in the laundry. Government-required paperwork takes precedence over caregiving. It is not unusual to see a dozen seniors — some with dementia, some in wheelchairs, some heavily sedated — lined up in front of a television staring vacantly at a rerun of I Love Lucy.

“They deserve better,” Armstrong thought. So she pulled together a team of 26 researchers from six countries (Canada, Britain, Sweden, Germany, the United States and Australia) to reimagine institutional long-term care. Could it be a humane, dignified, financially viable option?

The team included doctors, pharmacists, architects, economists, psychologists, social workers, historians, philosophers and communication experts. It began by collecting success stories from Europe and North America and identifying the most promising practices and best ideas in the field.

That was five years ago. Armstrong and her colleagues have now done 25 site visits in 10 jurisdictions; interviewed thousands of long-term care residents, workers, managers, policy-makers and advocates for seniors; published 50 academic papers and released a 86-page public report entitled “Promising Practices in Long-Term Care.”

Last week, she and co-author Donna Baines of the University of Sydney in Australia led a panel discussion in the dining room of Hart House at the University of Toronto. “The receptive was very positive. People are excited by the possibilities.”

It will take many more community forums — and a lot of public pressure — to change the mindset at the ministry of health and long-term care. It regards the elderly as a financial burden and nursing home workers as an expense to be controlled.

For one evening, Armstrong and Baines managed to change the public dialogue from failures and shortcomings to promising practices. They provided proof that nursing homes don’t have to be grim, depressing places. They offered hope to desperate families, exhausted caregivers and aging boomers contemplating their future.

Armstrong acknowledged afterward that it will take a prodigious effort and a significant public investment to reach the level of long-term care regarded as normal in countries such Germany, Sweden and Britain. But even without a cash infusion, she argued, there are ways to make life better for the residents of Ontario’s nursing homes: Label their clothes properly before sending them to the laundry; allow them to make a cup of mid-afternoon tea or go to the fridge for a beer; let them eat chocolate or ice cream if they wish; make the decor less hospitallike and more like a home. Give personal care precedence over paperwork. Reorganize who does what to bolster teamwork and reduce staff turnover. These reforms are not costly.

Three principles are vital for high-quality long-term nursing care, the researchers concluded:
* It fosters person-to-person relationships.
* It respects individual differences, while striving for equity.
* It offers dignity to older citizens regardless of their infirmities.

One of the biggest impediments to progress, Armstrong said, is the province’s knee-jerk response to scandals. Any time something goes wrong in one of Ontario’s 629 nursing homes, the ministry of health imposes blanket regulations. These one-size-fits-all rules reduce the ability of care providers and nursing managers to tailor their practices to the needs of residents. “We’ve become so obsessed with safety and standardization that we’ve taken the life out of living.”

So far, there’s been no sign of interest in the project from Queen’s Park. That is not likely to change until Ontarians open their eyes and raise their voices. Instead of complaining after their elderly parent is admitted to a nursing home, they need to speak out for everyone’s parents. Instead of giving up on long-term care, they need to push back when policy-makers offer a visiting home-care worker.

< http://www.thestar.com/opinion/commentary/2016/01/15/nursing-homes-dont-have-to-be-grim-depressing-places-goar.html >

Tags: disabilities, Health, housing, ideology, mental Health, participation

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