COVID-19 has gone through long-term care (LTC) like a forest fire. Our seniors are the tinder and part-time, poorly paid staff are the spark. Personal care for the elderly, disabled, and children is still largely “women’s work.” Pay is so low for personal support workers that there was a serious shortage before COVID-19.
But all organizations need adequately paid and trained staff to accomplish their mission. Like having non-slip flooring, treating employees with care so they can better care for others should be LTC care admin 101. It hardly outlines a new model of care. LTC should provide social and physical environments where the frail elderly can thrive. And these settings also protect vulnerable Canadians from communicable diseases.
Another prerequisite is non-profit personal care. Yes, the private sector should provide the wheelchairs, food, and cleaning materials. And, the non-profit sector is not a pristine alternative. But we want to minimize the incentives for underservicing. The evidence shows overall poorer quality care in for-profit facilities related to lower staff ratios. Our public resources for personal care should go to workers, not investors.
There are two major strategies for LTC reform. The first is a different LTC institution. The second is to move LTC to the community.
Some older LTC institutions need to be completely overhauled. Many residents still live two or four to a room in 30 to 40 bed wards. Every person must have their own room and their own toilet, for their dignity and safety.
And, we don’t want facilities that feel like warehouses with a dozen different staff in a resident’s room every day. Some new homes have 500 residents. With contingent workers working on several wards in several institutions every month, it’s not whether, it’s when, there will be a major outbreak.
In contrast, in homes embracing the American Eden Alternative or the British Butterfly model, residents typically have their own rooms and live in 8 to 10 room houses.
At Saskatoon’s Sherbrooke Community Centre’s “The Village,” nine or 10 residents live in their own rooms in their own houses. Each house opens onto an indoor streetscape, “Poppy Lane” with a hairdresser, gift shop, market, art studio and other amenities.
The previously separate housekeeping, dietary, and personal care staff have been cross-trained so a small number can provide all the house’s care. In case of an outbreak, each resident can be isolated and individual houses can be isolated from others.
The reduced risk of infection is a side benefit of Sherbrooke’s implementation of the Eden Alternative. The small numbers of staff and residents enhance human relationships, vitalizing residents and caregivers.
The other model of LTC is intensive community care. In the 1980s, San Francisco’s On Lok Seniors Services pioneered the Program for All-inclusive Care for the Elderly. PACE is now found in over 150 American communities. Participants are eligible if they are assessed as needing LTC by a state assessor. They can choose either institutional care or PACE.
Program participants live in their own housing. Many live in supportive housing and some live with family. PACE provides all needed health services at home 24/7. A lot of services (e.g. diagnostic, rehab, bathing, as well as socialization) are provided in congregate day facilities that operate 10 to12 hours a day. The day centres have subacute beds so families can get respite and participants can get IV treatments and other care without hospitalization.
It works. On Lok’s clients are as healthy and happy as they can be. PACE participants have lower health care costs, longer life expectancy, improved quality of life, and reduced use of acute and long-term care.
PACE provides much better communicable disease protection than traditional LTC because each resident has their own home, which can be easily locked down during pandemics.
Provinces are planning to spend tens of billions of dollars building new LTC facilities in the next decade. The COVID-19 crisis has highlighted that we need new ways of providing LTC to protect residents from plagues of communicable disease. But we also need to eradicate the noncommunicable plagues of old age identified by the architects of the Eden Alternative — loneliness, helplessness, and boredom.
We need new models of care that prioritize human relationships, dignity, and safety. That means a moratorium on new LTC facilities that don’t look like Sherbrooke Community Centre’s Poppy Lane. And let’s save billions of dollars in bricks and mortar with a Canadian version PACE.
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