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Long-term Care: Seeking solutions on seniors’ issues

Posted: April 28, 2017

(November 3, 2016)

By: Heather Rivers, Woodstock Sentinel-Review

In Sweden, long-term care residents are cared for in a very different manner than those residing in Canadian homes.

According to Dr. Margaret McGregor, who was part of the Re-imagining Long-term Residential Care: An International Study in Promising Practices project that included researchers from Canada, the U.S., the UK, Sweden, Germany and Norway, a single staff member looks after one or two long-term care residents.

McGregor, who was a PSW before becoming a family physician, has worked extensively in nursing homes in British Columbia.

She visited Sweden, considered one of the best places in the world to grow old, as part of her research and spoke about it at an Ontario Health Coalition conference on reforming long-term care on Oct. 28.

She shared her experiences in Sweden with Postmedia during a telephone interview Tuesday.

“In Sweden, one personal support worker does everything,” she said.

From getting coffee in the morning, to administering medicine and doing laundry and personal care, one person does it all.

“It is full-on care,” McGregor said. “(The PSW) gets to know the residents really well.”

McGregor explains this type of care — which adds up to about four hours of care a day — is a great deal different than long-term homes in Canada where residents are lucky to get one hour of care a day.

And in Sweden, PSWs are mandated to sit and just talk with their patients for at least half an hour a week.

They also emphasized the needs of the family by communicating regularly with them about their family member.

“We need to assure family members their needs are looked after,” McGregor said. “That was really impressive to me how much they thought about the family.”

Weekly staff meetings in Swedish homes are designed for employees to feel valued and recognized.

“When people feel valued, they bring value to the workplace,” she said.

McGregor explained while examining solutions for new models of long-term care, government needs to look to several other countries for advice.

“The question is how do we reproduce that in Canada?” she said. “It’s a complex and multi-layered. Minimally we have to have enough people to develop these relationships.”

Following the tragic news last week that Woodstock registered nurse Elizabeth Wettlaufer had been charged with the death of eight patients in long-term care, seven of which allegedly occurred at Caressant Care in Woodstock, experts can only hope the tragedy may spark more interest in issues that have been plaguing long-term care facilities such as limited oversight and understaffing.

“It’s very, very shocking that this went on so long undetected,” said Maureen Etkin, executive director of Elder Abuse Ontario. “For the most vulnerable people to be treated so at the end of their life…it makes me wonder at the value we place on seniors? I wonder why it takes a story of this magnitude before we pay attention?”

A recent statement from the chief public health officer of Canada cited the statistic that as many as eight seniors are victims of family violence every day.

“That is a staggering statistic,” Etkin said. “It speaks to the need for quality care as we grow older. If we don’t fix it now, this is what we have to look forward to as we grow older.”

In long-term care facilities she said staff are experiencing a crisis in staffing, while caring for patients with more complex conditions.

“The types of people that go into long-term care are much different than 30 years ago,” Etkin said. “People, on the whole, are living in their homes or community much longer. They are much more frail, much more medically complex. It’s a much more heavier load of care for people working in long-term care. You have to ask yourself is that a place you want your parents or grandparents or even yourself to be taken care of?”

Across the spectrum, lack of staffing was the most common theme for experts in the field of long-term care who have been analyzing the long-term care system.

“We are absolutely committed to making improvements in long-term care,” said Katha Fortier, a former RPN and assistant to UNIFOR national president Jerry Dias.

Fortier was part of a panel at Ontario Health Coalition conference on reforming long-term care last weekend.

“It boils down to time,” she said. “There just simply isn’t enough time.”

Fortier said nurses and PSWs are now dealing with more patients, some as young as their 30s and 40s, with acute problems such as mental health issues.

“Some evenings there are one or two staff on a floor of 30 people,” she said. “They are just not equipped and there is not enough staff.”

According to Dr. Eric Hoskins, minister of health and long-term care since 2003/04, the ministry almost doubled funding for long-term care, from $2.1 billion to more than $4 billion in 2016. An additional 4,600 staff have been hired at Ontario long-term care homes since 2008, including 2,500 PSWs and 2,100 nurses.

“These new staff have helped improve patient care and reduce wait times by almost half since 2008,” Hoskins said in a written statement. “Our government is committed to ensuring that residents in long-term care homes receive the care they need in a safe, secure and compassionate environment.”

All licensed long-term care homes include a staffing mix of nursing services and personal support services that is consistent with “residents’ assessed care and safety needs and that meets the requirements set out in the LTC legislation.”

He said 100 additional inspectors have been hired over the last three years and the ministry continues to take steps to “strengthen our inspection procedures.”

“Any failure to meet these standards is unacceptable to me as minister and I fully expect long-term care homes to provide residents with the quality of care that Ontarians expect their loved ones to receive,” he said. “My ministry will continue to utilize every tool at its disposal to ensure that non-compliant homes are brought in line.”

But experts predict unless something substantial is done, the problem can only worsen over the next two decades, when Ontario will see a huge increase in the number of elderly citizens, as numbers double or even triple.

Currently 24,000 Ontarians await long-term care placement, many languishing in hospital beds while they wait.

“In the future there will be twice as many seniors looking for homes,” said Candace Chartier of the Ontario Long-Term Care Association, the largest association of long-term care providers in Ontario.

In 2010 the Ontario Long Term Care Association commissioned the Conference Board of Canada to undertake an investigation into “the innovative potential” of Ontario long-term homes.

A report entitled Why Not Now? is a five-year plan released in 2012 by an expert panel that looked at several areas of innovation.

The panel envisioned long-term care homes as “hubs of innovation” that work closely with hospitals.

“The goal of every home should be a committed and competent medical staff that works together as a team to assure easy accessibility at all time,” the report said.

Expert panel recommendations include a nurse practitioner in every long-term care home, a significant increase in number of long-term care nurses with advanced or specialized training, creation of a long-term care specialty, the creation of new PSW roles, a comprehensive update to college and university programs to better prepare front-line workers for the emerging market.

Chartier said it is her association’s wish long-term care facilities take on a broader role, at a much lower price, in the health-care system in transitioning those in hospital to long-term care beds.

“We feel it’s an untapped resource,” she said.

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