'twenty seven deaths from choking, 100 cases of abuse'
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military report doesn't tell us anything we didn't know already. stock/getty
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the report released by the military this week on the state of several long-term care homes in canada was grim: cockroaches, underqualified and overtaxed front-line workers, no personal protective equipment, residents choking on food. patients dying.
in the wake of the damning report, which found that many long-term care facilities did not have adequate infection control practices in place, did not provide proper nutrition for residents and failed to keep many patients safe, canadians are left seeking answers about the state of care in this country.
the revelations have prompted experts to call for new federally-led strategy on how long-term care facilities are operated and managed.
susan braedley, an associate professor in the school of social work and the department of health sciences at carleton university an co-investigator of a long-term study on reimagining long-term care, says there’s a dire need for a new long-term care model.
one element of that model would to eliminate the for-profit element. “you can’t make a profit in this business and expect good care,†she says. “it creates conflicts that erode care.â€
that’s because for-profits have to make money and provide dividends to shareholders — which means they’re cutting back on the supports seniors need, she says. the report released by the military found that many staff members were afraid to use medical supplies for residents beyond those that management permitted for fear of retribution, often leaving patients soiled or at risk of medical conditions, such as bedsores.
and these practices have been shown to lead to a higher risk of death. in the 2015 report, hospitalization and mortality rates in long-term care facilities: does for-profit status matter?, researchers found that one year after admission and before discharge, 11.7 per cent of residents in privately-owned long-term care facilities died and 25.7 per cent had at least one hospitalization. after 12 months of follow-up, residents in for-profit facilities had an annual hospitalization rate of 462 per 1000 versus 358 per 1000 in not-for-profit facilities.
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braedley argues that long-term care should be under the umbrella of federal funding in the same way as libraries, education and healthcare are — and proposes a new model. she says that the covid-19 pandemic has highlighted a number of design and operational failings that need to be addressed going forward.
better design
braedley suggests that instead of ward rooms, long-term care facilities should provide single rooms with private bathrooms to residents to reduce the spread of infection, keeping patients in units of 9-11 people. she says numerous studies have shown that this provides a high quality of life while minimizing infection risk.
more hours of care per resident
she also feels the average four hours of daily care that is currently allocated to each patient is insufficient – and not all provinces are even meeting that target. currently in b.c., for example, 86 per cent of care homes are not funded to meet the ministry of health’s target of 3.36 of hours of care per day, according to a 2019 report. increasing the number of hours means not cutting back on staff, says braedley. staff reductions in a number of for-profit long-term care facilities were found in studies to result in a lower level of quality care.
higher wages and more ft employment
the employment status — and wages — of front-line workers need to be raised to improve accountability, she argues. too many underpaid long-term care staff are forced to find employment at multiple homes, which during the pandemic has led to the spread of the covid-19 virus among healthcare facilities. “long-term care homes are not great at giving workers full-time jobs,†says braedley. “we know this doesn’t work for workers,†adding that burnout rates among frontline long-term care workers are high.
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improved ministerial inspections
provincial inspections are also need to change. braedley says that way inspections are conducted have changed dramatically within the past decade. citing ontario, she says that while inspections were formerly aimed at providing guidance around how to improve the facilities, over time they became more focused on meting out punishment. “at one point they became more punitive,†she says. then they became virtually non-existent.
and the long-term health care facility assessments are not aspirational, she says. “the quality measures are based on the absence of things — not about the presence of high-quality care,†says braedley. “instead, it’s all about risk-management.â€
nutrition and cleaning should be taken in house
nutrition is also in need of change. an auditor’s report of ontario long term-care homes from between january 2018 and may 2019, found there were 660 incidents involving food and nutrition issues. the report notes that these incidents involved choking, missed meals, healthcare providers feeding residents food with the wrong texture, and gastroenteritis outbreaks.
“this represents about 1.3 incidents a day and includes 27 cases of unexpected deaths for reasons such as choking or aspiration and about 100 cases of abuse, neglect or improper treatment of a resident by home staff related to food that resulted in harm or risk of harm to the resident,†reads the report.
it concluded that “the ontario ministry of long-term care (ministry) do not have sufficient procedures in place to confirm that residents are receiving sufficient mealtime assistance and that they receive food and nutrition services in accordance with their individual plans of care.â€
braedley says that for nutrition and the quality of food to improve, its preparation must be taken in-house. she says that most food preparation is outsourced to large food catering services that focus on mass production, rather than nutritional value or flavour.
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cleaners also need to be hired on staff— rather than outsourced — with laundry onsite, she says. “under covid-19, this became very important,†she says there were many cases of cleaning firms told by their managers to reuse cloths and other cleaning supplies at multiple long-term care homes, potentially spreading the virus.
although there isn’t one model for quality long-term care, braedley says that canada, as well as many other countries she has studied, have many blueprints of what can work. “you can’t just cut and paste, because [the models] are culturally embedded,†she says.
and there are shining examples. she notes that some ottawa-area long-term care homes hire professional artists to work with residents, helping them to produce and show their work. a home in germany that she visited has dementia patients prepare and eat their own meals. other homes organize pottery sessions, golf tournaments and choirs.
“there are homes that are absolutely doing an amazing job,†she says.
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