- by Ian DeWaard
With nearly 80 per cent of COVID-19 deaths connected to long-term care facilities, our collective attention has been turned toward Ontario’s eldercare facilities. We hear news of military personnel, hospital staff, and even education workers being deployed to assist with the overwhelming impact that this deadly virus has had in long-term care homes. We have also seenhorrifying reports coming from the military about the conditions they found when they went in to help.
In response to mounting calls for a public inquiry, the province promised to launch an independent commission. To that, people at work inside that system deliver a wince — oh no, not another inquiry.
Experience tells us that while the commission does its thing, there will be no forward action. The promise of an independent review pacifies a rightfully angry public, but it also means that the implementation of the necessary changes will be again left for some future government to manage. This will allow the decades of neglect to continue.
The Long-Term Care Homes Public Inquiry, resulting from the killing spree of nurse Elizabeth Wettlaufer, provides a recent example. Prompted by a serial murderer’s actions, inquiry commissioner Justice Eileen E. Gillese stated that the focus of the four-volume final report was the “strained but not broken” long-term care system. It’s been nearly three years since that inquiry was launched and, to date, most of the 91 recommendations have yet to be introduced.
The Gillese report is not the first of its kind. Gathering much dust on some government shelf are reports from public inquiries commissioned by previous governments. Most of these, like the Wettlaufer inquiry, were struck up in response to other, no less tragic events. These include the Price Waterhouse Cooper report on the Long Term Sector (2001), the Smith Report (2004), the Sharkey Report (2008), and the Donner Report (2012). Each of these made numerous recommendations that successive governments failed to implement.
On some other dust-covered shelves are ignored coroner’s recommendations, countless reports, studies and prebudget recommendations authored by people who best know long-term care — academics, industry associations, labour groups, or resident and family member advocates.
And yet, despite all of this collected insight, successive governments fail to take action. That’s because it’s not answers that we’ve been missing. The underlying problems are already understood. We don’t need another inquiry or study or commission if it delays desperately needed action.
Time after time, it’s been made clear that Ontario lags on the simple metric of hands-on care time, per resident, per day. This needs to be the feature piece in any plan of action. Six minutes — the time a personal support worker is given to get an elderly and frail resident from bed to breakfast — is simply not enough, especially when also observing infection control protocols. As some innovative and progressive models of care are demonstrating, increased care time leads to higher resident satisfaction, lower rates of resident and staff injury, less acute care costs, and a more contented, engaged staff. Examples of these experimental models include the joint work being done by Schlegel Villages and the University of Waterloo, and the Butterfly Model of Care being deployed by some municipally run facilities.
Precariousness and pay
Ontario must contend with the long-term care industry’s inability to attract and retain workers. According to Advantage Ontario, over 50 per cent of personal support workers are retained for fewer than five years. Caring jobs have become undervalued and undesirable. For proof, we can look to the significant increased use of precarious part-time and casual positions, and to wages that have steadily declined over the last 10 years, when adjusted for inflation. Combine that with the growing personal costs to acquire necessary qualifications, back-breaking and stressful work, and frailer residents — it is small wonder that fewer and fewer people choose to enter and stay in this field of work.
Documentation overload
The sector has become so regulated that staff can spend more time documenting their interactions with residents than actual time providing hands-on care. The emergency orders issued during COVID-19 have suspended the documentation of unnecessary information and we have the opportunity to learn from this exercise — let’s not waste it.
Facility upgrades
The province still has a glut of old and outdated facilities, and replacement of these is long overdue. These are expensive to operate and they complicate the containment of a virus. There is stimulus money that will be provided to kick-start our economy in the coming months and years. Upgrading long-term care facilities and fast-tracking the promised 15,000 new beds is an excellent way the federal government can help the provinces deal with this crisis.
In remarks on May 6, Minister of Long-Term Care Merrilee Fullerton and Premier Doug Ford both acknowledged that, after years of neglect, the long-term care system is indeed broken and promised that this government will get to the bottom of it.
We’re already at the bottom. The military report confirms it.
Ontarians, especially our grandparents and parents, need action, and we need a government with the fortitude to act while learning more about what went wrong.
Ian DeWaard is the Ontario director of the Christian Labour Association of Canada, a multi-sector union that represents 8,000 health-care workers in Ontario, and 60,000 members nationally.
originally published in the Waterloo Record; shared here with the permission of the author