Long Term Care: Health Benefit?
The first rule of politics: don’t ever waste a good crisis! In exercising the need to continue to cultivate voter support, times of crisis present a magnificent opportunity to curry favor with voters and potential voters. The longer the “crisis period”, the more opportunity for elected officials to raise the level of their political capital or spend it.
Such has been the case with the Covid-19 pandemic. In Canada we have been spared the drama that seems to play out in some jurisdictions; in some of these situations the stakes are enormous and competition for air time and influence is beyond anything we can fathom in New Brunswick.
But clearly, as the Canadian version of pandemic drama unfolds we see where “the ship is leaking” and the best that can be done now is to mitigate the risk and damage. In Canada, the eyes are clearly on Long Term Care. Covid-19 has brought deaths amongst seniors and residents of long-term care facilities to the fore. Thankfully, New Brunswick has been spared this drama in long term care.
The Prime Minister, in his Tuesday message, invested good air time assuring Canadians of Canada’s commitment to supporting the provinces in improving the system of Long-Term Care. His words of commitment and assurance constitute a message that seniors advocates have wanted to hear for decades: It is our seniors who built this country, who helped to get Canada to where it is today, and we need to see that their care is good and safe (a paraphrase).
In New Brunswick, that message has been communicated for many years by the Senior Citizens Federation, the Nursing Home Association, the Special Care Home Association, the Coalition of Seniors and Nursing Home Residents Rights, the Home Care Association, and others. Over 40 years ago, health planners and professional leaders were trying to prepare Canada for the day when Senior Care would need a higher priority.
The health and long-term care systems in Canada, however, are influenced strongly by the forces of the status quo, that being hospitals, emergency departments, professional interests, funding crises, and construction of superb facilities. In times leading up to elections, it seems that the public gives more credit for ribbon-cuttings and promises of new initiatives and funding than in the substance of what is behind those announcements.
We will not know, for some time, why some facilities have seen such a high number of deaths with the despair that brings while others remain functioning without such incidents. Why does the resident population of one home get attacked by this virus with such vengeance while other facilities remain apparently unscathed? This will be a hot topic for review and analysis following the settling out from the pandemic and it would be wrong to be casting blame in any direction.
Hon. Jagmeet Singh, Leader of the NDP party for Canada, called for including Long Term Care under the Canada Health Act last week. In the same story, he called for the abolition of free enterprise in the long-term care system in saying that Canada “should put an end to privatized facilities and establish a universal framework for seniors care.”
Mr. Singh is absolutely correct in asserting that Covid-19’s impact “on this demographic has made the need for a consistent and equitable framework for seniors more relevant.” Mr. Singh has said, and we should be grateful to him for doing so, what others have been saying for decades! It is fashionable in the run up to elections for political leaders to mention commitment to seniors, and occasionally in the past, some modest benefits would be extended as if that were resolving issues.
But the system of care needs a higher priority with action behind it, not political talk.
Long Term Care is largely a housing issue with health support. People move to long term care because one or more health issues prevents them from living safely alone at home. Because of these issues, the residents may be able to be managed safely at home with superb home care, in New Brunswick through a combination of Extramural and Home Support. Or if their care requirements reach a threshold where they need to be served in a facility, they may elect for housing and care in a Special Care Home. The majority of frail seniors and persons with mental challenges can be cared for at either of those two levels. Then if care requires round the clock access to nursing intervention, the nursing home is the place to be.
Each level of service provision is governed in provinces differently but rarely is government the service provider. Services are provided by organizations based on provincial legislation and regulations specific to that province and its traditions and culture.
Each province has its own methods of contracting with and regulating the activities of service providers. In some provinces, the nursing home sector has been almost exclusively operated by not for profit organizations while in other provinces the system is predominantly characterized by the private sector ownership and operation.
The public discussion too often gets distracted with the focus on eliminating the private sector from long term care. That discussion deflects attention and energy away from the real issues of long-term care and this is where a long-term care strategy, federally driven, could be helpful.
Just as there may be some poor performers in private sector long term care facilities there may be equally poor performers in the not for profit sector. Indeed, in New Brunswick many of the privately owned facilities, and there are hundreds of them, are innovative, provide superb care, and enjoy great public image. Much of the innovation and progress in Canadian long-term care has had its origin in the private sector where quest for excellence has been paramount.
Great long-term care can be assured with strict adherence to mandatory training and continuing education standards at all levels. Owners, operators, and service provision personnel all need initial mandatory training as well as on-going, continuous learning to ensure knowledge and practice conform to established standards. Owners and operators must, indeed, have mandatory training in developing and maintaining a culture of service excellence. In some provinces, the membership and certification in the Canadian College of Health Leaders, for instance, is viewed as a very useful asset for operators.
The regulatory processes need, also, to be overhauled. The airline industry in North America remains safe because those who regulate it have worked and trained in the industry, speak the language, know what is important or not. By the same token, long term care services must be regulated, using a system of relevant standards, by personnel who have worked in the field, trained in the field, in some cases have been certified by professional bodies.
Design standards appear to be in need of review. Dr. Bill Thomas, the founder of The Eden Alternative, has deflated the dreams of the advocates of large buildings by citing the need to develop small “communities” in which frail elders and persons with Dementia and other cognitive challenges live safely. In the design of York Care Centre, for instance, that thinking was integrated into the planning of the Tower which consists of “10-bed pods”. Old designs based on an antiquated “hospital model” are proving to be inappropriate for long term care of residents.
A national strategy? Yes. Simplistic Solutions? No. We must, in the wake of the pandemic, look for evidence not perception before embarking on more strategies.
Ken McGeorge is a retired CEO in major teaching hospitals and long-term-care facilities. He was co-chair of the New Brunswick Council on Aging and is a columnist with Brunswick News. His email address is firstname.lastname@example.org.
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Ken McGeorge, BS,DHA,CHE is a career health care executive based in Fredericton, NB, Canada.