Crisis in Long Term Care

This letter was emailed to the provincial politicians and authorities:

                Clinton Halladay                 April 25, 2020

Honourable Elected Officials:           

It is with both sadness and solace that I key this article.  Sadness at the loss of life being experienced due to the ravages of COVID-19 in some Long-Term Care (LTC) Homes, and solace that the LTC where my wife resides is case free.

Lanark Lodge, a municipally owned, 163 bed residence located in Perth Ontario, is a flagship for the management and care of our loved ones with whom they are entrusted.  Administration and staff of all genres have consistently been ahead of the curve with planning and preventative measures to thwart this devastating virus.

I firmly believe that all LTCs, whether private, not-for-profit/charitable or municipal have done, and are doing, everything within their power to avoid and stop this terrible virus. No one would consciously contribute to spreading the infection.

Residents in LTCs, my loved one, your loved ones, our loved ones reside in these facilities for the attention, care and well-being they deserve, and which cannot be otherwise provided.  Statistically, 90% of residents have some form of cognitive impairment, many experiencing multiple afflictions. A wide variety of medical conditions is further complicated by age, with 81% of residents being over the age 75 years, and 54% over the age 85 years.

The problem, the root of the issue, is not the homes, not the administration, not the staff.  The root cause lies squarely at the feet of Government. Funding must flow to these institutions. Years of fiscal neglect by all political parties, both Federal and Provincial, is responsible for the deplorable situation we now find ourselves. NO, this inaction did not create the virus, BUT it has hamstrung our ability to counter it in our LTCs.

The Ontario Government proudly announced in the 2019-20 Provincial Budget, “funding increases to preserve front-line staff and maintain current levels of service provided for resident care and accommodation”. A noble pronouncement, however, preserving and maintaining an already inadequate level of funding is not acceptable. Also, this “increase in funding” through the magic of government accounting and the case mix index actually resulted in a net decrease is available funds, an $80,000 reduction for Lanark Lodge for 2019-20.  Thankfully, following extensive lobbying, this was deferred but not retracted. In fact, a cut of $120,000, for Lanark Lodge, actually took place in March 2020, in the middle of the COVID-19 Pandemic, as the Structural Compliance envelope LTCs previously received was replaced by a funding application process.  Sadly, experience shows that funding by application is rarely approved.

The Ontario Long Term Care Association (OLTCA) has proposed an immediate incremental injection of:

  • $100 – $184 million immediately;
  • $100 million annually for the next three years;
  • $400 – $484 million in total.

Yielding to the woeful state of remuneration, on April 25th, Premier Ford announced an hourly pay increase, plus a monthly bonus, for a period of 16 weeks. This is a resounding acknowledgement of inappropriate wages and must be the starting point for compensation going forward.

There are three distinct areas requiring attention and action:

  • Staffing:   Staffing is the critical issue.  Medical advances are allowing us to live longer, which translates into residents entering LTCs at a more advance age and requiring an advanced level of care. It is of no help to increase funding to hire more healthcare staff when compensation is inadequate to attract candidates.  Reports of PSW to resident ratios of 1-30, and even 1-50, are not unheard of. This is further exacerbated through regular and COVID-19 illness absences. In an interview on April 23rd, Minister Fullerton maintained “very few” of Ontario’s long-term care homes have critical shortages of staff or personal protective equipment, but she did not provide a figure.  Certainly, a different perspective than of those actually on the frontlines!
  • Training:  Training corelates with staffing. There are not enough people entering Healthcare to address shortages let alone permit expansion.  Several colleges and universities have dropped PSW courses due to negligible or no enrollment even in these times of staff shortages.  This is neither a result of limited employment opportunities nor lack of demand. It is a direct result of:
    • Sub-standard wages;
    • Difficult working conditions;
    • Lack of job security;
    • Contract rather than full-time employment;
    • Lack of benefits: i.e. sick leave, pensions, vacation credits.

People will neither study nor train for occupations for which they cannot earn a living     wage without having to work multiple part time, short duration contract type jobs.

  • Infrastructure:  Whether new builds or retrofits, the footprint and infrastructure of the facility must be designed with specific functionality to meet, even exceed, the requirements of residents and staff.
    • Facility wide HVAC systems
    • Legislated maximum/minimum temperatures;
    • Designated isolation rooms;
    • Common areas/staff lounges for break and rest periods by neighbourhood;
    • Appropriately positioned nurse stations to facilitate seamless care processes;

An immediate and substantial increase in funding is clearly needed and the OLTCA budget proposal is a start.  I submit however, rather than just throwing out some numbers and correlating them for some politically motivated soundbite, let us actually do the homework.

Minister Fullerton stated at her April 23rd interview, “I think we have to look into and learn from everything. We learned from H1N1 and we learned from SARS; this is above and beyond any of those things,” she said. “A focus has to put on these to see what else could have been done and what more can be done.”.  If we had truly learned from H1N1 and SARS many of these conditions would have been addressed already. May these not be idle words and truly be a call to action.

Yes, increase funding immediately and get study courses rolling to ease some pressure.  The longer haul is to truly study the situation: what is working, what isn’t, what do the signs and the science indicate for the future, etc, etc., and then fund the need.  Servicing the real need with arbitrary funding is the proverbial square peg in a round hole.  We require an all hands on deck, all stakeholders involved, war-room approach.

An upside of this tragedy is we have proven that decisions can be made quickly, funds can be found and made to flow with little delay.  The sad point of fact is we did not have to be here!  Had proper social responsibility and accountability been exercised over the previous several years, we would have been well positioned to counter this devastation in our LTCs. The residents of LTCs, our loved ones, deserve the best quality of life possible. They deserve better than we are providing. They are vulnerable and marginalized and depend upon us and their government to act in their best interests. Going forward, let us truly demonstrate we have learned our lesson and never again place our loved ones in such avoidable peril.

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