GUEST POST BY DAN LEVITT
While frontline workers have finally attained long overdue hero status, their experiences are no longer making headlines. The news cycle has largely moved on to Third Wave variants and vaccinations.
But as the executive director of a long-term care (LTC) facility that had a high rate of infections (156) and deaths (26) before staff and residents were vaccinated, I am pleading for changes to the long-term care system. The pandemic must be the watershed moment for eldercare renewal. With aging infrastructure, chronic underfunding and understaffing, we can all agree that the seniors care system needs improvement.
Anyone who has spent time working or living in LTC or Assisted Living – and those who have supported a family member or friend needing care – is well aware of society’s institutionalized ageism that has resulted in the current state of eldercare. In a recent survey sponsored by the Canadian Medical Association (CMA) and the National Institute on Ageing (NIA), 96% of older Canadians said they would do everything possible to avoid going into an LTC home after seeing what’s happened to residents of such facilities.
Among OECD member countries, Canada fared worse with double the number of deaths in nursing homes during the first wave of the pandemic when eight out of every 10 deaths took place in LTC settings. Now that LTC staff and residents have been vaccinated, infections and deaths have been reduced to a trickle across the province.
But it is time now to start planning – and executing – changes in the care facility sector. The current infrastructure and health human resource pool does not meet current demands and will need to increase over the next decades to build capacity for the baby boomers demographic who will undoubtedly expect – and demand – a different journey than their parents experienced. A hospital-style nursing home built in the 1960s with long corridors where staff are rushed to porter seniors to and from large dining rooms for their meals that are made in a cafeteria-style kitchen is far from desirable for older adults with multiple chronic conditions and dementia.
Having multiple people in rooms is also undesirable yet in LTC, this has been accepted. The overcrowding of communal space in nursing homes without the ability to physically distance for staff, the elderly and their visitors, created a perfect storm for virus transmission.
At the beginning of the pandemic, as health planners and infection control experts began to empty beds in acute care and even prepare field hospitals for infected people, older persons were seemingly left out of the priority for such care. Indeed, those living in LTC and AL were advised to update their advance care plans should they test positive for COVID-19. They were also advised to decline a transfer to a hospital and accept their fate at their care home without the option of a potentially life-saving intensive care unit, including a ventilator. That is one reason why hospitalizations of the very elderly appear to be so much lower than among those in the under 80 age groups. Hospital resources were prioritized and allocated to patients who had a better chance of survival.
In the first wave, sufficient supplies of PPE were not available to all staff and many said they were stuck purchasing items at retail stores, only later to be reimbursed. While hospital staff were on stand-by for admissions of COVID-19 positive patients, outbreaks within care homes kept increasing, leading to uncontrollable outcomes and far too many deaths.
Families were on the outside looking in at the horrors. Staff were doing the absolute best they could with the situation and resources available to them. The horror was the lack of priority to protect and support older adults and their caregivers; they were ignored as decisions were made about fighting the virus. With virtual video conferencing, window visits and only essential visitors limited to a single-family member, there was unimaginable hardship of the older persons living in care who spent far too much of their time relegated to their small bedrooms.
Reliant on staff for personal care, mobility, dressing, toileting, grooming, eating, and human connections, the situation was dire. Loneliness, helplessness and boredom were all too common for many nursing home residents before the pandemic. During the pandemic, even in the most robust eldercare settings, this plague was like exposing kryptonite to Superman. And the impact of mental wellness will be felt for years to come.
It’s time to rethink our treatment of the elderly in Canada and prioritize not only vaccinations but the allocation of resources that will lead to the transformation of LTC and AL living options. As well, those living in the community who wish to remain in their houses for as long as they can, with the supports and care provided by a well-coordinated elder care system, should be able to attain their goals. People should be able to access neighbourhood amenities and social connections to ensure they are not isolated.
As federal and provincial governments plan budgets and program priorities, they must prioritize the rights of older persons. This is, after all, a matter of human rights.
Dan Levitt is executive director of the Tabor Village elder care community in Abbotsford.
He is also an adjunct professor of gerontology at Simon Fraser University, an adjunct professor of nursing at the University of B.C., and a sessional health sciences instructor at the B.C. Institute of Technology.