Pandemic politics and long-term care

I haven’t been posting during the height of the COVID-19 pandemic because we needed to have a single focus to deal with the virus and rebuild the economy. Now that we are crawling back to health I shall be more active.

During the pandemic closures, one of my real-world friends and colleagues posted on Facebook, “I’ve been thinking furiously of late about the life cycle and how and where we live toward the end of our lives. My generation (approaching 70) will do everything we can NOT to end up in a seniors’ residence, where, as we have learned with this crisis, conditions are often horrific and (this is the most heartbreaking part) many people are dying alone and uncared-for.

“My generation, the boomers, is large in numbers and outspoken. Things must change. I hope fervently that this crisis will provide the impetus, but how tragic that this is what it takes to make society consider how we treat our elders.”

Her post was one of many about the situation in long-term care facilities across Canada. I can’t count the number of people who posted on social media: ‘this is terrible, someone should do something’.

It is terrible. But to those who have paid attention or experienced it prior to this pandemic have long known the problems and issues. It’s part of why I launched this blog.

And now the Canadian Institute for Health Information has used COVID-19 statistics to confirm the poor situation in Canadian long-term care. In Canada 81 percent of COVID deaths were in long-term care facilities, while world-wide the average is 42 percent! In Nova Scotia 97 percent of all COVID deaths were in long-term care! We beat Alberta, Ontario and Quebec, where 70 percent of deaths were in care.

In Nova Scotia, the Advocates for the Care of the Elderly (ACE) have been lobbying for better facilities, more staff and improved care for over 14 years. Conservatives, New Democratic and Liberal governments have heard ACE’s complaints, concerts, predictions and recommendations, and have allowed the problems to continue under the guise of “studying” the issue. Well, when do you have enough study? When do you act?

Former NDP cabinet minister Graham Steele in his book, What I Learned About Politics: Inside the Rise-and-Collapse of Nova Scotia’s NDP Government, told us that politicians and organizations love to say something is being “studied”. Study sounds like something is being done, when the real purpose of any study is to give cover for inaction.

Any premier or health minister who claims to being surprised by the conditions under which our parents, grandparents, older relatives and friends are living is being dishonest. They know what’s happening. However, they have insulated themselves from direct front-line contact to have a layer a deniability built in.

As for the comment that someone should do something, it is uncomfortable to hear, but we need to look in the mirror. We are the someone and the solution. The problems in long-term care exist because of complacency and how many families use these places as warehouses for the elderly.

People claim they would do more, but are so busy. Well, are you too busy to love? Social media is great for launching go-fund-me campaigns for strangers and petitions for all manner of causes, but beyond a few clicks and digital transactions, how involved do people get with the lives of their older family members, former friends or neighbours?

My mother was in a nursing home for eight months. I went to see her every day. A granddaughter who lived nearby went several times a week. My sister went in weekly. We let her know she wasn’t forgotten. And the facility management knew we were involved in her life and care. In those eight months I saw many residents who had no visitors. The only people who touched and talked to them were the staff.

Another family member is currently in care. The facility was on our watch list based on the experiences of others we know. Until the pandemic locked us out, her husband took two meals a day with her. I went in four or five times a week and one of her daughters also visited. (The others live too far away.) Again, we were/are present and involved in her life and had no problem with how she was treated. But again, management knew we were involved. So many of the other residents I see strapped into chairs in front of television sets day-after-day have no one to visit them and no one to pay any interest in them beyond professional obligations.

The problem is equally shared by the public, politicians, and bureaucrats.

The bureaucrats and provincial ministers who have legislative and legal over-sight of these facilities and responsibility for those in care, have turned blind eyes to failures in care and building maintenance. They have hidden behind crown immunity and bogus interpretations of privacy regulations to protect themselves from real responsibility. They receive the pay, perks, privileges and pensions regardless of their performance.

One of the most telling examples of the laissez farie attitude of bureaucrats was the death of Gilles Duceppe’s mother. Duceppe is the former leader of the Bloc Quebecois. You would think his national profile and political connections would assure his mother is well cared for. But in January 2019, the 93-year-old Mrs. Duceppe got up in the middle of the night and accidently wandered outside into -35 degree weather wearing only her nightdress. The door locked behind her. The official cause of her death was listed as hypothermia. In reality it was neglect.

When Mrs. Duceppe went outside an alarm rang. A staff member turned off the alarm and didn’t bother to check why it sounded. No one did a bed check to see all residents were safe. Mrs. Duceppe was outside for six hours in plain view of a security camera that no one monitored. There was no need for her to die. Not then, not that way. Her family are suing the facility.

If that can happen to the mother of a high-profile politician, what hope is there for the rest of us?

There are numerous other problems in long-term care facilities, like acts of violence, which are discounted and covered up. Each act is considered a one-off incident, when in reality there are thousands of acts of violence in Canadian long-term care facilities each year. This is resident-on-resident, resident-on-caregiver and caregiver-on-resident violence. I don’t have the number at my finger tips, but a few years ago I was told the level of violence was over 4,000 acts a year! Much of this is hidden under the cloak of privacy or given a pass on the assumption the offender is of diminished capacity. That’s not acceptable.

So what can we do?

First, visit the person you know in care. If you’re at a distance call them or call the home to discuss their health and care plan, and for regular reports. Then ask someone else to visit.

Secondly, write, email or call your MP, MLA/MNA/MPP to express your concerns about senior care, about a specific home and individual if you know one.

Thirdly, insist on better pay for care givers.  The people who work the front lines are only paid $18/$20 per hour for physically and emotionally demanding work. They burn out, which creates high staff turn-over. This turnover is upsetting to residents and is inefficient for facilities which have to spend an inordinate amount of time and money recruiting and training new staff about the residents and procedures.

Fourth: we need real inspections done on a regular basis by inspectors who have the authority to force facilities to act asap to correct their deficiencies.

Fifth: we need more long-term care beds. In Nova Scotia over 700 hospital patients aren’t actual patients. They were, but now they are waiting for a long-term care placement. This volume represents up to 60% of acute care beds in most rural hospitals. Collectively these 700 occupied beds are equal to the largest hospital in Atlantic Canada. If we had more long-term care beds we could save the expense of building a $4 billion new hospital in Halifax. That is a massive, political planning failure.

I suspect government planners have resisted creating more long-term care beds because they figured the problem would die out.

Those planners have overlooked the new demographic in need: millennials. Two 2019 studies in the U.S. found millennials are in worse health than their grandparents and are going into care decades earlier than other generations and will be there for many more decades than their grandparents.

So, in building long-term care beds we need to develop separate facilities to accommodate younger residents. Right now anyone needing long-term care goes to a facility occupied by the elderly. That isn’t fair to teenagers and other younger people who may be paralyzed by an accident, born with a genetic disorder or have another need. It’s also a different type of care, so is unfair to the care giver.

Until we sort out long-term care and do so meaningfully, we should immediately stop talk of replacing the VG in Halifax. If we emptied those 700 acute care beds we might not need a replacement hospital.

Better long-term care, better healthcare, better government starts with us. We are the ‘someone’ to do something.

 

 

 

 

 

 

 

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11 Responses to Pandemic politics and long-term care

  1. Bernie says:

    So well put. I suspect that the studies being conducted will “continue to continue”. I too have experienced having a loved on in a care facility and my daughter works in one in another province. The good facilities are good mainly because of the staff and their positive spirit. It behooves us to keep their spirits up by really looking after the staff and compensating them better than we do now. The residents affected are ourselves just a short time down the road!

  2. elder70 says:

    I would like to begin by saying thank you for mentioning the ACE Team and your accurate comment on the work we have have been doing. After fourteen years it is heartbreaking for the ACE Team to know, had the various governments listened to our pleas for improvements to the long-term care system, many needless deaths, not only those that have occurred because of COVID-19 but for the many deaths that have occurred because of simple neglect and abuse that have been happening for decades.

    What we have observed is there is only about ten percent of long-term care residents who receive visits from family members on a daily basis. A great many residents receive no visitors at all which is one good reason why there are so many cases of neglect and abuse happening in nursing homes. You are correct when you say each act is looked upon as a one of situation. As a matter of fact, there is an average of 400 cases of neglect and abuse happening every year in Nova Scotia, some resulting in death and declared homicides. Only 20% of the cases are founded and for those that are investigated, none are ever contested in court leaving many families without closure or a sense of justice done.

    Nova Scotia had more COVID-19 deaths at 53, in nursing homes than the entire country of Australia at 29. The low death rate in that country was due to the fact staffing ratios of resident to worker were much lower allowing for better care for the elderly and virus control. They also had ample PPE and were better prepared for the Corona outbreak.

    At the beginning of the COVID-19 outbreak and it was becoming apparent the elderly were going to be severely affected, Prime Minister Trudeau declared, “We must do better for the care of the elderly in Long-Term Care,” I am happy to hear there are talks happening between the Federal and Provincial governments to bring about that reality. I won’t believe it until I see it. If it were left up to Stephen McNeil and his governing Liberal party, nothing would change. Further encouragement comes from the fact Dr. Janice Keefe, Chair for the Nova Scotia Expert Advisory Panel for Long-Term Care has recently been appointed to Royal Society of Canada as part of a National Long-Term Care Committee mandated to come up with a report that will advise the Federal Government on a National Long-Term Care Strategy. According to the RSC website, this report must be finished within the next few months. I just hope what the Prime Minister stated was a deliberate truth and not something he said to make us all feel good, which prompted me to write the following letter to him.

    June 9, 2020

    The Right Honorable Justin Trudeau, P.C., B.A., B.Ed.
    The Honorable Patty Hajdu, Minister of Health

    Dear Prime Minister;

    I am writing to you today because of the hope you and your government have created during a very difficult time in Canadian history. You showed great compassion and empathy to seniors when publicly stating, “We have to do better for our elderly population”. Your willingness to say this publicly showed me your understanding of the systemic failures that have resulted in avoidable COVID-19 deaths in Long-Term Seniors residential care. This bold declaration also carried with it a promise of change and for that I and the ACE Team are grateful.

    After Minister Hadju saw the devastating number of COVID-19 deaths and infections in Long-Term Care facilities Minister Hadju also made an emotional address to the nation. She said, “Politicians must speak deliberate truths and not just make statements they think will make people feel good”. The ACE TEAM salutes Minister Hadju for her bold statement that anchors politician’s response to this Canadian seniors’ health disaster in the reality of preventable deaths and not in political posturing and public appeasement.

    Unfortunately in Nova Scotia our provincial Health and Wellness Minister, Randy Delorey claims, erroneously, this horrendous number of COVID-19 deaths, 52 occurring at the Northwood Seniors facility, is not due to any gaps in the Long-Term care system. However, The ACE Team has seen tremendous gaps and failures in the system for the past fourteen years. Since 2013 we have witnessed health care, in general, deteriorate to the point of being in a crisis, particularly with Long-Term care. The Minister’s disconnect from the national consensus that systemic change in long-term care conditions is imperative is very disconcerting.

    The ACE Team has been in consultation with the Minister and other Health and Wellness personnel for fourteen years and we have brought many gaps in the system to their attention. Through a Freedom of Information request, we have discovered four hundred cases of neglect and abuse per year. The elderly have endured everything from resident to resident /worker violence, malnourishment, over medication, outbreaks of bedsores resulting in deaths and even sexual abuse. It appears that The Homes for Special Care Act and the underfunded Department for the Protection for People In Care have neither the resources nor organizational culture able to protect people in care. This assessment comes even when deaths have occurred and leaves the families of seniors without any sense of closure or of justice being done.  

    It appears to the ACE Team that our advocating for funding new long-term beds, with a one senior one room ratio, as outlined in Nova Scotia legislation, and more appropriate staffing levels has only resulted in meetings where government leaders and bureaucrats pander to us with promises of plans and reports aimed at improving seniors care. In truth, Long-Term Care funding has been cut to the bone in recent years. No Long-Term care beds have been built during the current provincial governments mandate and before the COVID-19 pandemic deaths this government was proud of that fact. With the current lack of funding seniors still sit in their faeces filled diapers for up to ten hours, receive a once per week bath, and have inadequate nutrition. It has taken COVID-19 to reveal to the entire country the horrible neglect and abuse the elderly have quietly endured for decades. While I talk of cuts and the lack of funding, it appears it is because of the fact long-term care is profit-driven by mostly private operators that are causing the elderly to be subjected to neglect and abuse. Dr. Michael Rachlis of the University of Toronto stated, “We have to stop wasting money we already have.” Money is not the problem with Health Care and specifically LTC;
    In Nova Scotia, $1B per year is spent on Long Term Care. The Money is waisted by a failure of our elected officials and the bureaucracy they continue to build, have abdicated their responsibility, and
    focus on their customers in LTC. Seniors have been abandoned by the system and the “For Profit” segment that regularly strips away needed staples of life to reach ever-increasing corporate Profit Projections at various levels of management in the organization with life-threatening consequences, uncovered in the various military reports. Shameful! The ACE Team is asking who will act to change this situation? 


    Background

    The National Observer has a detailed report, by Judy Haven outlining the deficiencies within the Northwood facility and in general throughout the Long-Term Care system in Nova Scotia. When the Provincial government closed all schools, from daycares to universities, gyms, libraries, theatres, and community centres they paid little to no attention to nursing homes and eldercare residences. It seemed like the elderly were an afterthought or no thought in the government COVID-19 planning process.

    The last comprehensive plan developed in Nova Scotia was under provincial Conservative leader Rodney MacDonald. It was the Ten Year Long-Term Care Plan which would have seen 1500 new long-term care beds created by 2014. The Plan also included the replacement of nine aging long-term care facilities with new homes that consisted of no more than sixty single occupancy rooms each with their private bathroom. If Northwood had been a facility based on this model we would not be seeing the current devastating numbers of deaths there.

    The COVID-19 pandemic has revealed the startling fact that underpaying essential health care workers at Long-Term Care facilities has directly contributed to COVID-19 deaths and infections. Health care workers moving between facilities to work enough hours has resulted in disease transmission.  

    The Need for a National Health Care Accord

    The COVID-19 crisis in Long-term Care facilities and society at large is a compelling argument for the need for a National Health Care Accord. The last National Health Care Accord ended under the Harper Government and while I understand your government attempted to ratify a new National Health Care Accord three years ago the result was weak Bilateral Agreements. 

    The Bilateral Agreement between the Government of Canada and the Province of Nova Scotia in 2017 resulted in the loss of one billion dollars of funding, over ten years, to the Nova Scotia Health Care System. The corresponding cuts in Provincial funding of one hundred million dollars per year, resulted in severe cuts to the Long-Term Care system resulted in the freezing of staff wages, cuts in meal budgets, reduced staffing levels, and reduced training.

    Recommendations

    Short –Term

    The ACE TEAM is asking for the Federal Government to make an immediate, significant, financial contribution to the Nova Scotia Health Care system with the mutually agreed-upon understanding that a specific percentage of the contribution be directed to addressing Long-Term Care issues as revealed during the COVID-19 pandemic.
    That the Federal Government partner with its Provincial Health counterparts and local citizen stakeholders like the ACE TEAM hold a Long Term Care consultation. The goal of such a consultation will be an immediate and significant change in the direction and funding of Long-Term Care in Nova Scotia and other provinces.



    Long-Term

    That the Federal Government invite its Provincial counterparts to engage in creating a National Health Accord with the inclusion of a National Long-Term Care System protected by the National Health Act, the only way to ensure to break the systemic neglect and abuse the elderly have been enduring and end the practice of using the elderly as cash cows to increase the wealth of the rich.


    Summary
      
    The ACE TEAM has great confidence in your expressions of care regarding the preventable COVID-19 deaths and infections of seniors living in Long-Term residential care. We expect that the Federal government will become a strong presence in addressing this deplorable national health care crisis making Long-Term Care changes a legacy of this administration. 

    The ACE TEAM understands the division of Provincial and Federal powers when it comes to health care responsibilities but are convinced that Federal funding and cooperative leadership with the provinces is essential to facilitate desperately needed Long-Term Care changes.
     
    Please help Nova Scotia seniors in Long-Term Care escape from living conditions that are sure to result in more COVID-19 deaths.

    Thank you for responding to this correspondence.
    
With respect,

    Gary MacLeod
     Chair, The ACE Team,
    Advocates for the Care of the Elderly
    The ACE TEAM
    2053 Old Sambro Rd
    Halifax NS B3V 1C1

    • Good of you to reminder us we have a Minister of Health for Nova Scotia. He seems to have been missing for the last four months. He has made no statements, issued no press releases, attended any meetings or events. He’s the invisible man.

  3. Mary McDaid says:

    Thanks for your insightful article on this very difficult challenge. I do differ with one point. Higher wages do not necessarily increase attention and a sense of responsibility. This comes from a) the administration itself and b) a constant and thorough goal setting and oversight by a governing body. The fact that most governments have neglected this responsibility is part of the problem in some cases.

    These recent events have lead us to rewrite our own personal directives. We are specifically noting that long term care is not an option for us. I would like to think that our governments (both federal and provincial) will be able to address this critical issue, but we need comprehensive, coordinated change across the country.

    • I think higher wages would both attract more people to the career and be an incentive for those caregivers who are good, but feeling burned out, to stay. I’ve found that in the private sector and in government, higher paid people get more respect and are listened to over those who are considered a ‘commodity’.

      There are good long-term care homes around. I don’t condemn all of them. But we have to do our homework, we have to inspect the facilities our loved ones are sent to and we have to speak up.

      When AIDS was first on the scene an AIDS activist in the U.S. Larry Kramer, who recently died, used to scream, “Silence = Death”. At first I thought he was rude. Later I realized the truth of his statement. It should be a requirement of citizenship that we speak up. We should never again tolerate the silent majority…

      • Mary McDaid says:

        Very good points. I totally agree that wages are too low for these important roles. I simply feel that increased wages alone, without massive overhaul with an aim to change, will not be enough.

      • Agreed. A change would be if the existing regulations were enforced. We are the province of Westray. Let’s never forget that mining inspectors turned a blind eye to the infractions of the mine operators, leaving 26 men buried underground to this day.

        You wouldn’t know it, but we have a Minister of Health and a Minister responsible for seniors. Where have they been for the last four months? They have been silent. It’s as if they have disappeared, along with all of their other cabinet colleagues.

  4. elder70 says:

    Yes, Health and Wellness Minister Randy Delorey is conspicuous by his absence. He stuck his turtle neck out just long enough to shore up his government’s defense to do nothing to keep the status quo for long-term care by stating, “The deaths at Northwood were not the results of any gaps in long-term care.”

    And of course, the Department of Seniors Minister Leo Glavine, stated, when he was Health and Wellness minister during the Liberals first term, “No more money for bricks and mortar for long-term care beds,” It is no wonder, with this undynamic duo, we have had such poor outcomes with the Coronavirus.

  5. Careworker says:

    We have had enough studies and panels etc. Even this Northwood review is not going to tell us anything we do not already know.

    The average cca in a home takes between 3 to 5 years to actually become good and comfortable with the job. Until that time knowing how to handle many situations, speed and attention to detail can be lacking. It is the more senior staff( the ones that still have it in them) who pick up the slack and get what is missed. Unfortunately the average person does not last 3 to 5 years. Most are lucky to last a year.

    Now we tend to get international recruits because our local population is not even willing to attempt it anymore. The newcomers usually sign 2 year contracts, so we usually keep them that long at least but then they too, move on. Couple that with the more experienced staff retiring and the experienced folks are disappearing at an alarming rate while very few are staying long enough to become experienced.

    The expectations are increasing and the level of need and issues our residents have is making it all but impossible to meet needs. Unfortunately, I am not even close to optimistic that this or any government will be willing to spend the kind of money that will be needed to address this problem. I suspect that other than helping places achieve all private rooms, the government of the day will slap themselves on the back and say job well done and talk about wonderful homecare.

    I have been in the trenches and meeting with government officials and such on these issues for 20 plus years and have yet to see any significant changes.. They will say wonderful things, like this is now required, homes will monitor this and put policy X in place but the reality is that while doing such they put absolutely no resources into achieving it and there is no followup.

    • Politicians love bricks and mortar. It provides a photo op. Hiring people and raising the pay rates lack that photo op.

      • care worker says:

        Sad but so very true. bricks and mortar are also fixed costs, whereas wage increases and increased staffing are continual costs year after year.

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