Don’t Grow Old in Canada, Part 2

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If you were at all curious as to the reasons for the abuse and neglect of Canadian seniors in long term care (LTC) facilities discussed in my previous post, The Royal Society of Canada released a report detailing what it feels are the deficiencies at the heart of the LTC crisis in Canada.

The Royal Society echoes what any family member with relatives stuck in one of these homes has been telling regulatory bodies for almost a decade. The homes are poorly staffed by overworked and burnt out employees who are both unqualified and lack the motivation to care for the seniors in their charge.

“People who required a higher level of medical care lived in facilities staffed by regulated nurses (registered nurses and licensed practical nurses), with some complementary care by nursing assistants or orderlies. As costs increased, staff configurations changed. Today we see a decline in all regulated caregivers in most jurisdictions —even as the medical and social needs of older adults in nursing homes have risen sharply. The dominant staffing model in nursing homes now is a few registered nurses and some licensed practical nurses. Most direct care of residents is carried out by unregulated staff variously called care aides, personal support workers, orderlies or nurse assistants. Small numbers of other regulated care providers are included in the mix: physiotherapists and physio aides, recreation therapists and aides, social workers, occupational therapists, and others. Evidence exists, and continues to grow, that staffing levels and staffing mix are linked to quality of care and quality of work life.”

This race-to-the-bottom healthcare has been pervasive across multiple disciplines in the Canadian public health sector. With dental care, which is also not covered under the public health system, denturists (dental technicians not actual dentists) have been pushing legislators to allow them to perform procedures typically reserved for dental specialists.

Given a choice, I would want capable specialists handling my medical and dental treatment, and I expect, like replacing nurses with personal support and other care workers, the outcomes are going to be less than stellar at the hands of a system that seems keen to cut costs at the expense of patient welfare.

I can’t imagine the cause of these drastic drops in quality of care being anything other than the system running out of money. As such, cost reduction becomes a necessary component of an economy that hasn’t been serving the interests of Canadians for a long time. These cuts are likely to worsen with the current federal deficit ballooning by billions due to the covid crisis.

I’m not sure how far the reduction in quality of care goes. Maybe you’ll be able to get your appendix removed while getting your winter tires switched out. Perhaps there’ll be a clinic in the back of a Jiffy Lube that also does lasik. Why pay an ophthalmologist when you can drop down a rung on the ladder and train an optometrist to do it? Maybe we’ll slide all the way back to witchdoctors shaking a chicken bone rattle to ward evil spirits away.

The only bulwark protecting the rest of Canadians is that, unlike geriatric patients, we still have the mental capability to complain about our treatment. We can’t just be buried in a nursing home where they lock the doors, and the complaint filings go into a box that’s hooked up to the trash bin via a pneumatic tube, never to be read, or heard, or cared about in the slightest. Email complaints are filtered directly into spam, and those of us that have been vocally advocating for relatives have run into the bureaucratic equivalent of screaming into a dark empty room – the kind of government bootlickers capable of running a destitute and morally bankrupt elder-care system like the one found in Canada. Soulless despots that are presiding over broken families and institutions rife with abuse and misery that rivals even the deplorable sorts of institutions found in the communist world.

We have regulatory bodies, but it’s not clear specifically what they’re doing, or even if they’re actively engaged in the act of regulating anything. A cursory glance over the many first-hand accounts of poorly maintained nursing homes makes it clear that they’re not supervising these organizations particularly well. And according to the Royal Society of Canada, they don’t even really know the ideal staffing numbers for these facilities:

“No comprehensive empirical work has ever been done in Canada to determine minimal, adequate, appropriate, or optimal staffing needed to ensure good quality social care (quality of life) and health care (quality of care) for residents. It is long overdue.”

That’s not to mention the fact that we haven’t been collecting comprehensive data on the LTC sector at all:

“Canada lacks data for managing the LTC sector. This lack is pervasive and deep. If Canada cannot measure the vital aspects of this sector, we cannot effectively manage it. Managing a complex sector such as LTC embedded in the larger continuing care sector—without data—is like managing with a Ouija board. However, standardized (or any) data collection, analysis and use remain minimal across Canada.”

I can’t imagine a more careless and haphazard approach to running an elder care system. It’s insane how incompetent this is. I had some inkling, but I figured they were trying to save the province money, or maximize profits for these public/private homes, but it’s not clear what these government institutions are doing other than giving bureaucrats big money to stare at a wall and watch paint dry. You would figure this data would be the bare minimum knowledge that a regulatory body would have. Maybe their staffing recommendations were settled by having one of their employees throw a dart on a corkboard of numbers blindfolded – if they even had any recommendations.

The Royal Society of Canada indicates that unregulated support staff responsible for much of the heavy lifting in these nursing homes make a minimum of $12 an hour. For an organization like the Local Health Integration Network (LHIN), which is responsible for placing elderly patients into LTC facilities, many of the bureaucrats that administrate the organization are featured on a “sunshine list” because they make over $100,000 a year. Some make upwards of $300,000 per year.

“The LTC sector and nursing homes rely increasingly on unpaid care by family members and friends of residents. These are disproportionally women, especially for daily care. They provide many different care activities. However, our society gives little attention to respite for these caregivers or to the negative effects of their caregiving burdens.”

I remember spending 12-hour days taking care of my grandmother while the province gave us 3 hours of non-continuous help per day. What that means is you get three single one-hour blocks, so you would have time to run to the grocery store or have a quick nap. I don’t think my family’s experience was particularly unique. If you spend time in a hospital in wards filled with geriatric patients with cognitive impairment, you’ll see some very frazzled family members. It’s not only the province’s fault, typically the burden of care falls on one wing of a family, or sometimes even one individual, while the rest of the relatives do next to nothing. And when the caregiver is so burnt out that they can’t stand it anymore, their relatives wind up in a hospital ward waiting for access to a nursing home – which if you want to know a dirty secret into getting admitted quickly into one of these LTC facilities, it’s don’t take your relatives out of the hospital. Once you get them home, there’s no fire burning in the institutions, and it becomes your problem. Once you clog the system, and they figure out you can’t be intimidated, you’ll see the waitlists magically disappear.

To say this experience had a negative effect on how I feel about the Canadian healthcare system is probably an understatement. I said something similar in a previous post, but I get the sense that if the system can keep you productive, it will fix what ails you, but if it can no longer get anything out of you, your care suddenly becomes someone else’s problem (but they’ll still happily take taxes from your relatives every year). The wound is not quite as fresh, but I still have the haunting feeling that the way we talk about our healthcare system, and our country, doesn’t line up with my experiences trudging through these systems. It makes me wonder how many of our other pavlovian “well at least we have a better system than the states” responses are also not grounded in reality. When we hear these statements, the programming kicks in, eyes gloss over, heads nod, and then everything goes back to the way it was and never improves.

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