Earlier this month, the federal government committed to a $1-billion investment into long-term care homes across Canada over two years as part of its economic update.
The announcement and the investment are welcome responses to the devastating loss of life experienced in care homes from the COVID-19 pandemic over the last nine months. This financial commitment is also linked to significant public pressure placed on the government and fears of what the next wave or waves of COVID-19 will bring.
The investment, $500 million a year to be distributed on a per capita basis to provinces and territories, is targeted toward improving ventilation, carrying out infection-prevention and “control-readiness” assessments, hiring more staff and increasing the wages of existing employees.
While the investment is welcome, and greatly needed, there is an omission in the list of deliverables, one we believe would greatly enhance the quality of long-term care services across Canada – committing to, or deepening the commitment to, a palliative approach to care in long-term homes.
The pandemic’s impact on long-term care has been unprecedented and has exposed the growing trend over the last several years towards increased numbers of residents dying in long-term care.
Many Canadians who enter long-term care today have higher needs and acuity than in past years; their care is more complex and their stay often shorter. When it is apparent that end-of-life is near, decisions are often made on whether to transfer residents to hospital. Unless these patients have acute, treatable conditions and it would enhance their quality of life, transferring residents can be dangerous as acute care is not designed to support frail residents. Not to mention how traumatic moving locations can be for residents and their families.
Frequently, the best option is to have the resident remain in long-term care – however, the challenge is that the long-term care home is often not set up to provide a palliative approach. Longstanding gaps in service delivery due to chronic shortages in funding and staff have now become evident. Though running themselves ragged, the current workforce remains committed to providing high quality care. And yet, at the end of their shifts, many go home wishing they could have done more.
If there is any silver lining in all of this, it is that we must see the present challenges and gaps as opportunities to overhaul the system in meaningful ways, integrating palliative approaches to care that take into account what individuals need at the time, what’s most important to them, and whether they can benefit from a palliative approach that will aim to address their physical needs – in terms of pain and symptom management – as well as their psychological, spiritual, social and emotional needs. Focusing on all of these elements promotes dignity, respect and quality of life.
If the federal government is looking for a model to follow, it can start with a quality improvement project launched in British Columbia in pre-COVID times.
While there are variations of this model within many provinces, the B.C. project showed that frontline staff including healthcare aides, nurses and other members of the long-term care team benefitted from the introduction of tools to support early identification of the dying trajectory and resources that enhanced and encouraged conversations about death and dying, rather than avoiding them.
Weekly discussions about residents, education days, improved care planning and the introduction of nurses with palliative care expertise into the study sites supported the adoption of a palliative care approach. Uptake of the tools helped increase existing capacity in homes where end-of-life care is already part of the everyday work.
As it stands, workers are tired, frustrated and demoralized by their inability to provide the care that they know their residents and families need. We need to listen to them and act now to ensure these essential workers have access to enhanced training, and that the structural and systemic changes to support them are in place.
It is welcome news that the investment from the federal government will look to increase the size of the workforce and improve wages. Our hope is that health planners go beyond a focus on infection control and ventilation – no doubt important – to consider the structural and systemic barriers that have gotten us into trouble in the first place. If not, we can expect more of the same when the next pandemic hits, as it will.
Over the last nine months, when families were not allowed to enter care facilities and older Canadians took their last breaths from lungs under siege from COVID-19, it was the long-term care workers who were there to hold their hands through plastic gloves. They were tasked with helping people make one of the most significant transitions in life, often with inadequate training and resources.
The phrase “to die in vain” is used to describe when the ultimate sacrifice of life has been made with nothing to show for it. Let this not be the message left in history books about how we treated our older Canadians who fell victim to such unspeakable circumstances.
Let their lives and their sacrifice, as well as those of our essential workers, be our catalysts for change.
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Philadelphia Home Care is the most Reliable provider of senior care services in Philadelphia.
Palliative Care (PC) is just one of two medically-assisted End-of-Life (EOL) procedures to which any Canadian citizen should have access at the time and place of their choosing.
However, the other Consitutionally-Protected EOL medical procedure is MAiD — which unfortunately two successive federal political administrations have failed to accept, de-criminalize and de-stigmatize.
MAiD should also be provided on the same Charter-protected basis as PC –to any citizen (whether in LTC or otherwise) once that informed choice has been communicated by them.
To advocate public EOL investments in only LTC PC –and not equally in LTC MAiD– will not serve Canadians well — is shortsighted and is contrary to our Charter — which is the supreme “Rule of Law” in Canada.
Please put MAiD and PC on equal footing, with equal public funding in LTC, and offer both to anyone nearing their EOL so that they may make a fair and informed choice as to which medically-assisted death they prefer.
(They may also choose to have neither of these — and that also could be their informed choice.)
Currently in long term care in Edmonton, 85% of residents die in place, 15% in acute care. It is a Quality Indicator that we track.
Dr. Douglas Faulder
Medical Director, Continuing Care
Edmonton Zone, Alberta Health Services
Excellent idea. Our elders deserve it. It can be done.
A requirement to provide palliative care has been in the Ontario Long Term Care Homes Act for many years but the ltc licensees both for profit and non profit have ignored this legislated requirement. The various governments in power over the years who are responsible for the regulatory oversight and enforcement of the legislation have also failed to require compliance with this provision. This is a sad comment and evidence of the way care of older adults is ignored. Many people across the country who have been horrified by what has happened in this sector during the time of Covid keep on asking for requirements that ltc homes provide adequate care to residents that meet their needs, provide training to staff to meet these care needs, ensure that there is sufficient PPE and other equipment necessary for this care yet all these requirements appear in legislation,at least in Ontario, but may also be there in the legislation in other provinces. This hasn’t worked . Why?
Why do health care practitioners, licensees, other care staff and the governments responsible for regulation and enforcement feel that it’s okay to ignore the law which seems to require a level of care and attention to these residents that everyone seems to think is necessary. I’m tired of hearing how everyone is doing their best when the law seems to have been blatantly ignored by all involved.
If anyone can give me the answer to this, I’d love to talk to them .
Feel free to contact me at wahlelderlaw@gmail.com.
I’ve been an advocate and lawyer for changes in this sector to improve the care within ltc for the last 40 years and I see the same problems I saw on my first day working in this area as I see now.