Innovative models pave the way for safe, high-quality long-term care homes

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  1. neil stuart

    A great discussion piece. Kaleigh Alkenbrack is asking the right questions. In many respects, the our reliance on large-scale nursing homes is an industrial approach to care for the most frail elderly. The recent focus on ‘private vs. not-for-profit’ seems to miss the most important question of whether we have the best care models.

  2. Barbara Sklar

    The discussion should not be to decide which is better – Home Care or “LTC”. Many people would prefer Home Care, and it
    should be improved to allow for those who prefer to stay in their homes. For those who need LTC, we need to change the name to ‘Community Care’ and focus on integrating residents with innovative approaches such as the Green House project, Eden, Butterfly and others. There are many large homes in the GTA (some that could be donated), that could be retro-fitted. Condo builders should also be required to reserve areas in their buildings. Respect and dignity for our elders (and others who need 24 hr care) must be our priority.

  3. Denyse Lynch

    Thank you Kaleigh, for your article and Pat Armstrong’ research, both of which articulate my thoughts and the urgent needs of so many residents/their caregivers. My dad was a resident in LTC for 5 years. These were 5 years of absolutely unnecessary, unbelievable chaos, numerous upsetting, family/work-life disruptions and upheavals. This, as many caregivers experienced, resulted in emotional/mental stress, as well as great financial costs. Though dad passed, I “could not, not keep pursuing, advocating” for LTC quality improvements for our seniors/their caregivers. We have all paid dearly and sadly, unnecessarily. Many essential caregivers continue to trod this well-worn, immensely difficult, path.

    Through research, analysis of the LTC system, the government’s role in their functioning, overseeing and managing them, it is all too obvious, as to how/why they are as dysfunctional as they are and have been for decades. This Covid-19 virus exposed the dysfunction, clearly highlighting the root causes. Plainly evident, the leadership competencies, of LTC homes, government and their visioning, planning, organizing, operationalizing, decision-making, monitoring and follow-up are in plain view on our radar. The alignment and performance of these elements in LTC homes’/government leaders are requisite to the well-being and sustainability of all organizations. As importantly, their accountability to seniors, caregivers, all constituents are at the core of the terrible abuse, neglect, suffering, deaths, we experience. The Military quite accurately, in detail, exposed these elements as the root causes of the failures uncovered. Their report, widely circulated to all constituents, stakeholders, perceptively, factually captured the evidence brought forth by essential caregivers, over past decades.

    Questions of leadership (LTC management, government officials): Why were families’ concerns not believed, not acted upon all these years? Why were leadership (LTC, government) commitments/promises made, yet not kept? Why were penalties imposed on the non compliance of the LTC ACT, residents’, families’ rights, not commensurate with the horrific incidents that occurred in LTC? Why were more appropriate penalties/consequences, not imposed? Also, why was it families who had to leave good-paying, jobs/careers, to undertake, unpaid, and ensure the roles/responsibilities of LTC management/staff? Why were families, again, unpaid supervisors, the ones to monitor and report on staff/management’s non performance, violations of the LTC ACT to LTC’s management and MOH leadership? Why did caregivers have to sacrifice their ability to provide financially for their own futures and mentally, physically exhaust themselves?

    Would Ontario’s “laws/regulations” allow/enable private enterprises/organizations to function the way LTC homes have? Imagine customers having to do employees’ work in retail, finance & all other private sectors/organizations? Imagine customers having to function as supervisory management staff and bring shoddy, law/regulation-breaking performance to the attention of CEO’s/senior management? And then, why have customers also conducted follow-up, to ensure performance was/is corrected/improved? This never was a strategy for success in any model of organizational performance.

    The promised IRON ring around our seniors were simply wispy cobwebs, tossed away, along with human rights, blatantly disregarded by many LTC homes and by government’s abject failure to act in seniors’ best interests, over the summer. They did not act. Our government’s responsibilities are to: ensure the appropriate government ministers/managers have the right skills to exercise their designated responsibilities – to ensure, (like Quebec) that LTC’s hire more staff (for appropriate staff to resident ratio), train, equip them with appropriate PPE, pay them a living wage/benefits, ensure staff only worked in one LTC home, hold LTC management and government minister/managers accountable to the LTC ACT, residents’/ caregivers’ rights, insist on the up-grading of LTC homes for protection. This, a modest start, for current LTC conditions.

    Why are the leaders with the requisite competencies, skills, knowledge “absolutely” necessary to operate Ontario’s “government and health system” or, any system, organization, so silent ? Where are our guiding values, principles I’ve heard articulated by many health care and government leaders that I believed we all hold dear? All rhetoric?

    We know, words, commitments, promises and accountability always have mattered and will matter. Our leaders’ know their willingness to act, with urgency, to do the right thing, equally matter. Their responsibilities are to “willingly and firmly” enforce the LTC ACT, no matter how hard or, the cost. Families will not abandon their loved ones. Our values – treating loved ones, others, with care, respect, compassion, empathy ; we all need, all of these, as human beings. These are broadcast as important and stated as being carried out (by government and LTC homes). Family, community, knowing what is right and wrong, propel us to act. There are tremendous failures to be addressed, now, without further delay. The erosion of trust and feelings of betrayal are pervasive among us.

    I agree with Pat Armstrong’s research that: there are urgent lessons to be learned for improving our current system: “The central one is more staff, more autonomy for the staff. More attention to the social and the emotional rather than focusing on tasks and the medical. And comfortable physical environments.” Most importantly, Pat wants the future of long-term care to “go in the direction of standards and not standardization.”

    “It’s about adjusting the care to fit the population and not just the population but the individuals,” she says. “And all of that requires particular kinds of conditions of work. It requires more staff. It requires a recognition of skills. As we like to say in our project, the conditions of work are the conditions of care.”

    I concur with the comments of Neil Stuart, Michael Rachlis and Barbara Sklar. To caregivers and those who know better and are trying to do better, a heartfelt thank you. It is a long road, yet, do not give up. Please take heart, go confidently, with intention, respect, in the direction of contributing solutions, lobbying, for what is morally, ethically, right. This, for all stakeholders, constituents and ultimately, the well-being, productivity and sustainability of our society.

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