The pandemic – and particularly the first wave – shed light on major issues with the safeguarding system for our elders living in long term care facilities (LTC). A human tragedy that is both difficult to understand and also unacceptable for a rich and developed society such as ours in Canada; and especially given our clear engagement towards our social programs. This broad scale tragedy unfolded in several facilities (public and private) and in different provinces; most notably in Ontario and Quebec. Public investigations followed suit and revealed significant flaws in the safeguarding system and in securing required levels of care during the crisis. Many reasons underpin those flaws and staffing difficulties are high on the list. In certain instances, staffing shortages meant that residents were almost completely left alone without any help or care. The end result was a harrowing tragedy, which we are still painfully unpacking through the ongoing investigations. What happened? What should we do? How can we make sure that never again could such a tragedy occur?
Taking full stock of the LTC tragedy and ensuring issues are fixed in a complete and reliable way that guarantees a safe future are not easy endeavours. I already sketched a demographic portrait that means forthcoming and ongoing upward pressure on the quantity of care to be provided to our aging and growing population. In light of the above-mentioned tragedy, it may be advisable to pause and also reflect on the distinct nature of LTC facilities as it relates to the quality of care. This might prove useful to better understand the challenge before us.
LTC facilities are complex environments as they represent, unlike other care providing settings, a unique crossroads between the residents’ living and care providing environments. We can also add to the mix that LTC facilities are also a working environment to all staff offering the necessary services for the residents’ health and well-being. By doing so, we can now clearly see that LTC facilities are at the crossroads of three environments different in their nature, namely the living, caring and working environments. These three realities come together into one but still require specific and distinct attention. Our elders and their quality of life end up at the heart of these different beats. This is a unique and fundamental feature of LTC facilities, which may not be sufficiently known and acknowledged for the complexity it brings about.
In recent years, awareness and acknowledgment that LTC facilities are first and foremost « living environments » for their users have grown and the continuous improvement of living conditions has become a priority. Over the past fifteen years, partial progress or more complete improvements have been achieved in areas such as new quality assessment programs, nutrition services, privacy protection, personal freedoms as well as targeted investments aimed at enhancing the enjoyment of life and infrastructure. The end result is an encouraging overall improvement of the living environment, even though more efforts are still required. No matter how encouraging this may be, let us take stock that the caring and working sides of the LTC reality have not equally progressed.
On the one hand, a significant effort is necessary to beef up and standardize the care offered at LTC facilities. It must be better structured and shaped as a system of care that also ensures continuity of care with other services that may be required such as hospital-based ones. On the other hand, the quality of care goes hand in hand with the quality of the LTC working environment for staff. This aspect was brought to the fore by the pandemic first wave crisis, which put in the spotlight the staff shortages and the working conditions that are not conducive to efficiently attracting and retaining staff. In this context, support staff salary was often mentioned as a contributing factor to the staff shortages, which exacerbated the crisis. Many other factors that we do not fully master should be further analyzed and improved upon such as how we help the working and caring environments come together to the residents’ benefit. However, it is safe to say that if we wish to improve the quality of care, we need to also focus on improving the quality of the working environment at the same time as both are intimately tied together.
To distinguish three distinct and yet complementary parts (living, caring and working) within our LTC challenge may be helpful in crafting potential solutions. As such, it may be useful to split the challenge into those three specific targets and customize our efforts accordingly. These targets are different in nature and call for different solutions. Obviously, all required solutions for our elders who are at the heart of three different beats will require new investments. Total investment in Canadian healthcare (public and private) already amount to more than 264B$ / year or a little over 7K$, on average, per Canadian. More than one third of amalgamated federal and provincial budgets are invested in healthcare and respective provincial investment range from 35% to more than 50% of their government’s budget. As the demographic trend for the next decades forecast a substantial increase in the number of elders and as our life expectancy is constantly pushed forward by science, we can expect in-depth societal debates to come. These debates will certainly inform the way we take on the challenges of our health systems and be worthy of our attention. They will touch on fundamental issues for our society, which are of the utmost interest for future articles…
In the meantime, may you be well, may you be happy.
B.