Political and public attention is shifting from stopping COVID-19 to the delicate and uncertain challenge of recovering from it – to returning daily life to something close to what it was pre-pandemic and to getting the economy firing on all cylinders again.
There is a clear and present danger that important lessons that should be learned from the pandemic will lose place on the national agenda to more immediate concerns – getting schools, restaurants, pubs, theatres and sports venues open again and finding the wherewithal to deal with the federal and provincial deficits created by COVID.
It would be a national tragedy if action is not taken – starting now – to make sure that never again will elderly patients in long-term care homes – especially those in for-profit operations – be left exposed to the ravages of an epidemic, as they have been this year. Roughly 80 per cent of the COVID deaths in Canada have occurred among LTC patients.
What must done?
Today, I pass on suggestions from two readers, both insiders when it comes to long-term care.
One is John Crosby, a physician, who is the medical director of two nursing homes – “that through hard work and luck have avoided the coronavirus so far” – in Cambridge, Ont. The other is Elizabeth Clarke, a registered nurse and former director of nursing at a for-profit nursing home, who now lives in a retirement home in Waterloo Region.
Dr. Crosby has two suggestions. Get rid of the wards. All LTC patients should be in separate single rooms. “It is hard to maintain sterile conditions with two or four residents sharing a room and bathroom,” he says. “Many have dementia and touch everything and can’t remember to always wash their hands.”
His second suggestion: “Better pay for personal support workers.”
Elizabeth Clarke’s LTC experience began in 1976 when she was hired as director of nursing for an 84-bed for-profit home. Most of her staff were full-time with a couple of regular part-timers. With little staff turnover, they all got to know the patients, their medical histories and treatments. And they did not have to work in a second or third home to make ends meet.
She doesn’t think much of the lackadaisical way Ontario nursing homes are inspected. “Our nursing home was notified well in advance of an upcoming visit by the (provincial) government inspector. This time was used to hire temporary staff and to clean and improve conditions in the home before the inspector arrived. Following the inspection, the temporary staff was laid off. To my knowledge, this has not changed since then.”
She has several suggestions. Her first, like John Crosby’s, is to eliminate multiple-occupancy rooms or wards. And patients with infectious diseases must be isolated, she says, suggesting that nursing homes add infirmaries for that purpose.
Her second: “Geriatric nursing needs to have full recognition as a specialty and be treated as such. Remuneration for all staff in long-term care and retirement homes needs to be standardized across the province to provide full-time work and a living wage that is commensurate with other specialties.”
Third, Elizabeth Clarke favours the elimination of for-profit homes like her old one, but she thinks, realistically, it will not happen. “More oversight is needed to happen to ensure that public funds given to these homes are actually used for the provision of quality care,” she says. “… They should not be going into the pockets of top-heavy administrative staff and directors on the boards.”
Finally, she urges that realistic staff/patient ratios be standardized across the industry: “To expect one personal support worker to get 10 residents up, bathed, dressed and to breakfast in two hours is simply not realistic. This is how accidents happen, seniors get injured and staff burn out. It has got to stop!!!”
The suggestions made by the two insiders make excellent sense to me. However, being a layman, unencumbered by their intimate knowledge of LTC industry, I would take a harder line. Surely, it is time to legislate for-profit LTC homes out of existence and to treat chronic-care facilities, such as nursing homes, as extensions of the acute-care public hospital system – subject to the same standards of care as hospitals and paying hospital-level wages.