After COVID-19’s tragic toll, Canada must improve quality of life in long-term care homes

Long-term care homes and nursing homes have turn out to be the centre of attention within the midst of the COVID-19 pandemic, with over 80 per cent of deaths from the virus in Canada occurring in these homes.

This tragedy leads us to reflect on what we learned from a decade-long project led by Pat Armstronga distinguished research professor at York University, that checked out long-term care in 4 Canadian provinces (British Columbia, Manitoba, Ontario and Nova Scotia) and five countries (Germany, Sweden, Norway, the United Kingdom and the United States).

Our perspective was not as academics but as doctors: Bob James was a family physician and medical director of a nursing home in Dundas, Ont.; and Joel Lexchin an emergency physician in Toronto who regularly saw patients sent from long-term care homes.

When Bob worked in his nursing home, he was primarily in touch with the registered nurses (RNs), and we suspect this can be a common pattern for doctors. When Joel would call to get more information in regards to the patients he was seeing within the emergency room, the people he spoke with were the nurses (often the RNs). This was largely due to the RNs’ roles in leading the care teams for the homes.

But working on this project taught us many things that modified the best way we considered long-term care homes and the individuals who live and work in them.

Laundry, support and care

First and foremost, was the importance of the opposite staff to the care of residents. Specifically, cleansing and laundry staffin addition to kitchen staff, and naturally the care aids, or personal support staff (PSWs). We suspected that they played a vital role, but over the course of the project it became increasingly clear the importance of those roles in making life for the residents more enjoyable, or much more tolerable.

Laundry and food matters to residents and their families; and the cleansing staff often have long-term and shut relationships with the residents. These relationships improve the standard of residents’ lives and their physical health.

That recognition has turn out to be much more acute in the course of the crisis in long-term care homes that has followed the COVID-19 pandemic. First, these staff are women — almost 100 per cent of PSWs, plus nearly all of laundry, kitchen and cleansing staff, are women. As well, many are immigrants. They are the backbone of the care that residents receive in these homes. When these women are usually not capable of work because they’re unwell or fear being unwell, care collapses — especially when families are usually not capable of step into the breach. Many are also single moms or are precarious of their employment, so that they travel between jobs at two or three homes to earn enough income to survive.

Art and space

Second, incorporating architecture, history and art into the project provided insight into an entire other way of taking a look at long-term care — one which we had mostly ignored. We realized how much these elements of homes influence the best way that residents interact amongst themselves and with the staff.

Space matters. How long and wide are the corridors? How is the dining area arrange — what number of residents to a table? Do people at all times sit in the identical place at every meal? And outside of meals, is there an easily accessible and secure outdoor space for residents to experience the natural world?

What sort of artwork and music does the house have, and does it resonate with the life experience of the residents and supply something to have a look at apart from the ever present television set?

Re-thermalized on a budget of $8.33 per day

We also checked out food and food service in a brand new way. When Bob was the director of the Dundas home within the late Nineties, the province provided $7 per resident per day for food; by 2017, that had only risen to $8.33 per day. That meant that the kitchen needed to accommodate all of the special diets (regular, minced, puréed, diabetic, renal and so forth) on less money than our federal government gives to prisons to feed their prisoners.

Many homes don’t prepare their very own food and don’t use locally available foods. It is trucked in after which reheated — or within the terminology of some homes, re-thermalized. Missing were the smells of food being prepared, smells which might be often meaningful to residents. In some homes we visited, the standard of the food was wonderful, but in others it was bland and didn’t carry any appeal beyond just filling people’s stomachs.

Of course, with COVID-19, we have now learned that each time a latest employee comes into the constructing to deliver food or services, a brand new risk is introduced as well.

Future directions

We were struck by the innovation seen in Germany where there was adequate staffing, and co-operative workspaces (here we mean co-operative between the assorted staff positions, in addition to between the staff and the residents). In Germany, one in every of the staff doubled as a clown, and her non-verbal way of communicating through touch and facial expressions were also lessons for Bob in working with patients with dementia.

The German staff were able and, in actual fact, encouraged, to do the work that was needed, whether that meant that RNs washed dishes or registered practical nurses combed a resident’s hair. And the residents were encouraged to assist with the “chores” of the units, sweeping floors, setting tables, even cutting up the vegetables for the lunch meals! There gave the impression to be a rather more relaxed attitude toward the hierarchy than we see in Canadian homes.

For those of us doctors who’re considering changing the system, and we suspect that there are a lot of, the project and its conclusions has given us a vocabulary to make use of when working for change.

COVID-19 has taught us how much we in Canada must do to enhance long-term care, as we address over-stressed staff in understaffed and aging, underfunded facilities where staff — as a substitute of being seen as essential — are paid at minimal wages and treated as temporary staff.

As they are saying, this can be a marathon slightly than a sprint. We were hoping to have some reforms of the system before we want residential care ourselves since each of us are actually over 70. We are not any longer sure of that, but we still have hope that within the post-COVID-19 world, things might begin to alter within the directions we have now witnessed elsewhere.