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Will crisis spark long-term care reforms, or will we quickly move on to something else?

The most recent mass shootings in the U.S. – something of a return to pre-pandemic “normal” – elicited the usual calls for gun safety and the usual pushback from the ethically challenged but aggressive opponents of reform.

Crises bring the issue to the forefront, with time eventually putting it on the backburner … until the next time.

Long-time advocates for reform to this country’s long-term care system hope officials here don’t follow suit.

For advocates for improvements to care for seniors, the COVID-19 crisis has put into stark relief many of the shortcomings in the system, leading to widespread outbreaks, hospitalizations and deaths among the residents of many long-term care facilities – some 69 per cent of COVID-19 deaths in the country have been among residents of such homes, well above the international average of about 41 per cent.

Chronic underfunding, understaffing, poor pay and aging facilities were all issues before the pandemic struck. Some critics have been warning about the issues for years, though they may not resort to “I told you so” under the circumstances. What they’d like to see is action taken to improve the lot of long-term care residents today and post-pandemic, preparations that would serve residents well during the next pandemic.

That some facilities fared much better than others during the first wave of the pandemic suggests that those that were better prepared and/or reacted quickly are a model for the kind of improvements advocates want to see.

Paul Stolee, director of the Network for Aging Research and a professor in the University of Waterloo School of Public Health and Health Systems, argues the longstanding shortcomings in the long-term care sector didn’t mean pandemic had to be the crisis it became in such facilities.

“I don’t think it necessarily was inevitable, because we know that some homes who got on top of things early, took precautions, brought in protective equipment, made adjustments to their staffing so they didn’t have people going to more than one home. They beefed up their infection control protocols. They got through quite well,” he said of the contrast between some homes, indicating that those who came out the worst could have done better even under the current underfunded system.

Still, the pre-existing conditions made the sector ripe pickings for the spread of the virus, with Stolee noting that the first wave saw most of the attention focused on preventing the hospitals from being overwhelmed by the pandemic.

“I think the system in general was, in a way, a ready target for this kind of thing to happen. But part of the lack of preparedness was that our system took efforts to defend the acute care system, make sure they had the protective equipment, even at the expense of other parts of the system, discharged older people and others to home or to long term care homes so that they could free up acute care capacity. So the attention was very much ‘let’s protect the acute care system.’

“That’s kind of been the way our health care system has gone – the emphasis is on our acute care system. It’s well funded and well resourced, and other parts of the system are often an afterthought and don’t get the resources and attention they deserve.”

As those with chronic or not-easily diagnosed symptoms are often aware, our healthcare system isn’t as responsive as in the case of an acute illness, whether a broken bone or something in the vein of a heart attack or stroke. Or, as we’ve seen lately, mobilizing ICU beds to deal with those stricken down by COVID-19.

The situation is even worse when it comes to the diseases of aging, for which we have few remedies. The system isn’t set up very well do deal with the likes of dementia and care for the elderly, who are often seen as on a one-way path through the healthcare experience.

There’s a currently a divide between efforts to keep seniors in their homes with some level of support, long-term care facilities and hospitalization, with the system always looking to avoid having beds taken up by those suffering from chronic diseases of aging. Better levels of homecare would help on all fronts, suggests Stolee.

“We need to think about efforts aimed at prevention and rehabilitation. So, how can we prevent older people going into hospital in the first place or going into long term care?” he asked, noting the current crisis has highlighted the need for changes, particularly around spending more money and spending it more wisely.

“There is likely an inevitability that we’re going to have to invest more in the care of our older adults than we have. But I think there are some ways that we can strengthen the system overall, so that we can kind of mitigate what that overall cost impact is.

“One thing I think we need to do, as part of that is make sure that we look at the whole system, not just the long term care system.”

Stolee notes a strengthened homecare system would keep people out of long-term care in the first place.

“So many people would prefer not to live in a long-term care home; they would prefer to stay in their own home. So why don’t they? Well, there isn’t the level of home support available that can allow them to do that.”

Improving the lives of those currently in the system is a good start, and the numbers show what we’re facing an even bigger crunch down the road.

A new report from the Canadian Medical Association estimates the cost and demand for elder care will nearly double by 2031, when some 606,000 patients will seek long-term care, up from 380,000 in 2019. For Canadians aging at home, the demand for home care will increase to roughly 1.8 million patients, up from nearly 1.2 million. This increase is projected to cost $490.6 billion over the next 10 years, with the annual price tag of elder care services growing from $29.7 billion per year in 2019 to $58.5 billion per year in 2031. 

“We know the pandemic has exposed major cracks in seniors’ care,” says Dr. Ann Collins, CMA president. “It is not hard to imagine what awaits them in the next decade with no plan in place to address a growing demand for care along with changing expectations for aging at home. Planning and investment by all governments should be underway today to cope with this unprecedented demographic shift and the disruption to our current model of institutional care.”

To date, we’ve undervalued the long-term care system. Whether the current crisis prompts us to do better remains to be seen.

“We’re going to need to invest some resources,” Stolee argues. “I think if you ask most people ‘would you want a repeat of what’s happened in our long-term care sector? Would you like to see a much better standard of care? Would you like to see a long-term care sector in which people are living in something that’s much more home-like and conducive to a good quality of life?’ I think most people would be supportive of that.”

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  1. The article clearly describes a vision and strategy required of government leaders, at all levels, federal, provincial and territorial coupled with the support of health care providers to set the stage for the dignified aging of Canadians. The solution is not, as the article correctly points out, the medicalization of long term care, continuing care and home care. Improvements in the LTC sector are essential for example in standards of staffing, competency in care delivery, and accountability and reporting to the public. The pandemic has brought to our attention the need for a cultural change in the paradigm of aging. Aging Canadians must have financial security, safe shelter and the ability to live out their lives with dignity and zest. These are best achieved within their home settings for as long as possible. Building a national program of home care that is adequately funded by all levels of government is essential. Let us build communities and neighborhoods that facilitate aging in place for as long as possible – we owe it them.

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