Omicron: The pandemic of staff shortages

Malton Village, The Toronto Star, June 22, 2018.

In a recent Toronto Star article by Moira Welsh, the headline is “Long-term-care residents struggle with loneliness, physical, and mental decline amid staffing crisis”. 4000 staff members are infected across the province which translates into lack of hands-on-care for the many residents within LTC. Residents, particularly those living in institutional type LTC homes are struggling from loneliness and lack of physical movement. Some LTC homes are on full lockdown with residents isolated in their rooms! Click here

The staff shortage that came about is too complex to delineate here.  Certainly, many are infected with Omicron. And also problematic is government legislation that has capped pay increases at one per cent annually for three years. LTC Homes are seeing staff leave their jobs as they accept higher paying positions elsewhere.

If there is any good news about this, then look at the smaller emotion-based models of care where 8-12 residents live in homelike settings. These residents do not suffer loneliness to the same degree as they live in an environment where staff, residents and volunteers are like family. One private operator with 14 homes, has tried to attract workers by paying for accommodation, meals or transportation. They also planned ahead for the staff shortage and increased their staffing levels.

Currently, the provincial government is developing Regulations to accompany the new “Fixing Long-Term Care Act, 2021″. Sufficient staffing is key to meeting quality improvement criteria without living in a continuous emergency situation. The use of full-time, consistent staff, who are provided a living wage and provide four hours of direct care must begin now, not 2024!

Social Connection is Essential in Long-Term Care Homes

 

The Hover Green House, Longmont Colorado copied with permission

Currently there are over 40 Ontario LTC homes with one or more staff and/or residents affected by COVID-19. Over a year ago, there were nearly 4000 residents who died from this virus. We have come a long way since then! We now have residents double vaccinated and boosted, staff required to be vaccinated and we have learned that as the virus numbers rise, action needs to be taken immediately to help keep residents and staff safe.

And so, Rod Phillips, Minister of Long-Term Care just announced that residents will not be allowed to leave their home for social purposes and access to long-term care homes by general visitors will be paused but that designated caregivers may continue to enter long-term care homes. These visits by designated caregivers are so important for the residents as they struggle with loneliness and isolation. For more information click here.

In institutional type LTC homes where there are 32 bed-units often with two residents in a room and long hallways, the infection control measures that are put in place such as eating meals in residents’ bedrooms, and no scheduled activities, diminish the residents’ feelings of social connectedness leading to loneliness, depression, and isolation.  On the other hand, we know that in emotion-based models of care, social connectedness remains during viral outbreaks. These LTC homes have small homelike spaces for 10 – 12 residents, with common dining and living areas that are not closed to the residents.  The physical design of the emotion-based models provides an environment where the transmission of viruses is easier to contain.   Activities continue and residents feel like they are at home!

We urge you to do your part to bring an emotion-based model of care to long-term care homes in Ontario. Contact you MPP and make this a “ballot” issue in the upcoming provincial election!

 

More staff for long-term care homes!

 

Hats off to Long-Term Care Minister, Rod Phillips, and the Ontario Government for providing funding to hire more than 4000 new staff in long-term care (LTC) homes! This concrete step will help move the yardsticks towards increasing direct care hours for residents to an average of four hours/day. All residents in Ontario LTC Homes will benefit from this news.

This is a first step towards transforming our LTC home system and one which demonstrates that the Ontario government recognizes and values the care that staff provide. However, staff recruitment for LTC homes is becoming an issue. A strategy to help mitigate this crisis is to create LTC homes where staff want to work and residents want to live!

Let’s hope the government will build on this first step of increasing staffing by looking at how care is delivered. There are emotion-based models of care in existence which have shown how to use the funded hours of direct care most effectively resulting in residents who enjoy a quality of life and staff who enjoy working with those who live in the LTC homes.

We urge you to do your part to bring an emotion-based model of care to long-term care homes in Ontario. Write to your MPP or to your City Councillor, or write a letter to the editor, or any other action that you think will help to promote a quality, dignified life for our seniors living in long-term care homes.

If we don’t speak up for our seniors who will?

Long-term care home system: a ray of hope on the horizon

The Ontario government is currently reviewing and revising the LTC Act.  Now is the time to ensure that the Residents’ Bill of Rights is no longer violated.

This new legislation ‘will look fundamentally at what the foundation of long-term care needs to be in Ontario” and respond to recommendations from Ontario’s Long-Term Care COVID-19 Commission and others.

While all the recommendations in the Commission’s Report merit implementation, the following two recommendations are critical and need to be included in the revised LTC Act:

  • Ensure that family members are never denied access to their loved ones in long-term care homes (recommendation #31), and
  • Recognize the need for a transformative culture change using an emotion-based approach to care where residents, staff and families feel part of a community and are treated with dignity and respect; where there are small home home-like environments, where there is adequate, full-time, well-paid staff, who are trained in empathy and culture change and where family members are integral members of the team (recommendation #58)

Please encourage the Ontario Government to do the right thing and bring transformative culture change to long-term care homes in Ontario.  Write to your MPP or to your City Councillor, or write a letter to the editor, or any other action that you think will help to promote a quality, dignified life for our seniors living in long-term care homes.

 

Will the Ontario government finally clean up its Act! continued…..

 

As noted in the previous blog post, the Ontario Government has long fallen short in meeting the existing Residents’ Bill of Rights (which falls within the Act).   Here are several more aspects of the Bill where expectations aren’t being met and where implementing an emotion-based model of care would meet those expectations:

  • Every resident has the right to live in a safe and clean environment. Transformative culture change to an emotion-based model of care would make this happen.
  • Every resident who is dying or who is very ill has the right to have family and friends present 24 hours per day. A culture change to an emotion-based model of care would ensure this happens.
  • Every resident has the right to receive personal care that accommodates physical, medical, emotional, and social needs. To succeed, we need a culture change to a resident-centered, emotion-based model of care.
  • Every resident has the right to receive assistance towards independence based on a restorative care philosophy to maximize independence to the greatest extent possible. An emotion-based model of care is needed.
  • Every resident has the right to have his or her lifestyle choices respected. Transformative culture change is needed to ensure this happens.

The urgent need for this transformative culture change cannot be repeated enough!  Already this issue seems to be disappearing from the Ontario Government’s radar.

We urge you to do your part to bring an emotion-based model of care to long-term care homes in Ontario. Write to your MPP or to your City Councillor, or write a letter to the editor, or any other action that you think will help to promote a quality, dignified life for our seniors living in long-term care homes.

If we don’t speak up for our seniors who will?

 

Will the Ontario Government finally clean up its “Act”!

 

It has been decades since any stripe of government has paid heed to or lived by the fundamental principle in the Ontario Long-Term Care Homes Act, 2007 and Regulation 79/10 (which came into force in July 2010):  i.e. “[A] long-term care home is primarily the home of its residents and is to be operated so that it is a place where they may live with dignity and security, safety and comfort and have their physical, psychological, social, spiritual and cultural needs adequately met.”

 Supposedly the Ontario Government is in the process of proposing changes to the Act by the fall 2021.

The Government has long fallen short in meeting the existing Residents’ Bill of Rights (which falls within the Act).   Implementing an emotion-based model of care would meet those expectations:

Every resident has the right to be properly sheltered, fed, clothed, groomed and cared for in a manner consistent with his/her needs.  A culture change to an emotion-based model of care would make this happen.

  • Every LTC resident has the right to NOT be neglected by the licensee or by the staff. Transformative culture change to an emotion-based model of care would ensure no LTC resident is ever neglected.
  • Every LTC resident has the right to be protected from abuse. Transformative culture change to an emotion-based model of care would make sure no LTC resident is ever abused.
  • Every LTC resident has the right to be treated with courtesy and respect, in a way that recognizes their individuality and respects their dignity. A culture change to an emotion-based model of care is a MUST.

Please do your part to bring emotion-based model of care to long-term care homes in Ontario. Write to your MPP or to your City Councillor, or write a letter to the editor, or any other action that you think will help to promote a quality, dignified life for our seniors living in long-term care homes.

 

Leadership matters!

Sherbrooke Village in Saskatoon where the Eden Alternative has been implemented

Happily Ever Older: Revolutionary Approaches to Long-Term Care by author Moira Welsh was published and released in February 2021. It provides a welcomed breath of fresh air in illustrating the successes of various innovative models (such as the Butterfly effect, the Eden Alternative, the Greenhouse project, and the Dutch model – Hogewey) that bring transformative culture change to long-term care homes abroad, in the United States, and in Canada.

A common theme throughout the implementation of these models is leadership. “Nothing on the frontline changes without a cultural shift that is embraced, nourished, and demanded, starting at the top. Without that shift, and it’s a dramatic one, transformation will not succeed.”

What is long overdue is a government that has the political will and leadership ability to bring such change to Ontario’s long-term care home system. Even in light of the tragic consequences the pandemic has brought to the forefront, the Ontario Government still seems paralyzed and has yet to officially respond to the Independent Long-term care Covid-19 Commission’s recommendations. If it doesn’t seize the moment now to implement these recommendations, we risk yet another abyss of neglect in caring for the elderly in our long-term care homes. Already this issue seems to be falling off the radar of the Ontario Government.

The implementation of the Eden Alternative at Sherbrooke Village in Saskatoon was made possible due to the exemplary leadership of CEO, Suellen Beatty. “Beatty may be the face of Sherbrooke but she is adamant that its success relies on a team approach. ‘I never did anything by myself……It has to be a leadership style that is warm and inviting. That can inspire people, and you have to have a really compelling why. Why are we doing this?”

Happily Ever Older is an upbeat book offering hope that meaningful change in our long-term care home system is possible. The book should be compulsory reading for every politician (at any level) and every provider/operator of a long-term care home.

Examples of kind expressions of humanity towards residents in these innovative long-term care homes and other gems are woven throughout the book and are delightful. We will feature some of these in upcoming blog posts.

Please make the time now to write to your MPP and/or your city councillor to help make this meaningful change happen.

Shining a light on the tragedies of COVID-19

The Toronto Star article on Crisis of Care printed Feb 7, 2021, focuses on the “inertia” of government that has led to a failure of the long-term care home system.

For more than four decades, a doctor working in the system has witnessed:

  • Poor business decisions that affected delivery of quality of care
  • Too much time spent on paperwork and not enough time on direct care of residents
  • Not enough adequately trained staff
  • Verbal, physical or sexual abuse of residents

And now more than 3000 residents have died from COVID-19. In April, Premier Doug Ford called “the widening cracks in the long-term care system a wake-up call to the world” and spoke of the need to form an “iron ring” around vulnerable seniors. Well, that has not happened. In fact since April, there have been many more deaths due to Covid-19 than there were in the first wave. When will the government stop promising and start doing? How many more deaths are needed before inertia turns to action. Our vulnerable seniors deserve nothing less than to live their remaining years in a safe, caring environment. Read more here.

Please support Transformative Culture Change in Ontario’s Long-Term Care Homes by sending an email to info@LTCcommission-CommissionSLD.ca

#ChangeLTCNow!

ENOUGH IS ENOUGH!

According to a recent article in the Toronto Star, since January 15, 2021, 2721 residents of long-term care homes and 8 staff members have died from COVID-19. Read here. Thousands more are sickened, neglected and denied basic rights! Since the pandemic began, some 87% of all COVID deaths in Ontario have been among those over the age of 70 and about 61% of deaths have been in long-term care homes.

The long-term care system is broken and has been for many years!  We are slowly losing a generation of people to this pandemic. They are our elders, our grandparents, mentors, visionaries who paved the path for a better world for all of us. And when they need more care than they can receive in their home, we move them to a medical institutional warehouse, remove their ability to make choices, take away their individuality and stifle their creativity. We schedule their day from morning to night, medicate them when they resist, and when family members become upset, we wonder why. Then COVID-19 arrived and the inadequacies of how we care for and about our elders in long-term care homes have come to light!

As of October 2020, there were 11 long-term care homes in Ontario that had either adopted or were in the process of adopting the Butterfly model of care.  These homes along with the Green House Project homes in the U.S. that have embraced transformative culture change have reported better outcomes both pre and during the COVID-19 pandemic and have experienced fewer deaths than the institutional models of care that exist in most of our traditional long-term care homes. 

Please consider sending an email to your local MPP or City Councillor urging them to look at what these homes have done so that the Ontario government can bring an end to the inhumane treatment and needless deaths of our vulnerable elders.  Enough is enough!

Will the Government bring change to Ontario’s Long-Term Care Homes?

Members of C.A.R.P. Ottawa’s Advocacy Working Group on Long-Term Care presented to the Independent Long-Term Care COVID-19 Commission on November 26th, 2020.  

The purpose was to explain how transformative culture change, an emotion-based model of care, would not only improve the quality of life for residents, families and staff in Ontario’s Long-Term Care Homes but would also help to mitigate the impact of future viruses.  

Key points presented were as follows:

-The fundamental principles of transformative culture change are consistent with the principles outlined in Ontario’s Long-Term Care Act which states:

“A long-term care home is primarily the home of its residents and is to be operated so that it is a place where they may live with dignity and security, safety and comfort and have their physical, psychological, social, spiritual and cultural needs adequately met.”

Despite many new regulations and many millions of dollars spent on education and new programs, it is obvious these principles have not been adequately met – for decades.

Transformative culture change is a philosophy that uses an emotion-based approach to care where residents, staff and families feel part of a community and are all treated with dignity and respect: where there are small home-like environments; more direct hours of care for residents, where staff work full-time, are well-paid and are trained in empathy and culture change and where families and caregivers are recognized as an integral part of the team.  Staffing, inspections, design and family involvement are all critical elements of transformative culture change

-There are four innovative long-term care models that have successfully embraced transformative culture change.  These models have existed for years in the USA, Europe, the U.K. and more recently in parts of Canada and even Ontario:  The Butterfly Model, The Eden Alternative, The Green House Project and the Hogewey Villages. These homes have experienced better outcomes than our traditional homes both pre and during COVID-19. 

The “ask”: That the Commission recommend the Ontario Government commit to move towards transformative culture change in Ontario’s Long-Term Care homes.   This commitment could start by examining the long-term care homes that have already embraced this model of care to determine best practices and lessons learned, including how they have managed financially within current budgets and the current legislation.  This commitment could also include revisiting the new builds that are being fast-tracked to ensure Ontario does not end up with the same old institutional designs, that once built, will be with us for the next 3 decades.

We know this can be done since it is being done right here in Ontario, right now.  These innovative models are being led by a few who have taken the leap and the risk to improve the lives of residents, families and staff.  There are currently 11 long-term care homes in Ontario that have either implemented or launched the Butterfly Model of Care resulting in transformative culture change. 

Anyone wishing to support Transformative Culture Change in Ontario’s Long-Term Care Homes can send an email to info@LTCcommission-CommissionSLD.ca

For more information on the Commission www.ltccommission-commissionsld.ca

Kudos for the Ontario Long-Term Care Staffing Report!

The Ontario Ministry of Long-Term Care Staffing Study Advisory Report, released on July 30, 2020, identified a number of challenges to the current staffing strategy for long-term care. Apart from workload and funding issues as well as increased acuity needs of residents, the Report also identified that “the culture of long-term care is one based heavily on compliance, which can create a punitive environment for staff.” 

Their recommendation states that, “The culture of long-term care needs to change both at the system and individual level.” The Report calls for a look at the philosophy of care within long-term care homes and specifically cited models of transformative culture change such as the Butterfly model and the Eden Alternative as models of care which focus on emotional care and relationship building. The Report’s findings indicate that “Operators reported that their staff frequently request working in homes that have implemented emotional models of care as they feel better supported, more collaboration within the team, and are able to spend more time with residents. (Region of Peel Long-Term Care, Submission to the Staffing Study Advisory Group 2020)

For more information about the Long-Term Care Staffing Advisory Report click here

Thank you for your support of transformative culture change. Your letters to your MPPs and City Councillors do make a difference! You can also help by sharing this post and others with at least one of your contacts.

An Opportunity for Lasting Change?

At the end of July 2020, the Ontario Government announced the creation of the Independent Long-term Care COVID 19 Commission.

The three commissioners appointed to the Commission are:

Angela Coke, former senior executive with the Ontario Public Service; and
Associate Chief Justice Frank N. Marrocco (Chair), member of the Superior Court of Justice since 2005;
Dr. Jack Kitts, recipient of the Order of Canada and recently retired as President and Chief Executive Officer of the Ottawa Hospital.

“The Commissioners of Ontario’s Long-Term Care COVID-19 Commission have a mandate to investigate how and why COVID-19 spread in long-term care homes, what was done to prevent the spread, and the impact of key elements of the existing system on the spread.”  The Commission will have a secretariat of 12 FTEs (full-time equivalents) and will submit its report by April 30, 2021.  For more information about the Commission including its Terms of Reference and guiding principles, go to: https://www.ltccommission-commissionsld.ca/about/index.html

Many thanks to those of you who sent letters to your MPP’s and City Councillors as a result of our last post.  Your help makes a difference! CARP Ottawa, with whom we continue to work, subsequently sent letters to both Minister Fullerton and the Commissioners requesting that recommendations for transformative culture change be developed.