The tragic loss of life in long-term care homes due to COVID-19 has exposed many of the problems that have plagued Ontario’s Long-term Care Home system for many years. Many strategies have been tried over the past 35 years or more to repair the system, including stronger policies and more regulations, investments in staff, and support from specialists. However, it is evident that these have been insufficient to appropriately address the inherent weaknesses in the current system.
The current medical/institutional model of care within many LTC homes led to some horrific and tragic circumstances resulting from the impact of COVID-19 and remains a huge issue for future viral outbreaks if changes do not occur. Under the present system, it is very challenging for staff working in LTC homes to provide appropriate and respectful care to address the physical, psychological, social, spiritual and cultural needs of residents, as described in Ontario’s Long-Term Care Homes Act.
Many factors contribute to the current status. Too few staff, not enough hours of direct care, staff working in more than one LTC home, not enough Personal Protective Equipment, are well documented factors that have existed for some time in LTC homes. However, even if/when these factors are addressed by the Ontario government, the present LTC home system will still be one that causes and prevents quality of life for residents, staff and families.
Most LTC homes in Ontario organize and deliver care based on:
- A medical model of care focusing on diagnosis and treatment.
- An institutional environment with long hallways and 32 beds on unit. Laundry carts, drug carts, and food carts are visible in the hallways and the unit takes on the look of an institutional setting. Hospitals use this model.
- Task oriented approach to care not person centred or relationship based.
- Staff are focused on tasks of feeding, scheduling, and cleaning, an antiseptic end of life! Even fun is scheduled!
- If staff have time, they will sit with the resident. It is not a priority to develop relationships with residents.
- Top down approach to decision making. Leadership makes the decisions and lets staff know what needs to be done.
- Staff are hired for specific positions, most based on education qualifications and not whether they are suited to work in LTC. Lower on the list of recruitment indicators for hiring are: ability to problem solve; critical thinking skills; caring about and working with seniors, communication skills and empathy.
- Education/training of staff is done mostly through videos and staff sign off once they have viewed the training. There is no discussion, mentoring, or role modelling.
- Families/caregivers do not feel welcome in some of the homes. They feel that their input is not welcomed or needed yet who knows that person the best? If families/caregivers input is not valued, then the care that residents receive may not be appropriate for their emotional and social needs.
- Regulations objectify residents according to tasks not needs. Existing culture is oriented towards regulatory compliance. The consequence, as reported by long-term care partners, is that staff become overly focused on regulated tasks sometimes at the expense of positive resident outcomes. This culture leads to care providers who may be afraid to speak up to report incidents or errors, out of fear of being reported for non-compliance.