The tragic loss of life in long-term care homes due to COVID-19 exposed many of the problems that have plagued Ontario’s Long-term Care Home system for many years. Strategies such as stronger policies, more regulations, investment in staff, and support from specialists have been tried. These strategies were insufficient and failed to appropriately address the inherent weaknesses in the current system.
The impact of COVID resulted in horrific and tragic events. And if changes don’t occur to the current medical/institutional model of care in many LTC homes, the future could hold more viral outbreaks. It is very challenging for staff in these facilities – under the present system – to provide appropriate and respectful care. Care that includes the physical, psychological, social, spiritual, and cultural needs of residents. These needs are described in Ontario’s Long-Term Care Homes Act.
Factors that contribute to the current system:
- Too few staff.
- Not enough hours of direct care.
- Staff working in more than one LTC home.
- Not enough Personal Protective Equipment.
These are well documented factors. And they have existed for some time in LTC homes. The present LTC home system will still be one that causes and prevents quality of life for residents, staff, and families – even if/when these factors are addressed by the Ontario government.
Most LTC homes in Ontario organize and deliver care based on:
- A medical model of care focusing on diagnosis and treatment.
- An institutional environment that looks like a hospital with long hallways filled with laundry carts, drug cars, and food carts.
- A task-oriented approach to care – not person centred, or relationship based.
- Staff focus on feeding, scheduling, and cleaning, and even a measure of fun or entertainment is scheduled.
- There is no priority to develop any kind of a relationship with residents and staff will only sit with residents if they have time.
- Leadership makes the decisions and lets staff know what needs to be done. There is very little input from those who are dealing with residents.
- Staff are hired for specific positions based on their education qualifications and not necessarily whether they are suited to work in LTC.
- The ability to problem-solve, critical thinking skills, caring about and working with seniors, communication skills and empathy are low on the list of recruitment skills.
- Education/training of staff is done mostly through videos. The staff sign off once they have viewed the training.
- There is no discussion, mentoring, or role modelling, after receiving training through the videos.
- Families/caregivers often do not feel welcome in some of the homes. They feel that their input is not welcomed or needed.
- Family/caregiver input should be valued, so the care the resident receives is more appropriate for their emotional and social needs.
- Residents are objectified by regulations that adhere to tasks, not needs.
- Existing culture is oriented towards regulatory compliance.
- Staff become overly focused on regulated tasks sometimes at the expense of positive resident outcomes.
- Care providers may be afraid to speak up to report incidents or errors, out of fear of being reported for non-compliance.
Cold and clinical warehouses where people go to die must change. We need warm, compassionate, homelike places where residents can truly live. Ontario’s LTC homes urgently need a revolution in how they provide care.