Experts say that what Canadians have heard over the past few months about the state of some long-term care homes and the mental health of residents is a window into an ongoing set of issues with the current model of long-term care.
Since the pandemic began, there have been staggering numbers of COVID-19 outbreaks and deaths in these homes, reports from the military showing neglect of residents, and stories from families that their loved ones are declining faster due to increased isolation. Long-term care home residents account for 81 percent of COVID-related deaths in Canada, twice the rate of an average of 42 percent globally.
As shocking as this is for some Canadians, these recent problems aren’t new, and they have roots in the way we choose to handle an elderly population in this country.
Dr. Sherry Dupuis, Co-Director of the Partnerships in Dementia Care (PiDC) Alliance and Research Scientist at the Research Institute for Aging, says there’s a reason why coming up with sustainable solutions to long-term care issues hasn’t traditionally been a priority.
“Ageism is very much at the root of it,” she said. “When we don't value older adults or aging, it's easy for us to institutionalize them to segregate them from us in our communities, and not provide them with the supports they need.”
COVID-19 has not only emphasized this reality, but it presents an opportunity to reflect on how to sustainably move forward with different models of care, post-pandemic. The primary model of care in long-term care homes is rooted in a biomedical structure, which focuses on physical care.
Several experts, including Dupuis, feel a relational care model is the way forward.
“People need to have food to be nourished. They need to be clean… But that's not all people need to live a good life. We shouldn't have people in homes just surviving,” Dupuis said.
Relational care centers around the idea that compassionate relationships are just as important to care structures as physical care and are vital to a person’s wellness. It is through these relationships that people can thrive, because they encourage a sense of belonging, value and purpose.
The relational care model doesn’t just extend to residents. It’s a holistic approach that considers all actors in the care context. Giving staff enough support extends to how they care for and develop relationships with other staff and residents. It creates a new culture of care.
“We need to be concerned about nurturing the relationships that staff have with residents, that staff have with families, and that staff have with each other,” she said. “If we care about people in relationships, we're going to be more likely to care about their well-being.”
There are also advocates of a person-centered method of care, which places higher importance on a person’s individual needs rather than a general standard for each person. But Dupuis has noticed that the homes using this method still have a predominantly biomedical approach. She also says the person-centred model doesn’t ensure all people in the care context have the support they need to live well.
The current systems of care are also task-focused, and this makes it hard to have enough time in the day for staff to nurture relationships with residents. There are recreational staff, but Dupuis says the resident-to-staff ratio makes it harder to bond with everyone.
Dr. Penny MacCourt is the founder of HealthWell Educators and Consultants Ltd and has a research focus in aging, mental health and service delivery at the University of Victoria. She says that loneliness, boredom and helplessness are common among residents of long-term care homes. During a pandemic when they can’t see their families, this becomes worse.
“It also comes down to culture where, you know whether the staff and the management are really there for the residents and are willing to take individualism rather than efficiency,” she said. “Everybody's been encouraged in the last 20 years to think about efficiency.”
Dupuis and Maccourt say placing more value on the physically and mentally demanding work of care home staff can make positive changes in the short-term. It’s common for frontline workers in long-term care to be underpaid. They also lack enough opportunities for secure, full-time work.
This is part of the reason why staff often work multiple jobs at multiple homes, which can increase the risk of spreading COVID-19 between homes. British Columbia’s long-term care homes were not hardest hit by this dilemma, and MacCourt attributes the success to consistent staffing.
“When COVID came in, they said across the board, all the care-aids will work for the government for six months, and they all get $25 an hour,” MacCourt said.
Workers were also mandated to work at only one facility during the pandemic, to decrease opportunities for spread. This also meant allowing full-time work.
“I can’t see how they could possibly turn it back now,” she said. “That’s one of the benefits that’s come out of this, it’s a stabilized workforce.”