Philosophy on Elderly Care Needs Overhaul: Expert

By Chinta Puxley, Canadian Press

July 5, 2008

Canada

 
Ontario should look to the example set by Nordic countries and turn its understaffed, institutional long-term care homes, where residents are more likely to be restrained and medicated, into small community homes where staff have the time to drink coffee with their elderly charges, geriatric experts say. 
In the wake of an analysis of nursing home inspection reports by The Canadian Press which found three-quarters of the province's homes are not meeting some of the province's 400 standards, some say it's time to fundamentally rethink how Ontario cares for its vulnerable residents.

The provincial inspection reports, from April 2007 to March of this year, show some long-term care homes have been cited for failing to provide a minimum of two baths a week while other residents didn't own a toothbrush.

The majority of homes in Ontario were cited for violating the specific set of standards that ensure residents are well-fed, clean and free of pain, as well as dictating how homes care for incontinent residents and when they use restraints.

Ontario ombudsman Andre Marin said he is preparing to launch an investigation into whether the governing Liberals are holding homes to account and is calling for people to share their experiences of long-term care homes.

But geriatric expert Christopher Patterson said virtually all societies have been guilty of neglecting their elderly parents and grandparents, a trend his research suggests has not wavered since the Renaissance.

"It's really depressing," said Patterson, chief of geriatric services at Hamilton Health Sciences. "These are the people who have built our society, who have fought our wars, who have raised us and we don't appreciate them.

"They've paid their taxes and, at the end of the day, they're treated abysmally."

While Patterson said respect for the dignity of the elderly is hard to come by anywhere in the world, Ontario could learn from other jurisdictions to improve its nursing home care.

Ontario's long-term care homes are among the most short-staffed in North America, he said, keeping company with only a few of the southern American states.

While Swedish residents get an average of six hours of care a day, Ontario residents generally get an average of three hours - the majority of which comes from a personal care worker rather than a registered nurse.

The province's homes are also more likely to restrain residents leading to stress, injury and - sometimes - unnecessary deaths, he said.

"We certainly overuse them," Patterson said. "There is clear evidence that restraints don't actually save injuries but actually cause them."

A 2001 report by Pricewaterhouse-Coopers, comparing Ontario's longterm care homes to those in other jurisdictions, found over a third of the province's elderly residents were restrained and given antipsychotic drugs while only six per cent of them received therapy.

"Without exception, Ontario [longterm care] residents receive less nursing care than their counterparts," said the report, adding this might explain why Ontario residents are more likely to be restrained or given drugs.

"Generally, pharmaceutical approaches require less staff time than behaviour management and evaluation programs."

Experts say European countries, particularly in Scandinavia, take a completely different approach - from the architecture on up. Long-term care homes in Sweden, for example, are hard to pick out because they look just like any other residence.

Once inside, 98 per cent of residents have a private room, usually equipped with a kitchen and bathroom, said Marta Szebehely, professor at Stockholm University. The homes generally don't have more than 30 rooms and residents receive about six hours of care a day - from help dressing and bathing to social activities such as singing or going for walks, she said.

The same small group of residents also eat together and are encouraged to help prepare the meals, regardless of their level of dementia, Szebehely said.

"Often, the social life in a nursing home takes place in the kitchen and the staff and residents usually have coffee together between meals," she said.

"The 'family' rather than the 'hospital' is the ideal of residential care," she added. "The more generous funding and staffing levels make a difference."

Alan Findlay, spokesman for new Health Minister David Caplan, said the minister wasn't available to comment on how Ontario's long-term care homes compare to other jurisdictions.

York University professor Pat Armstrong, who co-authored a study comparing the Nordic system with several Canadian provinces, including Ontario, said workers in this country laugh when asked if they have a daily coffee with their residents.

Instead, she said they talk about not having time to explain to residents why they have to go back to their room, not being able to sit with residents when they are crying, or not allowing residents to even thoroughly chew their food.

Ontario's health-care system seems permeated by an attitude that if you can't cure people you simply abandon or "warehouse" them, she said.

"None of these people are going to be cured," said Armstrong, adding a complete philosophical overhaul of the province's elder-care system is needed.

"Our whole attitude toward the aging of the population ... is panic - this is going to cost us a million bucks and, therefore, let's figure out how we can not provide care instead of making it a priority and saying what would good care look like?"

Donna Rubin, CEO of the Ontario Association of Non-Profit Homes & Services for Seniors, said the province doesn't need to completely overhaul the system but could make it more attractive for homes to help residents live more independently.

Under the current system, Rubin said the more dependent and helpless the residents, the more funding the homes receive. Instead, she said the province should be giving homes more cash to help residents learn to feed themselves again or use the toilet on their own rather than relying on diapers.

"It's a lot easier to feed somebody quickly yourself than to help them try to get the motor skills back to feed themselves independently," she said. "You need the funding for the staff to do that."

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