Shocking revelations from Canadian Armed Forces members about the state of care in five Ontario long-term care facilities during the Covid-19 crisis have Albertans wondering if the same things could happen here.
Irene Martin-Lindsay, executive director of the Alberta Seniors Communities and Housing Association (ASCHA), says no.
“Ontario and Quebec have very different models than we have here in Alberta,” she said. “We also offer far more publicly-funded seniors’ housing options.” She said Alberta also has the seniors’ lodge program that does not exist in other provinces.
The Canadian Armed Forces (CAF) were called in to augment staff at five Ontario facilities in late April. A report signed by Brigadier-General C.J.J. Mialkowski, commander of 4th Canadian Division, Joint Task Force (Central), outlined a disturbing litany of shortcomings in the care provided to residents at all five locations.
The findings ranged from poor professional standards and conduct to neglect and even abuse of residents.
“It’s horrible,” Martin-Lindsay said. “Neglect is never okay. Not having the right services, and any abuse, is not okay by anybody in our sector.
“Reading those stories, quite frankly, is disturbing.”
Mike Dempsey is northeast Alberta vice-president for the Alberta Union of Provincial Employees (AUPE). He agrees that an Ontario situation is unlikely here.
“I don’t believe it’s happening, I have seen nothing from our members that it is,” he said. “But the potential is there.”
Dempsey said the private, for-profit model of delivering housing and care creates an incentive to cut corners in the name of profit. All five of the Ontario facilities in the CAF report are privately-owned.
He points to a 2016 study by the Parkland Institute that found residents require on average 4.1 hours of care per day. “The public system was close to that, about four hours. But they found that the private sector is about 3.1. So about 30 percent less care is given in private because they routinely have less staff, they cut corners,” he said.
“They pay less than the public ones, and so then it’s harder to recruit.” Meanwhile, he says, public money and residents’ money is going to pay executive salaries and dividends to shareholders.
Martin-Lindsay doesn’t believe the ownership model is the defining factor for the quality of care. She estimates there are about 1,000 long-term care facilities in Ontario, and the five that needed military intervention were the very worst cases.
“It does worry us about this whole growing attack on private sector, because what we know is that private-sector options are actually needed,” she said. “The lodges started to target lower-income seniors in 1999, which opened up the door to other options. I might want a two-bedroom or I might want to have different services.
“But this model, like all supportive living, has to be licenced, which means they go through a licencing inspection that looks at all of the services they provide and that they meet all of the criteria.”
ASCHA represents public, nonprofit, and for-profit operators of seniors’ housing. Martin-Lindsay says the association conducts training, shares best-practices information, and guides public policy through its advocacy.
Dempsey says AUPE, as the representative of 17,000 workers in for-profit seniors’ residences, has concerns that part-time and casual employment are more prevalent in those workplaces. The lower pay rates and lack of benefits can lead to overwork and burnout as staff have to work at more than one job to make a living.
This situation led to pandemic regulations that workers can only work at one site, in order to limit transmission of the virus. Dempsey said the time is now, before a second wave of Covid-19, to put safeguards in place.
“I’m expecting a ‘Round 2’ to come a little sooner rather than later,” he said. “That being the case, we need to get our ducks in a row in this brief period when the caseload seems to be lowered, so that when it hits we’re starting to become more prepared for it. And I fully believe the only way to do that is within the mandate of a publicly run system.”
Martin-Lindsay agrees that funding and staffing should be top priorities. Putting seniors’ supports under the health budget, where it competes for funds with acute care, is part of the problem. Housing and care for seniors, which can save the health system money in the long run, is underfunded.
“What we need is good community options that allow us to provide those wraparound supports where people want to be with their friends, with their families,” she said.
“I think that the issue is giving it the importance that it deserves, and not keeping it in the health budget where all they can have is medical checkmarks and lists, and they don’t treat the whole person. I think we need to move seniors’ care and supports and housing in an integrated way out of the health file and into a community-focused, community service model. That is really the underlying root issue.
“As long as I’m just this ‘poor somebody,’ we’re never going to get the proper staffing. We’re never going to get the proper funding, and we’re never going to be that important,” she said.
“Society should be measured by how well they take care of their most vulnerable.”
Health Advocate offers advice on continuing care
Alberta Health Advocate and Mental Health Patient Advocate Janice Harrington says her office has seen an increase in calls over the past couple of months, including a number of issues related to continuing care.
“The number one issue in this area has been around the lack of opportunity for visitation, and we have been happy to see some of those concerns addressed by the Chief Medical Officer of Health,” Harrington said.
Other issues relating to continuing care include a need for clear information on how to access care, who to speak with when there are concerns, and assistance in understanding the process for choosing a facility.
“In terms of protecting family members from substandard care, we encourage family members to be polite, but persistent,” Harrington said. “Seek first to understand. When starting at a new site or with new caregiving, ask open-ended questions. Ask lots of questions about how things will work and what to do, who to contact if they don’t work that way.”
Harrington encourages people to learn about the standards for their specific setting (for example the Continuing Care Health Services Standards and Accommodation Standards) and be familiar with them. Family members should also learn about Resident Family Councils (https://www.alberta.ca/resident-family-councils.aspx) and participate to the extent they are able.
“It is important to develop a relationship with the administration and staff at the site so you can have a partnership and a workable communication process,” she said. “We very much encourage family to participate in the care planning process.”
Alberta has a Health Charter (https://www.albertahealthadvocates.ca/education/Pages/Health-Charter.aspx), and Harrington encourages Albertans to become familiar with it. “Our office is here to respond when people feel they have not been treated in a manner consistent with the Charter,” she said.
The Alberta Health Advocate’s office has not received complaints similar to those contained in a Canadian Armed Forces report on five homes in Ontario.
“I can tell you our office has not heard of issues to the extent that has been reported in those other provinces,” Harrington said.