General · 26th January 2012
With a combination of good genes, good health care, safe housing and a generous dose of luck, many of us will become elderly and frail some day. When it is no longer possible to live independently, what kind of care will be available?
Dignity Denied is the title of a recent report from the National Union of Public and General Employees. NUPGE represents 340,000 members delivering public services across Canada, many of whom work in long term care (LTC). Dignity Denied offers a sobering look at the state of elder care in Canada, through the eyes of the elderly, their families, and the workers who support them.
Canadians cherish our public health care system. For many of us, Medicare in some way defines who we are as a country. We are proud that health care is available to all, regardless of income or social status. Unfortunately however, long term care (LTC) is not included under the Canada Health Act and is not a fully insured health service in any of the provinces or territories.
For the poorest seniors in Canada, income from Old Age Security and the Guaranteed Income Security totals $1267.41 per month. In 2005, 35.55 of seniors fell below the low income cut-off. Another 19% of seniors had incomes barely above the cut-off.
Charges for basic accommodation in publicly supported LTC facilities in B.C. range from $927 to $2229 per month. There are very often extra charges for incontinence supplies, laundry, baths, haircuts, walkers, wheelchairs, etc., etc. For too many seniors, and their families, the care that is needed is simply unaffordable.
To make matters worse, there are not enough publicly supported LTC facilities to meet the needs of a rapidly growing demographic of citizens in their 80’s and 90’s. On average, across Canada, there are only 90 LTC beds per 1000 seniors. Wait lists for the facilities that do exist are often long.
At the same time, provincial governments have opened the doors to for-profit facilities. In B.C., a bed in a private sector space costs an average of $4718 per month – well beyond the reach of most seniors. Ironically, given the pressing need for more beds, the vacancy rate in for-profit facilities in B.C. is 11.8%.
Some families are forced to borrow money to pay for the care of their loved ones. Others may sell the family home in order to pay for care, thus endangering the financial security of the spouse. In too many cases, LTC is simply not affordable or accessible and so family members, often women, provide the care themselves resulting in stress, lost work time, and loss of income and future pension benefits for the care provider.
Seniors who can’t afford a LTC facility and who have no informal family support will often experience deteriorating health and require expensive interventions when they eventually come to the attention of the health care system.
What is the best use of public funds when it comes to LTC: public or for-profit?
Dr. Michael Rachlis, a respected Canadian health care researcher reviewed the literature for 39 LTC facilities and reached the conclusion that not-for-profit LTC facilities:
• had lower hospitalization rates for residents
• had more staff and provided higher salaries and benefits
• had lower staff turnover rates
• were less likely to be cited for deficiencies than for-profits
• were much less likely to use physical restraints on residents
• tended to spend more on nursing care and less on administration
• attracted more volunteers, played a major role in planning community networks of services, and provided more support for research and education.
In a study of 167 LTC facilities in B.C., published in the Canadian Medical Journal in March 2005, researchers found that the number of hours provided per resident per day was higher in not-for-profit facilities and concluded that “public money used to provide care to frail elderly people purchases significantly fewer direct care and support staff hours per resident per day in for-profit LTC facilities than in not-for-profit facilities.”
Thousands of Canadians work in Canada’s LTC system, striving to provide respectful services that honour the dignity of the elderly, in the face of increasingly stressful and disrespectful working conditions.
Wages and benefits are generally lower than in other health care institutions. Some governments, including the B.C. Liberals, have favoured the for-profit sector, which has reduced staffing levels, pushed down wages, and cut or eliminated some of the services, such as music and recreational therapy, that made a difference to residents’ quality of life.
Jobs such as cooking, cleaning, maintenance, security, and laundry are contracted out to multinational corporations such as Sodexho and Compass Group, creating fragmentation where there were once staff groups united in the common goal of providing quality care.
Since 1987, the average number of days Canadian health care workers lost due to illness or disability has been 1.5 times higher than for all other workers. A 2002 study of workers in nine LTC facilities in Ottawa found significant levels of emotional exhaustion, leading to high staff turnover which in turn caused a negative impact on working conditions, staff morale and quality of care.
A 2009 study by the Canadian Centre for Policy Alternatives found that most workers felt that workload and staffing levels were of greater concern than wages, although wages were comparatively low. They were most concerned about issues that had a direct impact on the care they were able to provide.
NUPGE proposes that LTC should be integrated into the Canadian Health Act as a medically necessary service available to every citizen, regardless of income. NUPGE also proposes increased funding for public, not-for-profit LTC, which has been proven to provide better care at less cost, and enforcement of optimal care standards.
NUPGE also wants to see improved working conditions and wages for those working in the LTC system. To quote the report, “The dignity and respect we wish for our parents and grandparents should be extended to those who provide care for them.”
Dignity and respect. Shouldn’t those be the corner posts of the LTC system for our frail elderly?