Nursing Home Woes

Topping the extensive list of emails and letters received by the CARP National Office, is the dilemma of families faced with the problem of finding thean appropriate place care for in a long term care facility, for an aging parent.

Every province has its own system. In Alberta, you look to the Continuing Care System. In Ontario, the Community Care Access program is the gatekeeper to finding help at home, assisted living, retirement homes, or nursing homes. The recent Ontario budget included a three percent increase in the Long Term Care budget, from $3.5 billion to $3.7 billion for 2011/12. This is expected to add 1,100 Personal Support Workers, but even this is not adequate to satisfy the needs.

They may be called Nursing Homes, Long-Term Care Homes or Homes for the Aged, but they are all the same thing, and they provide care and services for people who are no longer able to live independently, or who require onsite nursing care, sometimes at a high level. They are owned by government, non-profit or private for-profit companies, and the provincial government is in charge of regulating, inspecting and setting fees.

On paper, they may be models of efficiency. In practice, questions continue to vex families.

Example: A 90-year old, who had been on the waiting list for two years, finally makes it to the top of the list. On inspection, the placement in a locked-down, end-stage dementia unit is deemed inappropriate by her family, as Mum is not at that stage, and her physicians state that placing her there would be detrimental to her health.

Nevertheless, the family is told if they refuse the bed, she will not be allowed to reapply for six months, unless there is a significant deterioration in her health, although the Long Term Care Act (in Ontario) has a provision that in the case described, status would be maintained.

Example: After a few mini-strokes, Mary needed more help than the family could offer. Once in the nursing home, rather than improving, lack of adequate care resulted in more illness. To alleviate the situation, her son took early retirement – at a considerable loss of income – moved her back home, trained himself to give her the help she needed, and with a few hours a week from a Personal Support Worker, provided care to the end of her life.

Example: In spite of her mother’s experience in one of the best facilities, a daughter writes that the personal care support staff/patient ratio, the lack of geriatricians, and Registered Nurses, the quality of food, are all detrimental to the health of the patient, Insufficient cleaning staff means lack of infection control, and over-worked nurses don’t have the time needed to properly asses changes in their clients’ health.

Hospitals complain that the system is clogged with “bed blockers” who are taking up acute care beds; some have even taken to charging outrageous fees to persuade them to leave. In most provinces, this is illegal: charges are limited to those charged for similar facilities in nursing homes. Patients would be only too happy to vacate, if only they had sufficient help at home, or a long-term care bed appropriate to their needs. And someone knowledgeable besides the family to help figure out what to do.

Since 2005, the wait times for nursing homes in Ontario, has tripled. This is in spite of the fact that more than 8,000 new beds have been added, and the province has launched a program of redesigning and retrofitting existing residences. Clearly there is a need to rationalize and organize access and capacity.

And what about family caregivers? A recent study by the British Columbia Law Institute and the Canadian Centre for Elder Law states that 80 per cent of elder care is delivered by family members, and that the preponderance is done by women. Hours of care provided by government programs vary from area to area, even within the same province. In a recent article in ZOOMER magazine, entitled “Who Can Afford This” Ian MacNeill speaks to the issue of home care – both private and government – and the unexpected costs that families can face.

Even with three or four hours of personal care a week provided by provincial home care, the client may need more and will have to pay for – or a family member will have to provide – meal preparation, laundry, house cleaning, supervision of medication, Low cost adult day care programs with transportation are helpful, but not always available. They should be – not only to provide a critical need but also to prevent the decline or medication mistakes that put people into hospital or on the waiting list for long term care.

According to the renowned American essayist and scholar, Henry Louis Mencken, “Old age ain’t no place for sissies”. Nevertheless, having made it to that stage, seniors have earned whatever help they require to maintain a decent, lifestyle.

Keywords: caregivers, nursing, homes, care