A lot has been said about the crisis in long-term care, especially since the outbreak of COVID-19 and the havoc that has been created among our vulnerable elderly. We all remember the thousands of deaths in long-term care institutions – and the promises of politicians to get the problem fixed.
The fundamental issue in long-term care is that care centres are inadequately funded to provide each resident with four hours of hands-on care a day. As well, many nursing homes in Ontario are built to pre-1999 standards and have as many as four patients per room.
An article published on Nov. 9, 2020, in the Journal of the American Medical Association by K.A.Brown et. Al, found that COVID-19 illness and death in Ontario nursing homes was directly related to crowding in rooms and bathrooms.
No big surprise.
The Ontario Long-Term Care Study Advisory Group announced its recommendation on July 30, 2020, that resident care needs required four hours of hands-on care per resident daily. This was an increase from the previous standard of two-and-three-quarter hours per day. Patients in long-term care have increased substantially in complexity and therefore care needs.
On Nov. 2, 2020, the policy change was announced by the Ontario Ministry of Health and Long-Term Care (MoH) to increase the number of hours of hands-on care per long-term care resident to four hours per day by March 31, 2025.
That’s a long way off.
Sudbury.com and other news outlets reported in October, 2021 the provincial government’s announcement that it intended to clean up long-term care centres by hiring more inspectors to ensure LTCs comply with current standards. There will be one inspector for every two long-term care centres, at a cost of many millions of dollars.
What about committing the resources that are needed to get the job done – four hours of care per resident per day – in the first place, as well as modernizing facilities before hiring more inspectors? This political knee-jerk is akin to the province saying, “We’re going to address the shortage of affordable housing in our jurisdiction by hiring more building inspectors” without first constructing the buildings.
Makes no sense.
The other confounding factor is the extreme shortage of health-care workers in the long-term care setting, let alone the shortage in the rest of the system. These personal support workers and nurses are the caring people for whom I have profound respect.
These are the people who come to work every day, spinning like tops to get all the jobs at least “done,” only to put in overtime to complete ministry compliance forms. Forms that don’t contribute much.
The nursing shortage (including PSWs and RPNs) is provincewide, including hospitals. On Sept. 26, 2021, the Toronto Star reported comments from the Ontario Nurses Association that about 10 to 12 per cent of all hospital nursing positions were unfilled. That number has only grown. ONA commented that this was predictable long ago. Just another example of bad planning at the provincial government level.
What’s worse, there are two funding formulas for long-term care in Ontario. All long-term care facilities get the basic provincial funding per resident. A non-profit home for the aged gets the same basic funding per resident from the MoH, but it is supplemented to the tune of millions by the municipality it is in.
The Journal of Public Policy reported in Volume 47, in September of 2021, that Toronto supplements its municipal homes for the aged by 20 per cent with municipal tax dollars. This is similar across the province.
This puts municipal homes at a distinct advantage and penalizes those residents at private care homes.
Patricia Carr of the Ontario Nurses Association is the team lead of the association’s labour relations group. She advised me that as of April 1, 2021, the starting wage of a registered nurse at a for profit home is $31.13 per hour. At Pioneer Manor, the starting rate is $34.40 per hour. The hospital starting rate is $33.90.
To make things more confusing, RNs at not for profit, non-municipal nursing homes have a starting rate of $30.90 because of the consequences of Bill 124. These are provincially negotiated compensation rates. Personal support workers and registered practical nurses are similarly disadvantaged in the private sector.
It’s not surprising then that when things get difficult and staffing is hard to fill, there is an out-migration of nursing staff from nursing homes to homes for the aged where the pay is better thus leaving private nursing homes acutely short of staff, as happened during the COVID-19 pandemic surge.
So, when a long-term care facility is short-staffed, they backfill their worker roster with health-care workers, usually from an outside agency. This occurs at a considerably higher hourly cost (somewhere close to double) without any adjustment from the MOH. That increase in money paid just takes care away from somebody else further down the line.
The Ministry of Health knows this. Industry insiders who do not wish to be named tell me that this is a topic of “lively discussion” at the ministry level.
What is desperately needed is an adequate and uniform pay scale for the personal support workers, registered practical nurses and registered nurses who work in our long-term care system, in order to stop out-migration or job shopping.
The pandemic has shown us the two principal shortcomings of long-term care: inadequate staffing and a plethora of buildings ill-suited to providing modern health care in the 2020s.
So where should the money come from to fund long-term care? The answer isn’t for the premier to go hat in hand to Ottawa and ask for a handout, as is usually done. The answer is in our own backyard, or rather on our computer screens, if we care to look.
Every few years, the World Health Organization publishes efficiency statistics on 191 nations. These are readily available on the internet. They involve a complex assessment of outcomes (good and bad) versus money spent. They are intended as a starting point to a discussion about health-care systems, about how they are run, how they function and the results they yield.
Our beloved health-care system is ranked in these tables. The system we believe to be one of the very best globally is ranked No. 30, behind Morocco. What’s worse, Morocco does it by spending about 40-per-cent less Gross Domestic Product on health care than we do. The new figures were posted on Jan. 14 in the WHO GDP Expenditure Database.
What a surprise.
There’s a lesson here. With some care and attention, we could save that 40-per-cent waste and turn it to good use. Like maybe adequate funding for long-term care. Fair and equitable wages for long-term care workers. Care for autism patients. Adequate funding for hospitals. These, just to name a few.
So why isn’t this happening? Why wouldn’t our leaders look at the statistics, scratch their heads and say, “We need to fix this.”
I’m scratching my head in wonderment right now.
Dr. Klaus Jakelski is a retired family physician and author, who remains active in long-term care. He resides in Greater Sudbury. You can learn more about him by visiting his website, Jakelski.com.
