Ageism contributes to poor care in long-term facilities

The COVID-19 pandemic has made it clear the disparity of care for residents in long-term care compared to that in hospitals. An indicator of that disparity is the fact that 80 per cent of COVID-19 deaths have been in long-term care homes so far.

image: mybetternursinghome.com

I’m avoiding the label of “the elderly” for these residents for reasons I’ll explain later.

The reduced long-term care is not for lack of dedication by workers but for political reasons. Barb Nederpel, President of Hospital Employees’ Union, told me:

“The pandemic has brought the problems in how we treat seniors and those who care for them into sharp focus. Twenty years ago, workers in long-term care earned the same wages and benefits regardless of their employer. Through privatization and contracting out, the BC Liberals forced thousands of these workers into lower paid jobs. Many took second or third jobs to make ends meet. To keep seniors and workers safe during the pandemic, public health officials are limiting workers to single sites and we’ve secured agreement from government to increase those wages back to the industry standard.”

For ideological motives, the BC Liberals argued that private care facilities could operate more efficiently. Privatization created a multi-tiered system where those who could pay more got better treatment.

The trouble with this model is that in this market where there is a labour shortage, workers will go to where they are paid more -leaving places that pay less short-staffed. The residents who call those places home suffer.

Ageism is at the heart of deaths in long-term care homes. The reduction in worker wages reflects the degree that we care about the residents of those facilities. The death of “the elderly” is seen as no big deal. People get old and die. The meme “Boomer Remover” that has been circulating reflects the dark humour of ageism.

To dismiss residents as “the elderly” robs them of their dignity as fathers and mothers, grandfathers and grandmothers, brothers and sisters. Let’s call them persons; persons who love and are loved, who laugh and cry, and make a difference in the world. Age should be just one aspect of anyone’s life, not a defining attribute.

Hospitals are relatively well-prepared for the pandemic in contrast to long-term care homes says Rona Ambrose, former Conservative minister of health and minister during the Ebola crisis in 2014:

“Our hospitals are ready. Doctors and nurses have been properly trained and are waiting to be called in for COVID-19 duty. Personal protective equipment is available, and, if not, it’s on its way.

“Meanwhile, caregivers in many long-term care homes are underpaid, lack training and don’t have PPE. How could this have happened when we knew from day one that long-term care homes would be centres of COVID-19 infection? How could we have failed our care-home residents so badly? There are hundreds of these facilities dealing with outbreaks across Canada (Globe and Mail, April 13, 2020).”

Post-pandemic, we will need to reset our values so that workers’ wages coincide with the value that we place on them. It’s too bad that it takes a pandemic for that disconnect to sink in. There has been an outpouring of appreciation for workers who have put their lives on the line to serve us. Let’s back up that appreciation for long-term care workers with a living wage.

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Baby boomers’ long term care goes bust

The long term care of boomers is an unfunded liability. Unlike the Canadian Pension Plan and Old Age Security, the long term care of boomers is not funded at all. Our health care is not prepared to receive their numbers.

image: genx67.com

Other countries with similar long-term care pressures, such as Germany and Japan, have established various forms of public long-term care insurance. Not in Canada.

As it now stands, long-term care falls on the shoulders of family members who provide for 75 per cent of home-care for older Canadians, unpaid. Canadians typically don’t see the gaps in the current publicly-funded care programs until they or a family member falls through them.

Research from the National Institute on Ageing at Ryerson University shows that if Canada continues on its current track, the cost of publicly funded long-term care for seniors – including nursing homes and home care – is expected to more than triple in 30 years, rising from $22-billion to $71-billion, in today’s dollars. Authors of the research, Bonnie-Jeanne MacDonald and Michael Wolfson, warn:

“There is no special fund or program to cover the costs of long-term care in Canada. And it is not covered under the Canada Health Act in the same way as physician and hospital care (Globe and Mail, October 8, 2019).”

Canadians are dreaming if they think that our health care system can deal with the onslaught of boomers that will be falling into long term care. Hospitals are now struggling to place seniors in long-term care facilities and the wave of boomers hasn’t even hit yet.

Private long-term care insurance is available but expensive because of the low number of people buying it. It hasn’t worked here in Canada and is unlikely to work in the future.

Private long-term residences are having trouble staffing. In Kamloops, Berwick on the Park’s supportive living unit will close next year leaving 20 residents without round-the-clock care, despite the fact that residents pay $5,000/month for the service. The director of Berwick wrote to residents:

“There are significant challenges to retain healthcare staff in the current labor environment. An extraordinary amount of energy has been directed at recruitment and onboarding staff to meet the obligations to successfully operate our licensed care unit. The forward looking labor forecast indicates that these challenges will continue for the foreseeable future (Kamloops This Week, October 10, 2010)”

Even if private long-term care were available, many boomers couldn’t afford it. Debt among seniors is increasing according to Stats Canada. In 2016, the proportion of senior families with consumer and mortgage debt doubled since 1999.

Boomers have led privileged lives. They grew up during a period of increasing affluence due in part to widespread post-war government subsidies in housing and education. Baby boomers were more active and more physically fit than any preceding generation and were the first to grow up genuinely expecting the world to improve with time. While they have accumulated wealth, many boomers have lived beyond their means.

Boomers’ optimism for a better world is going to be severely tested as they age.

Canada needs to establish a new long-term social insurance program.  Given that health care is controlled by provinces, a patchwork system will be the likelihood as boomers totter into old age.

The current rickety long-term care system is not prepared for the wave of boomers.