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More staff, better layouts: how to make long-term care homes ‘good living’

Coronavirus: Was the COVID-19 crisis in Canada’s care homes preventable?
WATCH: It is inside long-term care homes that the COVID-19 outbreak is taking hold, and taking lives. Half the deaths from COVID-19 in Canada are in care homes. In the most grim cases, people are left to die, alone, in their beds. And it's not like there were no warning signs.

Residents left in soiled diapers, cockroaches in living areas and people not getting three meals a day — just some of the allegations raised about Ontario long-term care homes by the military.

The military was sent in to homes in Quebec and Ontario to help them respond to the ongoing coronavirus crisis. More than eight out of 10 Canadian deaths from COVID-19 have been among LTC residents.

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READ MORE: Military teams raise concerns about conditions at Ontario care homes

But even with all this attention, it’s hardly the first time these kinds of problems have been reported — and government has previously sworn to change things.

Government reactions to scandals don’t always address the root problems, though, according to Pat Armstrong, a distinguished research professor at York University.

“The most common response is more regulation, and more detailed regulation, like, ‘What size should the windows be? How much protein should you have every day?’ and detailed reporting that takes a lot of time away from care,” she said.

“I would argue we don’t have a lot of evidence that it is hugely improved care.”

READ MORE: Who owns the 5 Ontario long-term care homes cited by military for extreme neglect, abuse?

The focus on for-profit vs not-for-profit homes might be overstated too, said Andrew Costa, a professor in McMaster University’s school of medicine.

In a study just published as a pre-print article, without peer review, his team found that the home’s age had more to do with the size and severity of COVID-19 outbreaks than whether or not it was for-profit.

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While it’s true that many large outbreaks have been in for-profit homes, he said, “That’s more the function of a few bad apples.”

Who will be held accountable for crisis in long-term care homes?
Who will be held accountable for crisis in long-term care homes?

Older long-term care homes tend to have more people sharing a room, he said, which makes it easier to spread a virus among patients. Newer homes tend to have more private space for residents and defined “wards” rather than having patients wander all over.

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“Where we’ve seen the worst hit, like the five in the military (Ontario report), four of those are for-profit, one is not-for-profit. But they are all old-style facilities,” he said.

In Armstrong’s estimation, the biggest problems have to do with money and, especially, staffing.

“That’s the bottom line: you have to have more people.

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“The second is that these people have to have enough time to respond to individual needs.”

Right now, she said, with so many temporary workers, many services like catering and janitorial staff being contracted out and a lack of training, staff aren’t able to get to know their patients, which affects the quality of care.

And, she said, in the case of a coronavirus outbreak, there wasn’t enough staff flexibility to run things as they should be.

Families react to allegations at 5 Ontario care homes
Families react to allegations at 5 Ontario care homes

Working in long-term care is skilled labour, she said, and can’t just be done by anyone.

“I think that we have totally failed to understand this is skilled work and we just dismiss it as something any woman could do. So why don’t you just call in a woman — or the military, I guess?”

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“It’s skilled work to get someone elderly to eat when they’re not interested and they have no teeth and they’re having trouble swallowing.”

Costa agrees. “More staff means better care. It’s that simple. Better-trained staff means better care.”

READ MORE: Inspection reports found mouse feces, neglect, abuse at Ontario long-term care homes before COVID-19

In her current 10-year project examining LTC homes around the world, Armstrong said she has seen good and bad examples of care. But even the good ones need to be properly tailored to the community they serve, she said.

In a paper published by the Canadian Centre for Policy Alternatives, Armstrong and fellow researchers are calling for limiting staff to a single nursing home and making their jobs permanent, providing better training, and raising wages.

In the long term, the group wants an end to contracting out services, and for-profit homes, as well as better-designed facilities.

Costa agrees with that last point. Old-style facilities with rooms shared by up to four people “should be immediately retrofitted to meet new standards,” he said. “And there should not be a single resident admitted to those facilities until they are retrofitted and inspected.”

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Long-term care homes are here to stay, Armstrong said, and they serve an important purpose. “We can’t shift it all home and we can’t provide 24-hour care in everybody’s home. So we have to have some form of communal living.”

There can be advantages for the people who live there, she said.

Residents tell her they like having company around, they like having activities and they like the security of knowing their medications are being taken care of, she said, all things they might not have living on their own or with a family member.

“It’s not like a private home. And it can’t be so. So why aren’t we focussing on how can we make communal living, good living?”

— with files from Mercedes Stephenson, Stewart Bell and Andrew Russell, Global News