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Now is the time for long-term care reform

Canadians have lobbied for long-term care reform for 50 years, but the urgent need for it has become painfully obvious to everyone during the past eight months.

Pandemic pressure has resulted in isolation protocols, capacity restrictions and clear examples of unethical patient treatment.

There is growing evidence that long-term care needs to move toward a community-based approach in which citizens are able to stay at home as long as possible.

More than 80 percent of COVID-19 deaths in Canada have been in long-term care facilities. Currently 6.8 percent of Canadians 65 years or older live in a long-term care facility and 30 percent of Canadians age 85 or older live in a residence for seniors.

Further, projected life expectancy increases predict the demographic of Canadians age 85 or older will increase rapidly in the next 50 years, with the greatest increase being in Saskatchewan.

Saskatchewan’s deep history of institutionalized care spans nearly a 100 years.

“Orphanages, residential schools, and mental health asylums are a few examples of archaic institutions of the past, designed with high volume and efficiency in mind,” said Dan Florizone, executive in residence at the Johnson Shoyama Graduate School of Public Policy.

Florizone is also the former President of the Saskatoon Health Region and former Deputy Minister of Health in Saskatchewan. His current academic research focuses on long-term care in Saskatchewan.

He said the most prominent of the many issues facing long-term care facilities in Saskatchewan is their design and structure. Many facilities in the Prairie provinces struggle with remnants of the institutional design model.

“While many primary care institutions have come and gone throughout Saskatchewan’s history, institutional models of long-term care for seniors and prisons, two major hotspots for COVID-19, remain. Florizone said he believes that “facilities designed on a model of care from the turn of the last century have fallen behind as medicine and research have evolved.”

In addition to outdated facilities, the North America culture surrounding institutionalizing seniors also negatively impacts their health and welfare.

By contrast, many European countries traditionally cohabitate with multiple generations in a household, where a much greater emphasis is placed on keeping people in their homes as long as possible before eventually transitioning to a community-based care facility.

Academic and population-based research has overwhelmingly shown that when people are able to be independent, comfortable, and living among their neighbours family and community, their physical and mental health are positively impacted.

One might assume that long-term care institutions are more cost-effective to operate, but Florizone’s research shows that one resident in a long-term care facility in Saskatchewan costs an average of $300 per day. Of this, the government pays $250 and a resident pays $50.

Not only are large long-term care institutions more expensive to operate than smaller community-based facilities, they are also more costly, per patient, to build.

However, a significant cost to smaller long-term care facilities is the increased expense associated with hiring more staff.

Florizone’s research supports a more targeted approach to building and operating long-term care facilities.

This would involve smaller facilities in existing neighbourhoods and smaller communities, where staff take on multiple functions in a home-like environment. Ideally, a care home should be situated close to amenities, walking paths, elementary schools, and green spaces.

An ideal care model brings health-care support to where people live, allowing people to age in place within an existing community. This implies the availability of a variety of home-based services for varying levels of independence.

While staying at home for as long as possible is ideal, a long-term care facility close to a person’s home is a close second.

Facilities where family members and spouses or partners can visit and become involved is important for quality care. Designing smaller facilities with personalized care will result in more humane and affordable treatment. Such designs also allow residents to age in place and to avoid being separated from their spouses. This factor alone is crucial to health, given the fact that perceived loneliness is the No. 1 predictor of premature mortality.

More than ever, large, institutionalized facilities, where personalized, quality care cannot be provided, are creating unacceptable living conditions for those who are confined there. Forced isolation had created a loneliness pandemic that was wreaking havoc on our elderly, even before COVID made a terrible situation worse.

Long-term care reform cannot come soon enough and for many it will already be much too late.

Katelyn Duncan, PAg, BSA, is a Saskatchewan farmer and agrologist.

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