The time to act on quality of life issues in nursing homes is now

To the Expositor:

I was concerned when I read the letter by Larry Killens of South Baymouth in the August 24, 2011 edition of the Manitoulin Expositor, ‘Where do our politicians priorities lie?,’ Page 5, indicating that our prisoners receive better care than our elders in nursing homes. I wish to support the concept that our elderly are being short-changed:

The following is an excerpt from CBC News special program entitled ‘Nursing Homes: Fear and Violence’ which aired October 22, 2007. “Canada’s nursing homes are supposed to be places where seniors go to spend the rest of their lives in security and safety. But a CBC News investigation, ‘Beaten Down: Fear and Violence in Canada’s Nursing Homes’ has found that long-term care facilities can be dangerous places where residents attack residents, residents attack staff and staff abuse residents.”

Why are we being so archaic and myopic with our elderly in nursing homes? We are merely sheltering them. Generally, both residents and staff are unhappy. Many employees show signs of daily ‘burn-out.’ All concerned, from government legislators on down seem reluctant to participate in the process needed to provide value-added enhancements, rather than just basic care.

Many of our residents, estimated at 50-70 percent, are suffering with dementia and they are mixed in with residents who are cognitively unimpaired but physically frail. This puts these residents at greater peril since their frailty makes it challenging for them to defend their own territory from wandering residents with dementia. Items get taken, sometimes with aggression. At night often there is wandering or calling out and this disturbs others who are trying to sleep.

Employees in the long-term care setting seem to come equipped with infinite patience. They are ‘people persons’ and they understand the challenges of working in such an intensive setting. They get bitten, scratched, spit-on and verbally abused by residents who are cognitively impaired. We may not be able to change this without chemical restraints, but we can change the setting by separating the severely cognitively-impaired residents to a safe secure area where they will not impact on the dignity of people who are still rational of mind. Such a change will avoid many of the baby boomers looking for alternatives when they need this service.

On Manitoulin, The Wikwemikong Nursing Home has always had an excellent reputation caring for Native and non-Native residents. Despite its aging architecture, it has maintained a positive ambience due to the excellent staff and the camaraderie between residents and staff. Unfortunately, over the last few years, the government has stepped in and changed this ambience. I do not blame the compliance team that is sent with their rule book and their blinders because they are just doing their jobs. One can’t help think that there must be a better way to reach standardization without throwing ‘the baby out with the bathwater’.

St. Michael’s Extended Care Centre in Edmonton, Alberta was well on the road to achieving some of these alternatives, 15 years ago. Their motto was: “Care with Love and Dignity.” Under the direction of an enlightened engineer, Bohdan Shulakewych, this home provided a separate area for residents with dementia. This space was circular for unlimited ‘wandering’ and it was always locked. Walls were padded for safety. Religious and other familiar icons decorated the walls. Gentle music was playing in the background. Each room boasted a photo of that resident at age 30-40 years when the mind was still clear so residents were able to find their own rooms without assistance. A mailbox and display case where valuable treasures could be shown, but not removed, sat just outside each door. Recreational activities included tasks learned at younger ages: folding laundry, preparing and pinching dough for ‘pyrohy’ (pierogies). These activities helped residents feel worthwhile and added dignity to their lives.

In the nursing home, there were two levels of care on two floors. The upper level housed residents with more intensive care needs. The lower level held residents that needed fewer hours of nursing attention. Staffing ratios corresponded with the various levels of care. One addition to this regime might be a ‘pain management’ and ‘end of life team’ that will allow even more options.

There were other areas in this complex of multilevel care including an independent structure for seniors that could live well on their own. A dining area was available for them but they could also prepare meals in their own apartments. A central kitchen provided the food for the entire complex. The writer was privileged to run this kitchen for a number of years.

A newer concept to long-term care was built in the basement of St. Michael’s. An old fashioned street greeted residents, members of a ‘Day Support Program,’ and visitors alike. Window fronts for several ‘shops’ included a cafe where residents could share a pastry or a cup of tea with a family member, a recreational area, physiotherapy, computer stations and other relevant services. The street lamps and signs added to the charm of an old fashioned village street.

This is the kind of ‘elder care’ the baby boomers will be seeking, not a nursing home where they are living side by side with dementia; where they may be seated with someone who will take their food or yell at them. Incontinence adds its own issues. They may share a room with a more vocal resident who no longer differentiates between night and day.

If the government does not see the need to change the regulatory and funding system for these homes to provide alternate, more dignified levels of care, then more private enterprise will likely create them and current nursing homes will become even more a measure of ‘last resort’ for most. In the United States 66 percent of nursing homes are for-profit organizations and only a small percentage, about 7 percent, are run by the government. It is my understanding this is similar to the Ontario ratios.

Perhaps the ‘not-for-profit’ nursing homes model with an astute management team is our best option. This would include a board comprised of business people and consumers, all of whom have both a nose for dignity of care and business-management skills. This entity will not be vested primarily in the bottom line but will ensure that established standards of care and dignity are respectfully maintained.

A Globe and Mail article by Margaret Phelp published in August of 2007, includes: A study of B.C. nursing homes published two years ago in the Canadian Medical Association Journal found that staff levels were higher in not-for-profit facilities and concluded that “public money used to provide care to frail elderly people purchases significantly fewer direct-care and support staff hours per resident day” in for-profit nursing homes.

Another B.C. study published last year discovered that not-for-profit nursing homes run by hospitals, local health authorities or in chains reported lower rates of acute-care hospital admissions for problems like bed sores and dehydration generally considered to reflect poorer quality of care than for-profit or smaller, stand-alone, not-for-profit homes.

A final excerpt from the same CBC News article quoted at the beginning of this letter: “Given that the projected number of demented patients requiring institutional care is expected to increase dramatically in the coming years, it is recommended that the Ministry of Health, in consultation with representatives from the long-term care industry and the health-care professions, develop both a short term and a long-term strategy to manage physically aggressive demented patients. Inherent in this recommendation is the recognition of the principle that the safety of other vulnerable residents within long-term care institutions must be maximized.”

That was 2007. We still need to address these as well as ‘quality of life’ issues soon!

We need major structural change at the top to reflect changing needs to preserve dignity and respect. This must happen in consultation with the people on the ground, professional staff, community members, employees, and residents of nursing homes. Otherwise, the system is set to self-destruct as the ‘early to mid-60s crowd begins to demand alternative care options.

I am hoping this article will inspire others to share their thoughts and stimulate some action.

I am willing to help.

Maintaining the status quo is not an option.

Petra Wall, BA MSA RD
Spring Bay