Don Urquhart
Times-Chronicle
This is the first of a three-part series on the real impact of elder care in Canada.
The devastating impact of COVID-19 on elder care facilities across the country is leading some Canadians to re-think the whole gamut of senior living, elder care and long-term care homes, say elder care practitioners.
The tragedy in elder care homes, not yet fully played out across the country, is “an uncomfortable issue,” said one South Okanagan elder care provider, who preferred not to be named due to the sensitivity of the issue.
The care provider told the Times-Chronicle that in a conversation with a BC Interior Health colleague, both agreed that through the pandemic there has been a developing public sense that placing seniors in care facilities was, “like a death sentence.”
Not all agree with this dramatic assessment, but the release of a report last week by the Canadian Institute for Health Information assessing the impact on long-term care in the country over the first six months of the pandemic certainly lends weight to this view.
The report laid bare yet more unsettling revelations on top of the shocking things we’ve seen over the last year, like the fact that Canada’s elder care home death toll was the worst amongst the world’s wealthiest countries.
The report highlights that the proportion of deaths in nursing homes represented 69 per cent of the country’s overall COVID-19 deaths, significantly higher than the international average of 41 per cent.
Worse still, the second wave of the pandemic in Canada hit even harder, “proving to be bigger and broader, reaching more parts of the country and affecting a larger number of LTC and retirement homes than the first wave.”
The pandemic experience varied greatly between provinces and territories, and as Isobel Mackenzie, BC Seniors Advocate told the Times-Chronicle, taught B.C. an important lesson.
“We had a bit of a humility lesson in Phase 2 around what we were thinking about ourselves in wave one when we were looking so much better than everybody else, but that’s not the case anymore. And that’s true of long-term care as well,” Mackenzie added.
Indeed this is illustrated by the report’s findings which saw B.C.’s long-term care and retirement home deaths rise from three per 100,000 in the first wave, to 12 per 100,000 in the second, leading many to question what lessons had been learned in the first phase.
For a great many Canadians the long-term care home crisis was an epiphany of sorts. “But you have to ask yourself what is the wake-up call about?” said Mackenzie. “I think the wake-up call is mostly around what COVID revealed in care homes and not so much about what care homes experienced during COVID.”
An important distinction because for those with no first-hand experience, it revealed the nasty underbelly of the care home industry. “What we were horrified to learn was the degree to which people weren’t getting help. That’s what was really upsetting for us to learn about.” What was revealed was a myriad of problems across the board “and this clearly didn’t happen overnight,” Mackenzie added.
Again this is illustrated in the report, with its findings pointing to structural challenges in the sector and to the need for, “increased staffing levels, stronger infection control and prevention practices, better inspection and enforcement processes, and improved building infrastructure to reduce crowding and infection spread.”
“So, I think we need to pay attention to what is happening in long-term care and we need to look at the quality of life and we need to hold the people who are operating these care homes accountable for the experiences of the people who live there,” Mackenzie pointed out.
The combination of underlying problems and the highly contagious virus created a toxic situation. While the death toll is one tragic outcome, residents saw dramatically reduced contact with family and friends leading to a heightened sense of isolation and depression in some cases. Worse still, their frequency and quality of care plummeted. Doctor visits dropped 16 per cent, while hospital transfers for medical conditions fell 30 per cent.
Understandably, admissions to homes from the community plummeted 58 per cent between March 1 and end of August. As Mackenzie noted, not only did some families make categorical decisions to not put their elderly parents in a care home, others went further and pulled their parents out of homes.
“Some of them did it for a temporary period in time, and of that group some made decisions that they figured out they can manage it at home,” she said, adding that a clearer picture will emerge once a full set data has been compiled.
One important consideration that many overlook, is that not everyone is cut out for care giving. “There are different circumstances around your ability to care for someone who needs the kind of care offered in a long-term care setting,” Mackenzie said.
“For some, it became a case of ‘I thought maybe I will do this permanently and then realized no, no I can’t handle it,’ and their loved one will go back to the care home.”
It’s not about lack of love or concern for one’s parents, for instance, but some are just not “temperamentally equipped” to be a 24-hour caregiver. But in many cases, she said, these individuals will spare no resources to ensure their parents receive proper care.
For Brittany von Burg, program co-ordinator with Better at Homes, there has been a discernible shift in thinking on how, not just families of seniors but also retirees themselves, plan their senior living.
“I’ve already seen the shift,” von Burg said. “There are people who weren’t safe at home but because of COVID their family and support network have increased their support just so that they can remain in their homes.”
This support network includes both Interior Health and BC government-funded, United Way managed and Desert Sun delivered, Better at Homes program. The Better at Homes program is focused on enabling seniors to live independently at home.
“There is a fear of putting your family member in a care home and I think that will stick around for a long period of time, like 5 to 10 years” and this is causing a shift she says, with children of ageing parents and even retirees themselves, re-thinking what is the best, most appropriate and safest solution for long term elder care.
She said the wider thinking now is, “how can we focus on getting them the support so they can stay in their homes. I think there is a big shift.” This will naturally lead to expectations of figuring out other options, von Burg added.
In part two of this three-part series, next week we will look at some of the personal experiences of seniors and their families during the pandemic. In part three the following week we will look at what the future holds in store for elder care in British Columbia and whether societal notions of how to care for elders are changing as a result of the impact that the COVID-19 pandemic has had on Canada’s elderly.
