stressed staff, underfunding: canada must improve long-term care homes

by robert james and joel lexchin

long-term care homes and nursing homes have become the centre of attention in the midst of the covid-19 pandemic, with over 80 per cent of deaths from the virus in canada occurring in these homes.

this tragedy leads us to reflect on what we learned from a decade-long project led by pat armstrong , a distinguished research professor at york university, that looked at long-term care in four canadian provinces (british columbia, manitoba, ontario and nova scotia) and five countries (germany, sweden, norway, the united kingdom and the united states).

laundry, support and care

first and foremost, was the importance of the other workers to the care of residents. specifically, cleaning and laundry staff , as well as kitchen staff, and of course the care aids, or personal support workers (psws). we suspected that they played an important role, but over the course of the project it became increasingly clear the importance of those roles in making life for the residents more enjoyable, or even more tolerable.

that recognition has become even more acute during the crisis in long-term care homes that has followed the covid-19 pandemic. first, these workers are women — almost 100 per cent of psws, plus the majority of laundry, kitchen and cleaning staff, are women. as well, many are immigrants . they are the backbone of the care that residents receive in these homes. when these women are not able to work because they are ill or fear being ill, care collapses — especially when families are not able to step into the breach. many are also single mothers or are precarious in their employment, so they travel between jobs at two or three homes to earn enough income to survive.

art and space

second, incorporating architecture, history and art into the project provided insight into a whole other way of looking at long-term care — one that we had mostly ignored. we realized how much these aspects of homes influence the way that residents interact among themselves and with the staff.

re-thermalized on a budget of $8.33 per day

we also looked at food and food service in a new way. when bob was the director of the dundas home in the late 1990s, the province provided $7 per resident per day for food; by 2017, that had only risen to $8.33 per day . that meant that the kitchen had to accommodate all the special diets (regular, minced, puréed, diabetic, renal and so on) on less money than our federal government gives to prisons to feed their prisoners.

many homes don’t prepare their own food and don’t use locally available foods. it is trucked in and then reheated — or in the terminology of some homes, re-thermalized. missing were the smells of food being prepared, smells that are often meaningful to residents . in some homes we visited, the quality of the food was wonderful, but in others it was bland and didn’t carry any appeal beyond just filling people’s stomachs.

future directions

we were struck by the innovation seen in germany where there was adequate staffing, and co-operative workspaces (here we mean co-operative between the various staff positions, as well as between the staff and the residents). in germany, one of the staff doubled as a clown, and her non-verbal way of communicating through touch and facial expressions were also lessons for bob in working with patients with dementia.

as they say, this is a marathon rather than a sprint. we were hoping to have some reforms of the system before we need residential care ourselves since both of us are now over 70. we are no longer sure of that, but we still have hope that in the post-covid-19 world, things might begin to change in the directions we have witnessed elsewhere.