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Home-based continuing-care model highlighted in report by province

Long-term care expert highlighted several concerns, including keeping couples together, addressing staffing shortages, and making sure good family support is in place.
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Sharon Ryan holds a photograph of her parents Patrick and Louise Ryan outside Foyer Lacombe where her mother stayed. Ryan was able to care for her parents in their home until they went into palliative care. June 6, 2021

St. Albert resident Sharon Ryan was able to keep both her parents in their own home until they needed palliative care, a privilege she believes should be extended to as many people as possible.

“The emotional health was extraordinary for both (my parents) and for us, make no mistake about it, this was an extraordinary opportunity to experience unconditional love,” said Ryan.

On May 31 the province released a report that made 42 recommendations to update the continuing-care system. One of those recommendations was a shift to have seniors stay in their homes for a longer period of time.

The report recommends Alberta move from 61-per-cent home-care services to 70-per-cent services by 2030. The move to a more home-based model would, according to the report, reduce annual operating costs by $452 million and would have a cumulative capital cost savings of $1.7 billion.

It’s a great move by the government, said Ryan, but the government needs to make sure they give families enough support.

“(Families) need extraordinary support. The amount of exhaustion, you cannot even begin to imagine. If you need 24/7 attention to support, the caregivers will burn out, they will burn out,” said Ryan.

One of the largest gaps Ryan saw while her family was caring for her parents and one of the issues that caused her family the most stress was they could not find a doctor who was willing to make house calls.

 “(The government has) got to look at doctors who will make house calls. It is so difficult to transport vulnerable people to the doctors' offices, and then you've got to sit in the waiting room with these vulnerable people,” said Ryan.

Ryan said it was also difficult to get proper equipment, such as lifts. Self-care procedures such as pedicures were taken less seriously, despite the fact that conditions such as diabetes could make an ingrown toenail a serious issue – which both she and her parents experienced.

Pat Armstrong, a professor of sociology at York University and an expert in long-term care, said the report seems to suggest a larger portion of money goes to home care, which isn’t a bad thing unless the overall amount of money is reduced.

“If we're going to do home care, we have to provide supports, then we shouldn't diminish residential care in order to do that. And I'm not sure that that's entirely clear in the report,” she said.

Another thing Armstrong found interesting was the summary which stated couples should stay together, but then said all rooms should be private.

In a press statement, the province said it would provide support to couples and companions who chose to remain together in continuing-care facilities.

Shared rooms will, however, be phased out, and ward rooms, or rooms with more than two residents, will stop immediately.

Armstrong said it seems obvious that, with four people to a room, infection will spread more readily.

“That seems pretty obvious. I’m not even sure we had to have special studies to indicate that,” she said. “But there can be an argument named for rooms for two people – not just because of couples.”

In her work, Armstrong interviewed long-term care residents and found some residents enjoy the company.

“There’s no question, some people hate the person sharing the room. But other people say they like to share a room because they have company. Someone can look out for them; they can share visitors,” she said.

Armstrong is concerned, however, we are about to face a staffing crisis.

“I certainly think there is a lot of staff who are hanging in there because they don't want to leave people under these conditions. But how long will they stay?” she said.

Getting more people in isn’t going to solve the problem, she said. We need people with continuous training and education because the needs of residents are changing all the time as are our care strategies.

Staff need a whole range of conditions, such as full-time jobs, some control over their schedules, and better pay to make their work possible and to make care possible, said Armstrong.

“You can't focus on the residents if you don't have the conditions that allow you to do that,” she said.

Care doesn’t include just medical. There is a social aspect to care that is also important, which can involve casual conversation while giving care, such as while administering medication.

There is a higher likelihood of injury if staff are rushed. Staff in Canada can also experience high rates of violence from residents and their families.

Armstrong did a study comparing Nordic countries and Canada and staff-reported violence.

“Canadians were more than six times as likely to say they faced violence on a daily basis,” she said.

The difference was the Nordic countries had more time and more continuity.

“If you have more time with the resident when you're trying to get them up, or trying to bathe them, or do the kinds of things that have to be done on a daily basis, and to chat to them, and to do it in teams, you're much less likely to see people get violent or upset.

“I might lash out if I didn't have help to go to the toilet, and have the indignity of sitting wet all the time,” said Armstrong.

Hospital criteria in terms of clinical can’t be applied to long-term care.

“They're there a long time and, and it has to make life worth living, not just surviving. And the clinical is about surviving,” she said.

The province is set to develop an action plan on implementing the report's recommendations over the coming months and years.

Armstrong wants to remain optimistic that something will come out of this report, but she has her hesitations.

“We do all these studies and then we see nothing. The government promises it after the next election … Well, by that time, a lot of the people who are there now are going to be dead. We need to do it now. We just have to realize that we have a care economy that we need to invest in.”