Long-term care: quest for more beds or quest for quality of life, and can there be both?

Success in improved health care, pharmacological interventions and healthy living has led to a significant increase in life expectancy at the very time baby boomers are entering the later phase of life. This demographic reality is raising concern on a number of fronts almost to the point of hysteria. However, the sheer number of individuals turning 65 is not the cause of our current challenges in long-term care (LTC) in Canada, it is the cumulative effect of years of not prioritizing resources to support quality of life for older residents. Consequently, LTC is not adequately prepared or equipped to meet the complex care realities of today’s and tomorrow’s residents. With many of us living into our late 80s and beyond, the incidence of multiple chronic diseases increases as does the risk of cognitive decline and dementia. While the majority of individuals with these health conditions can live on their own in the community, increasing complexity and frailty is often associated with these situations. Over time, these challenges limit people’s capacity to live on their own even with home-care supports. It is true that the baby boomer population will fuel an increased demand for long-term care beds if the continuing care system remains the same. And that is just the point. The system needs to change. Home First and other home and community care interventions such as support for family and friend caregivers, technological advances to support physical and cognitive decline, and increased amount and stability of care delivered are critical to making a difference. Enhancements to government-funded home-care programs are essential particularly with the rise of one-person households. Multiple housing and care options that are affordable along the continuum of care are needed if we are committed to ensuring quality of life of our older population. I believe there will always be a need for LTC facilities enabling the right care at the right time and in the right place. But we have a major issue. For too long, the LTC system has been under-researched, under-funded and under-valued. We fail to acknowledge the training and skills needed to work with residents with increasingly complex needs. By not investing in efforts to improve working conditions, we miss opportunities to recruit and retain LTC staff. While there are many examples of good care throughout the country, unfortunate examples of insufficient care, inappropriate care, and even abuse continue to capture attention in the media. Any such case is one too many. Therein lies the critical question: how can we talk about quantity when the quality of what we have needs attention? Will our preoccupation with the need for more beds come at the expense of addressing the current deficiencies of the system? The old adage “build it and they will come” may be true—but with insufficient human resources, inadequate research for best practices, and lack of primary care, what will be the quality of life of older Canadians in LTC? Instead of throwing more beds at the problem, we have to do a better job of delivering quality care, ensuring quality of life, enhancing the quality of the work environment, and enabling a quality death. How can this be achieved? Here are a few considerations: Greater access to primary care, including nurse practitioners and family physicians; increased access to allied health providers; more attention to conditions of work; more time for point-of-care providers to engage with residents; capacity of providers to create supportive physical and social environments for physically and cognitively frail individuals; better relations and supports for family-and-friend caregivers; and better access to data for planning and enhanced research capacity to analyze these data. To really tackle the current challenges facing LTC, these areas need attention. Many baby boomers who are supporting their parents now are growing concerned about what the challenges in long-term care will mean for their parent(s) and potentially themselves in the future. What they may be only beginning to realize, through their own aging experience, is the fundamental ageism that exists in our society, and which contributes to LTC being a low priority. The question now is, will the baby boomer rise up and question where governments place their priorities? Will they demand change to improve the quality of life and care in our LTC system and ensure accountability? Will they drive the change needed to improve the quality of working conditions before we march ahead (or at least in parallel) to build more beds? Dr. Janice Keefe is professor and chair of the Department of Family Studies and Gerontology at Mount Saint Vernon University. She is the director of the Nova Scotia Centre on Aging, and the scientific director of CIHR-funded, Late Life Team entitled 'SALTY – Seniors: Adding Life to Years.' The Hill Times

Long-term care: quest for more beds or quest for quality of life, and can there be both?

Long-term care is not adequately prepared or equipped to meet the complex care realities of today’s and tomorrow’s residents, writes Janice Keefe.

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Long-term care: quest for more beds or quest for quality of life, and can there be both?

Long-term care is not adequately prepared or equipped to meet the complex care realities of today’s and tomorrow’s residents, writes Janice Keefe.

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