Social Justice Saturday: What kind of seniors’ home do you want your parents to end up in – or you?

Warren Buffett has a quote he uses to remind investors that companies can look promising on the face of it, but their warts (and worse) can reveal themselves pretty fast when circumstances change. Investor beware.

You’ve got to admit that’s a potent image! Buffett’s quote applies equally well to our social structures, which can seem adequate to their purpose … until a global pandemic hits. Then watch out for all those naked swimmers!

One of the many naked swimmers, aka societal issues, that has been revealed during this COVID pandemic is the scandalous number of deaths in nursing homes and the accompanying revelations of just how inadequately supported residents of many of our long term care homes are – in virtually every ‘wealthy’ country. I am ashamed to say that Canada leads the way in percentage of deaths in long term care homes, by far. A full 81% of our country’s COVID-19 deaths have been in our nursing homes. Other countries vary from a low of 10% in Hungary to 42% in the U.S. to 66% in Spain. The average among 17 ‘developed’ countries stands at 42%. That’s a lot of deaths in seniors’ homes, however you look at it.

Before we look at typical models of how these homes are run, let me remind you of the fact that there is a tsunami of challenges about to hit the long term care (LTC) sector, with or without pandemics. In many parts of the world, including Canada, there already are not enough beds for seniors (and others with chronic debilitating illnesses) in LTC facilities, so they are ‘warehoused’ in hospital beds. This is a lose-lose situation all around, since hospital beds are more expensive for governments than LTC spaces, and having the beds taken up by people who do not actually need hospital care means that the hospital can accept fewer patients than it otherwise could. A totally unacceptable state of affairs.

Now let’s put another factor into the mix. Our societies do not have so many more elderly people than we have LTC spaces for because of the Baby Boom; the baby boomers haven’t reached that stage yet. I happen to be an expert on that subject because I was born in the first month of the first year of the Baby Boom – 1946. Same year as (gulp) Donald Trump, George W, Bill Clinton, Sylvester Stallone, Dolly Parton, Sally Field, Liza Minelli, Cher, and many other well-known folks; all vital, none ready for nursing homes. We got the Baby Boom started (well, actually, our parents did) and we boomers continued to be born through 1964, nearly twenty years. So the truly frightening pressure on nursing homes due to the baby boomers is a ways off, but closing in fast and guaranteed to last a long, long time.

Some of my fellow 1946 baby boomers; we were the beginning of a long sustained wave of boomers!

The reason that the nursing homes are already overflowing is because, thanks to medical research and health officials that some political leaders are ignoring at their own peril, we are living longer. In fact we’re living a lot longer. Just to give you a taste of how things have changed, I’ve chosen a few countries to illustrate the point. This table shows life expectancy for ranges of years, averaging the expectancy for men and women. Instead of most of us dying off in our late 60s, we’re lasting into our 80s and some well beyond.

The bottom line is that in nearly every ‘wealthy’ country our nursing home capacity is insufficient for present needs, and the demand that is just around the corner is going to bring LTC systems to their knees everywhere.

That’s just the capacity issue. That doesn’t address why those who were in care during this pandemic were decimated by the virus. That has to do with antiquated floor plans, inadequate levels of staffing, inadequate support for the inadequate numbers of staff, and lack of oversight and accountability. All of this has to do with – you got it – money. If people are able to afford high-end private LTCs, then these issues are not likely to arise. Those residences are typically new, with private rooms and bathrooms for each person, and the level of care staff one would expect from paying the big bucks. But for the large percentage of the population who are in private, non-profit, or public care homes at more ‘affordable’ prices, the residents are likely to have roommates, shared bathrooms, crowded public spaces, and inadequate numbers of poorly paid caregivers. The reality is that this sector is already a financial albatross for most governments, and until now they have chosen to turn as blind an eye as possible because they just couldn’t imagine where the money would come from to do it right.

Image credit: publicradiotulsa.org

In most countries, including Canada, the private homes at this level get their money from the governments responsible for Social Services. Just as hospitals contract out food services and cleaning to private companies to try to save money, when those workers used to be employees of the hospitals, the governments responsible will contract out the running of care homes in the hopes of containing costs. Any of us who have been involved in RFPs and contract negotiations for such services know that you get what you pay for. Nothing more, maybe less. You convince yourself that you’ve shifted the responsibility to the private contractor, but, sorry, you are still responsible. Quality is scrimped as far as possible to match a contracted budget that will still allow for shareholders to get their payouts. This contracting-out model needs to be looked at very carefully.

In Canada’s situation, our two biggest (by far) provinces, Ontario and Quebec, made what turned out to be very poor decisions when faced with how to free up hospital beds for the expected wave of COVID patients, albeit with the best of intentions. They moved all the people in the hospitals who didn’t really require hospital care and were waiting for a bed in a provincial care home to whatever space could be made for them, at whatever care home. These decisions were made in order to free up beds for the critical COVID patients that were anticipated – but these vulnerable people were sent out into a system that was barely coping to care for the residents they already had. And don’t forget that everyone was scrambling for PPE and testing, from hospitals on down, with demand high and supplies scarce, all fighting an unknown enemy.

Everything in the system was geared up to fail in a situation like a pandemic. Roommates shared their space and their bathrooms, as is the case in most older LTC homes (just as it is the case with older university residences). There weren’t sufficient resources, or understanding, for caregivers to be given PPE or specialized training. Because most of the caregivers are among the lowest paid workers, including the invaluable cleaning staff, they kept coming to work when they were sick, both because they needed the money and because they knew that their residents needed them. Because the care homes were insufficiently staffed, often care workers worked between two different LTCs, thereby inadvertently spreading the virus even further. If there was anything that could have gone wrong, it did. It was a disaster waiting to happen. It wasn’t too different in other countries.

The big difference going forward is that, thanks to the wake-up call from the pandemic, governments can no longer turn a blind eye to the current unacceptable situation and, even more so, the vastly increased need for capacity and accountability that is looming on the horizon. Healthcare is already a huge expense for every government that has responsibility for their universal healthcare. And we all agree that there is nothing more important. Well, ensuring our most vulnerable seniors are cared for in their final time of need falls in the same category, like quality education for our youth. Tough decisions for governments, for sure, but that’s what they’re there for.

The same governments, strapped for cash as they are, are going to have to ensure that nursing homes are moved way up their priority list. The day of reckoning has arrived. They need to consult with the public and with experts as to the best models for structuring nursing homes for the next generation. They need to take into account lessons learned this year so that new plans mitigate those frightening cracks that made it so difficult to protect residents and staff from the virus. They need to ensure that new building and staffing requirements keep the residents’ ongoing quality of life in mind, not just their physical safety. It’s important that there are opportunities for socializing and stimulation, not just more warehousing. Governments must have solid and reliable accountability measures in place to make sure that these principles are maintained. They need to determine what the relationship should be between healthcare and long term care. And, finally, they need to accept the fact that the caregivers putting their heart and soul into keeping your parents – or you – safe, clean, and fed, and providing a caring environment – are paid a respectable wage, with benefits. How could we accept less?

 

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19 Responses to Social Justice Saturday: What kind of seniors’ home do you want your parents to end up in – or you?

  1. iidorun says:

    Hello Jane! What a great topic for your first Social Justice Saturday! I live in a location that has a lot of retirees – they are building more 55+/senior living homes than regular homes. Some have the full spectrum in one community – 55+ then assisted living then nursing home with onsite medical care. Unfortunately, a lot of the deaths from the coronavirus were from these communities. It is definitely an issue that was “uncovered” during this pandemic but honestly, I don’t think we have paid it as much attention as we should have. Politicians are more concerned about businesses. More than one politician has even said as much (https://www.nbcnews.com/news/us-news/texas-lt-gov-dan-patrick-reopening-economy-more-important-things-n1188911). It’s a sad state of affairs when people don’t care about you after you are done being a productive member of society. But I guess that’s the way of capitalism. Keep shining the light!! ❤️

    • Jane Fritz says:

      Interesting observations, Irma. Interesting and sad. It is beyond unfortunate that the U.S. has become so mired in partisanship and every decision is so politicized that concerns for the common good barely make the radar. Let’s hope that changes soon. Here in Canada, I was very pleased to see yesterday that our feds announced a big package to help the provinces cope with costs associated with handling the fallouts from COVID. The package is targeted as to what it can be used for and one of those targeted issues actually is improvements to long term care homes: increases In personnel and their salaries, PPE for their personnel, cleaning costs, etc. Here the military had had to be called in to help out in some LTCs during the height of the disaster!

      • iidorun says:

        Wow! That is fabulous! Here the military was called to tear gas peaceful protestors so the president could do a photo op on front a of a church that he never attends. (Sigh) Common sense for the common good needs to make a comeback here soon! I know Americans complain about high taxes in Canada but in times of crisis, that safety net is a lifeline.

        How is your shoulder by the way?

        • Jane Fritz says:

          For having a more equitable society, social safety nets are always a lifeline. The U.S. is an outlier in universal healthcare, parental leave, early childhood education, and many other areas of social policy, all in the name of low taxes even for the super rich. Warren Buffett’s been asking to pay more taxes for years! Maybe this year’s election will tell the tale.

          My shoulder is very slowly recovering; you are sweet to ask. I might ask you when you ever sleep! 😉

  2. Jean says:

    Liked the Buffett. Actually kinda funny and terrifying simultaneously. The pandemic has revealed what we suspected for so long..serious inequities in long term care homes for the patients. And a “forgotten” population which we all may fall into one day.

    • Jane Fritz says:

      Exactly. Let’s make sure that the federal and provincial govts don’t forget their promises to ensure changes are made so that these horrors can never happen again. And that goes for the care workers as well as the patients. I wish I had more confidence that this item will stay top of mind for the politicians.

      • Jean says:

        First, it helps to buy/live in a home where it minimizes driving to services, shops and park/green spaces. Liveable neighbourhoods where such amenities/essentials are only 15 min. walk away. A decision should be made long before one becomes frail. It makes me wince when some people wish to retire…out in the country. Seriously? Who is going to look after your needs if you are in a more isolated area?

        This will help prolong aging folks to live a few more years longer in their own homes…which should be 1 level not 2-3 levels with staircases.

        We would prefer to age in place….so we need to plan our final home not it terms of how young and healthy we were, but what we will become in a few decades.

        • Jean says:

          I should also add, we will lose capacity to drive safely without endangering others which is why such neighbourhoods are important.

        • Jane Fritz says:

          Very good point. It sounds like you’re preparing well for the future!

        • Jane Fritz says:

          Lol. I couldn’t agree more, Jean. Having lived in the country, there’s a time and a place for everything. If you’ve always lived in the country and your support systems are there, that’s one thing. But for the rest of us, late(r) in life usually isn’t the best time to embark on that adventure. One couple we know found out the hard way that you lose your water as well as everything else when the power goes out and you’re on a well; the pump doesn’t work!

        • Jean says:

          What an awakening for your friends.

  3. OmniRunner says:

    We have the same issues in the US.
    If you have money you can live in as nice a place as you can afford. When your money runs out, Medicare steps in.
    Of course Medicare pays at a lower rate and all facilities know this. Some will only accept private pay. Some will accept private pay and let you stay after your money runs out.
    There isn’t enough money in the world to solve all the issues that became blatantly obvious to the public as a result of this pandemic.
    I’m not sure what the answer is. Our schools need money. Hospitals, LTC, Public Health systems. You name it. Our bridges and roads are still a mess also, they just have fewer cars on them now.
    People spend their careers trying to solve these issues.
    I think I’d like to die with a shovel in my hands or running shoes on my feet.

    • Jane Fritz says:

      Thanks, OmniRunner. I’m glad you clarified the US system for me; I wasn’t sure. Yes, you name all the challenge areas. Of course, the US has a bit of capacity that it could tap into that the rest of us already do, called taxing those that have a bit more to aid those that have less for the common good. But that’s a philosophical issue for Americans. And I’m not sure that all the taxing in the world will solve all these social needs. I like your personal plan. I’ve already had to give up on the dying with my running shoes on plan, sadly, but we all hope to stay in control of our decisions as they become narrower. Here’s to that hope! 🤞🏃🏽‍♂️

  4. 😮 Warren’s quote is priceless and yes I agree can be applied to so many social structures, after ‘the s*** hits the fan’ (a very British saying) the truth is revealing! An aging population and dwindling pensions ‘reveal’ life for future seniors might not lead to a long and happy retirement for many (lol bet that’s cheered any readers up, sorry! 😀 ). Being serious for a second, I don’t WANT to end my years in a retirement home unhappy and uncared for. A friend of mine’s father collapsed and died age 75 whilst digging his beloved allotment! the fitting end he would have hoped for?

    • Jane Fritz says:

      Lol. The good news, A.S., is that spending the last part of your life in a care home is not inevitable. Personally, I do think your friend’s father had a fitting end. It would have been even better at 85 or 90, but a measure of a good life should really be about what we do while we’re alive rather than how long we do it for.

  5. Inkplume says:

    This is a great summary of the cracks in the system. As a Quebecer, where these cracks became craters during the pandemic, with a 93-year old mother in a nursing home, it’s a topic close to my heart.

    • Jane Fritz says:

      Linda, I’m so sorry you’ve had to have first hand experience with this heartbreaking state of affairs. And the reality is that making major changes rather than tweaks isn’t going to be easy. But the status quo just won’t work, especially once the full thrust of our aging boomers enters the “system”. It’s a sad and scary situation. My thoughts are with you as you continue to navigate this process with your mother.

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