We have all seen the headlines regarding the litany of concerns in our long term care homes.
Neglected residents; soiled bedding; unanswered call bells; sloppy feeding; expired medicines; cockroaches; callous treatment: the list is shocking and endless. Unfortunately, and it pains me to say this, I believe the allegations are true.
I practiced as a family physician for 37 years in this community. During that time I worked in long term care homes, also known as nursing homes, which are not to be confused with retirement homes or homes for the aged. Some long term care homes were large, housing 240 residents, others had fewer than 40. I have worked in many types of nursing homes. Some were municipally run, some were not-for-profit and others were privately owned, for-profit homes. I acted as physician for thousands of their residents throughout my career as medical director, on-call physician and a member of the attending medical staff.
The finest long term care homes I attended during my career are located here in this community: Centennial Place in Millbrook and Springdale Country Manor. These are both “for profit” homes, owned by private companies. They are precisely the type of home that has been the target of particularly harsh criticism lately. Among privately-owned long term care homes are the facilities that have experienced the highest levels of COVID infections and related deaths.
All long term care homes are funded equally, operate under the same regulations and meet the same inspection standards. Why are some homes doing their job so well while others are doing it so poorly?
I propose that the answer lies not in their ownership but in their management. Any good school, business or nursing home is a reflection of its management’s attention to detail, to the proper execution of the tasks at hand and the rigor of staff to monitor and assess their own performance. The homes I mentioned exemplified this attention to detail, discipline and care through consistent, professional staff, good communication and a dedication to their residents, setting a very high standard for all staff to meet, whether they delivered nursing, dietary, housekeeping or medical services.
We have heard calls for investigations, commissions and inquiries, but do we really need to go down this road again? Everyone from residents, their families, staff, and administrators to ministry officials know how to address the issue: more caregivers at the bedside. These homes need more funding for staff, which means higher taxes or spending cuts somewhere else to finance this. The solution of more care is simple but the path to get there is difficult. We need the will to do it.
When I mentioned professional staff in local nursing homes, I am really talking about attitude. Professionals perform their tasks because they see them as a duty entrusted to them and they take pride in doing them well. Whether the assignment is trivial or vital, doing it properly is the goal. Over the years I have seen bedside caregivers- health care aides and Personal Service Workers- deliver care that went above and beyond expectations, demonstrating extraordinary compassion on a daily basis. These roles are not for everyone, but for some it is natural and their abilities are reflected every day as they perform their duties.
At times, a resident lay dying with no family members to keep them company. I have seen staff stay after the end of their shift or come in early just to sit with a resident, share a hug or keep them company as they had their evening toddy. Others took residents to their homes for a pool party or brought gifts of slippers purchased at their own expense. I always felt challenged to measure up to the PSWs’ standard and was constantly humbled by their efforts as they maintained their good humour, grace and poise in often very trying situations. Their attachment to their residents went far beyond that required by their job, as evidenced by their genuine joy at a story, moment or accomplishment of their residents and their all too real grief with the passing of a one who was also a friend. As is often the case, the failings of a few has resulted in broad criticism and maligning in the media, as these staff members are all painted with the same brush.
The residents of our nursing homes are the most vulnerable and frail members of our society. There are 626 nursing homes in Ontario housing more than 77,000 residents and the vast majority of them are alive and comfortable due to the care they receive from PSW’s, not in spite of it. We as family members could not and most likely would not provide the necessary level of care these staff members provide around the clock, day in and day out.
While we look to guarantee that the reported abuses stop, let’s not forget that good care in this province is the rule and not the exception. In my experience, this particularly true in our neighbourhood. We should appreciate and acknowledge a job well done.
By James Liston, MD