Dignity Denied

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DIGNITY DENIEDLong-Term Care and

Canadas Elderly

National Union of Public and GeneralEmployees (NUPGE)

February 2007


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National Union of Public and General Employees

(NUPGE) is a family of 11 component unions that

represent provincial public sector workers and a

growing number of workers in the private sector.

NUPGE Components

British Columbia Governmentand Service Employees Union

Health Sciences Association of British Columbia

Health Sciences Association of Alberta

Saskatchewan Governmentand General Employees Union

Manitoba Governmentand General Employees Union

Ontario Public Service Employees Union

Canadian Union of Brewery and General Workers

New Brunswick Unionof Public and Private Employees

Nova Scotia Governmentand General Employees Union

Prince Edward Island Unionof Public Sector Employees

Newfoundland & Labrador Associationof Public & Private Employees

Whowe

are


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Contents

n Summary ...7by James Clancy

n Overview ...11Definitions Involving LTC Facilities

The Demographic Challenge

n Accessibility and Affordability ...15LTC & Public Health CarePersonal Costs of LTC

Accessibility & Low Income

Funding Formula Inadequate

Long Wait Times

Difficult Decisions

Political & Corporate Cronyism

A Better Way

n Quality of Life, Quality of Care ...29Canaries in the Mine

Government & Academic Reports

Ownership Matters

Monitoring, Inspection & Quality Care

n Workers Who Care for the Elderly ...37Privatization & Low Pay

Stress, Burnout & Turnover

Hearing from the Workers

The Union Advantage

n Conclusion ...43

n Recommendations ...44

n Endnotes ...49


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CANADIANS CHERISH our u n iversal, pu blic h ealth care syst em .In repea ted surveys and opin ion pol l s , suppor t for medicare i s

reaff irm ed as a fun dam enta l va lue . Our sys tem , for the m os t par t ,

provides universa l access to qua l i ty care for a l l , r egard less of

wea l th, social s tatu s or oth er barr iers . Sadly, th is un iversal i ty and

qual i ty of care ends for seniors a t the doors of long- te rm care

(LTC) facilities. Too often LTC is not available for the seniors who

nee d i t . Whe n avai lable, it i s f requen t ly una ffordable.

LTC is not included in the Canada Heal th Act , and i t i s not afully insured h eal th se rvice in an y Can adian province or terr i tory.

Iron ically, if a frail an d elde rly pe rson receives m edically neces -

sary serv ices in a hosp i ta l, those a re p rovided f rom th e pu bl ic

purse. Yet th e sam e person receiving essen t ially th e sam e service

in a LTC facility m us t pa y for it ou t-of-pocket. Our syst em is fail-

i ng t o p r ov i de t ens o f t housands o f o l de r Canad i ans wi t h t he

affordable care they deserve.

There a re profoun d dem ograph ic changes jus t a round the cor-

ner . We need a cogent , na t iona l long- te rm s t ra tegy to meet the

hea l th care n eeds of seniors , wh ich are becom ing ever m ore press -

ing. Here are som e sal ient facts : People aged 80 and over a re the fas tes t growing age

group in th e coun try. Man y seniors will enjoy he al thy

an d act ive lives long int o ret i reme nt , but m ost w ill ex-

per ience d isabil ity ne ar th e en d of the ir lives.

In 2002, there w ere 157,500 beds in LTC facil it ies across

C a n a d a . E s t i m a t e s a r e t h a t b e t w e e n 5 6 0 , 0 0 0 a n d

740,000 sen iors w ill ne ed a LTC facility by th e yea r 2031.

This is an incred ible gap an d i t requ ires governm en ts

to ge t se r ious a bout long-te rm plann ing .

More than 28% of Can adas seniors in 2001 were peo-

ple wh o arr ived as im m igran ts . Providing appropriate

care for these se niors is a chal len ge. Many worked in

low w age indu s t r ie s an d a r e n ow doub l y d is advan-

taged by a LTC system that favours the weal thy.

Incom e from OAS and the GIS to ta ls $1,079 per m onth .

Ch a r g e s fo r b a s ic a c co m m o d a t io n i n p u b l ic ly s u p -

ported LTC ins t i tut ions ran ge from $540 to $3,960 a

m onth . Pr iva te accom m odat ion cos ts a re m uch h igher.

Summary


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In 2003, 17 .7% of una t tach ed sen iors and 18.9% of un-

a t t ach ed fem ale seniors fe l l be low th e Low Incom e

Cut-Off . Anot he r 19% of seniors h ad incom es ba rely

above th e Cut -Off. For th ese sen iors, existing LTC fa-

cil it ies presen t a cost ly an d of ten inaccessible opt ion .

Most LTC residents a re requ ired to pa y for far m ore tha n th e

costs of accom m odat ion. They are forced to em pty their pockets to

pay f o r m ed i ca l and pe r sona l c a r e and , i n som e j u r i sd i c t i ons ,

they are forced to spend the i r asse t s in order to m ake those pa y-

m e n t s .

There a re a lso i s sues wi th th e qu a l ity of care th a t res idents re -

ceive. Worke rs carin g for th e frail elderly are ru n off th eir feet. The

m edia reported on a h un ger s t r ike in 2005 by an 86-year-old Alberta

wom an to pro tes t aga ins t the lack of s ta f f to provide ad equate care .

Other s tor ies repor t inadeq uate care , poor food, subs tan dard fa -cili t ies and rip-offs by for-profit owners.

Ot tawa has a respons ib i l i ty to provide adequate and ta rge ted

fund ing towa rd cost sh ar ing LTC program s. It i s th e resp onsibil ity

of provincial governm en ts an d terr i tor ies to bear the ir sh are of the

costs , to establ ish clear s tan dard s an d guidel ine s governing LTC,

and to provide ad equa te overs ight an d inspec t ion . Many of these

governm en ts ha ve fai led in th eir respon sibil it ies . That h as h ad a

devas ta t ing im pact , both on res idents an d the w orkers a t t em pt ing

to provide q ua l ity and compa ss iona te care .

The f inancing and del ivery of LTC requires sweeping reforms.

This is a m at te r of urgent concern to a l l Can adians a nd cer ta in ly toNUPGE an d i ts m em bers. Most of our 340,000 m em bers d el iver pu b-

l ic services to the ci t izen s of their hom e provinces, and m an y of

th ese m em bers work in th e LTC sector . We can offer som e lessons

based on our exper ience and so lu t ions based on common sense .

There is a bet ter way to he lp the elder ly an d th eir fam ilies .

Older Canadians a re not and mus t never be seen as a burden .

They worked hard to build Can ada in to the m odern an d compa s-

sionate coun try tha t i t is toda y. They survived th e Great Depress ion

and m any wore our count rys u ni form dur ing a w or ld w ar . They

paid the i r fa ir sh are of t axes an d th ey cont inu e to d o so . They are a

cont inu ing source of wisdom, exper ience a nd ta len t .

In th is paper w e discuss th e issues confront ing LTC in Can ada,

including the lack of access to adequate and affordable care. We

speak to th e s t ress en dured by fam ilies tha t h ave to m ake d i ffi-

cu l t choices regard ing the i r parent s and grandparent s . We a l so

cons i de r the c i rcum s t an ces o f t he wom en an d m en w ho wor k in

LTC faci l i t ies , providing care to our nat ions seniors . Too of ten

those workers a re underva lued , underpa id and burned out .

Our system is

failing to

provide tens

of thousands

of older

Canadians

with the

affordable

care they

deserve.


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I t i s t ime for bold and fundamenta l change . LTC i s exc luded

f r om t he Canada Hea l t h Ac t and , a s a r e su l t , ou r pa r en t s and

gran dparen t s a re l a rge ly le ft to fend for the m selves a t a t im e of

l i f e when they mos t need suppor t .

Our key proposa l i s tha t provis ions for LTC should be in te -

g r a t ed i n t o t he Canada Hea l t h Ac t t o ensu r e i t i s a m ed i ca l l y

ne cessary service avai lable to every ci t izen , regardless of incom e.

This is an essen t ial s tep in th e evolut ion of Can ada s pu bl ic m edi-

care sys tem . This wi l l r equ i re l eadersh ip f rom pol it i ca l l eaders

and we insis t they exercise their responsibi l i ty. We also propose

targeted and increased funding for public, not-for-profit LTC.

Our p l an wou l d r e f o r m t he f r agm en t ed , unequa l and i ne f f i -

cient del ivery of LTC that current ly exists . Our proposals would

grea t ly augm ent th e qua l ity of tha t care an d th e enforcem ent of

opt im al care s tan dard s. We propose en ha ncing the role of pu bl ic ,not-for-profi t LTC wh ich ha s been proven to provide bet ter serv-

i ce s a t l e s s o v e r a l l co s t . W e w a n t t o s e e i m p r o v e d w o r k i n g

condi t ions an d w ages for people working in the LTC system. The

d i gn i t y and r e spec t we wi sh f o r ou r pa r en t s and g r andpa r en t s

should be extended to th ose wh o provide care to them .

Our p r oposa l s wou l d a l so open new wi ndows o f dem ocr a t i c

disclosure in th e LTC system an d provide m ore publ ic accoun t-

abili ty and scrutiny.

Finally, the a vailability of inform ation on t h e sector th at is t im ely

an d comp lete is lackin g. Bui lding and m ainta ining an effect ive

long-term care system requ ires rel iable nat iona l informa tion onth e sector . Were call ing on al l levels of governm en t to do a m uch

bet ter job of gath er ing and providing system atic informa tion about

th e sector. Anothe r chal len ge we faced at th e t im e of wri t ing this

report was that several provinces were in the process of review-

ing and a m en ding the exist ing legislat ive fram ework for the sector .

We are com m it ted to up dat ing th i s repor t as n ew inform at ion i s

made avai lable.

This i s a s t ruggle about demons t ra t ing our endur ing commit -

m en t to hu m an digni ty. NUPGE is com m it ted to work t i relessly

toward tha t goa l .

Precious t ime is s lipping awa y. We m ust act now.

Jam es Clan cy

National President

Summary

This is a

struggle

about our

enduring

commitment

to human

dignity.


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Overview

Definitions Involving LTC Facilities

There i s a comp lex sys tem in Cana da to provide cont inuing care

to seniors . I t has been cal led a patchwork qui l t which contains

m an y incons i s tenc ies an d ineq ui t ies for the e lder ly people i t i s

in ten ded to serve . The sys tem inc ludes :

Home Care

Refers to a range of program s des igned to m ain ta in or imp rove

the hea l th and fun c t ioning of fra il seniors an d p eople wi th d i s -

a b i li t ie s . P ro g r a m s i n c l u d e : h o m e s u p p o r t , a s s i s t e d l i vi n g ,

res ident ia l care and o ther communi ty-based serv ices .

Retirement Homes

Offer meals , housekeeping and basic care services, usual ly for

an expens ive mon thly rent . They are a lmos t a l l p r iva te ly own ed

and are not requi red by governm ents to provide a m inim um leve l

of m edical care. They receive no pu bl ic fund ing.

Assisted Living Centres

Offer sup port ive hous ing and h om e care services. The inten t is

to provide the frai l e lder ly with a safe and affordable home-l ike

se t t ing tha t g ives them m ore cont ro l over pr iva te space an d en a-

b l e s t hem t o m a i n t a i n t he i r c apac i t y f o r s e l f - ca r e a s m uch a s

possible. Residen ts us ua l ly choose from a m en u of services, in-

clud ing mea ls , h ouseke eping an d person al support services. Public

hom e care program s m ay insu re some of the serv ices , but o thers

m ust be pu rchased out -of-pocket f rom the pr iva te sec tor. These

centres of ten operate as unl icensed and unregulated LTC faci l i -

t ies that offer expensive services.

LTC FacilitiesAre know n by var ious n am es in differen t Can adian p rovinces

an d te r r i tor ies . The y ma y be ca l led n urs ing hom es , res ident ia l

care facil it ies , special care hom es, cont inu ing care centres or per-

sona l c a r e hom es . They p r ov ide accom m oda t ion , bu t t h ey a l so

offer on-si te personal support and heal th care services. Most of-


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t en a person enters a LTC fac i l i ty on the recommendat ion of a

docto r or so cial service agen cy. The facili t ies a re p rovincially regu-

la ted , rece ive some governm ent fund ing an d, in m an y ins tan ces ,

act as chronic-care hospi tals .

This pa per ide n t i fies th em as lon g-term care (LTC) facil it ies .

They a r e t he f ocus o f ou r a t t en t i on he r e because o f t he g r ea t

need f o r r e s ea r ch , po l i cy and ac t i on t o enhance t he l i ve s and

m ainta in th e d igni ty of f rai l e lder ly sen ior cit izens.

The Demographic Challenge

Popu lat ion aging is one of th e m ost s t r iking dem ograph ic t ren ds

in th e wor ld today and Can ada i s no except ion . We are approach-

ing a m ajor t ipping point th at w ill ha ve profound effects on ou rcount ry and on u s as indiv idua ls .

Baby boom ers (people born be tween 1946 and 1964) a re

the m ost popu lous gene rat ion in Can adian h is tory. Those

born in 1946 will officially becom e se n iors in 2011 an d

m any of them are a l ready m oving in to re t irem ent .

Sen i or s com pr i sed 7% o f t he popu l a t ion wh en h osp i-

talization w as introd uced in Can ada in th e 1950s. In 2004,

t hey wer e 13% o f t he popu l a t i on , and i n 2031 t ha t

nu m ber wil l r ise to app roxim ately 25%.1

Can adian s are l iving longer . Life expectan cy, at age 65

years , is n ow 83 years overal l : 79.5 years for m en an d

85.3 years for wom en .2 People aged 80 and over are th e

fastest growing age group in th e coun try.

In 2004, there were 324,800 Cana dians aged 85 years or

over, more than double the nu m ber in 1981 and a lm os t

20 t im es th e n um ber in 1921.3

The percentage of o lder Can adians wh o live in LTC in-

s t itu t ions ha s been dec lin ing , ye t the absolu te n um ber

is growing. In 2002, there were 157,500 beds in LTC fa-

ci l i t ies throughout Canada.4

Es t im ates a re tha t be tween 560,000 and 740,000 seniors

w ill live in LTC facilities by th e ye ar 2031.5

The hea l th ca re needs o f t he f ra il e lde r ly a r e becom i ng

m o r e c o m p l e x . Al z h e i m e r s d i s e a s e a n d r e l a t e d

We are

fast

approaching

a major

tipping

point


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dem en tias affect 364,000 Canad ians over th e age of 65,

and these nu m bers a re pro jected to increase to 750,000

by 2031.6

More than 28% of Can adas seniors in 2001 were peo-

ple who ar r ived h ere as imm igrants .7 In Toron to, 43%

of those on wai t ing l is ts for LTC spaces do not have

En glish a s th eir fi rs t lan guage.8

An e s t im a t ed 700 ,000 wor k ing Canad i ans t oday ex is t

in what is cal led the sandwich generat ion. These in-

formal caregivers , mos t of them women, a re ra i s ing

their own chi ldren while car ing for elder ly parents or

relatives.9 This p laces a grea t burden upon them and

th eir fam ilies .

Overview


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I grow old . . .

I grow old . . .

I shall wear

the bottoms

of mytrousers

rolled.

T. S. Eliot


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CANADAS HEALTH care syste m is m uch ad m ired th rou ghou t th e

world. The or iginal legis lat ion surrounding hospi tal and medical

care insurance a t t empted to ensure tha t every Canadian had ac-

cess to m edical ly n ecessary services re gardless of abi li ty to pa y.

Bu t we a r e abandon i ng t h is vaun t ed com m it m en t wh en i t com es

to LTC for ou r frail and elderly citizen s.

LTC & Public Health Care

Cana dian p rovinces and te r r itor ies a re respons ib le for the ad-

minis t ra t ion and de l ivery of hea l th care serv ices , but universa l

access is a federal concern. For that reason Ottawa agreed, his-

tor ical ly, to return an a m oun t to provin ces and t err i tor ies equ al

to one-h alf of th e costs of pu bl icly adm inistered h eal th care. 10

Saskatchewa n Prem ier Tomm y Douglas , wh ose governm ent fir s t

in t roduced publ ic hospi ta l and m edica l care insu rance , saw those

as f i r s t s t eps t aken toward improving the genera l hea l th of the

popu lat ion. Em m ett Hal l, th e jud ge whos e royal com m ission rec-

o m m e n d e d S a s k a t c h e w a n s m e d i c a r e m o d e l f o r t h e n a t i o n ,conceived of pu bl ic hea l th care in broad term s tha t includ ed, for

exam ple , publ ic pharm acare and optom et ry program s.

Over the years the def in i t ion of hea l th h as been broadened to

inc lude hea lth p romot ion an d d i sease prevent ion as wel l as t rea t -

m en t , but few people real ize how n arrowly the pr inciples out l ine d

i n t he Canada Hea l t h Ac t a r e app l i ed . The Ac t s m os t s e r i ous

l im itat ion is th at i t covers only physician an d h ospi tal services.

Home care , long- te rm care and pharmacare a re not covered un-

der the Act . Provinces and te r r i tor ies a re f ree to develop the i r

own systems and insurance for these services, but LTC is not a

fully insu red s ervice in an y Canad ian p rovince or terr i tory.11

The sys tem tha t has developed i s a bewi lder ing pa tchwork of

p lans an d p olic ies , wi th wide var ia t ions in the nu m ber of spaces

avai lable, th e len gth of t ime p eople have to wa i t an d th e range of

fees at tach ed. This m ean s tha t the a vai labi li ty, cost an d qu al ity

of LTC depe nd s to a great exten t up on w he re people live in Can ada .

Accessibility& Affordability


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Beyond that regional quest ion exists another one of individual

means. There are s ignif icant differences between services within

LTC facil it ies tha t are covered by th e p ubl ic pu rse, and thos e for

wh ich individu als are forced to pay ou t-of-pocket . Those costs are

a barr ier to ci t izen s of low or even m odest incom es.

Throughout th e 1990s , governm ents across Can ada dec ided to

s lash fun ding on a wide ran ge of soc ia l program s. In th e 1995

budge t , t he f ede r a l f i nance m i n i s t e r r educed ca sh t r ans f e r s t o

the provinces by 40% over th e following tw o years . The m inister

announced t ha t by 1996- 97 p r og r am spend i ng wou l d be l ower

(relat ive to the s ize of th e econom y) th an at a ny t im e since 1951

an era in wh ich p ubl ic , un iversal heal th care d id not even exist .12

Som e province s, nota bly Onta rio, Alberta , and later British Co-

lum bia, seized on th e pu bl ics concern about d ef icits as an excuse

not on ly to cut back on h eal th an d social spen ding, but also to pr i -vatize services, including LTC facilities.

Provinces sh i f t ed de l ivery away f rom acute and chronic care

hosp i t a l s and i n t o com m uni t y s e t t i ngs . Pa t i en t s we r e a l l owed

less t im e to recover in hosp i ta l on th e expec ta t ion th ey would

r ece i ve hom e ca r e s e r v i ce s , bu t som e o f t hose p r og r am s wer e

a l so cut back , and o th er prom ised programs were n ever crea ted .

In addi t ion, a few provinces, such as Alberta and BC, s tar ted

talking sooth ingly about em ulat ing th e Ame rican Assis ted Living

m ode l. These p r ov inces began pa r t n e r ing w i th deve lope r s an d

rea l tors to promote Ass i s ted Liv ing as a res ident ia l opt ion tha t

fa l ls be t ween ind epen den t l iv ing an d ca r e i n a l ong - t e rm ca r efac i l i ty . The or ig ina l model represented a new and progress ive

approach to meet the needs of spec ia l popula t ions wi th l imi ted

abi li t ies . It ad vocated for a h om e-like set t ing th at gives residents

cont rol over th eir pr ivate sp ace, offer ing a com binat ion of safe

and s ecu r e hou s ing , ho t e l -t ype s e r v ice s such a s r egu l a r m ea l s

and hou sekeeping , nurs ing care and he lp wi th p ersonal care . Both

t he hous i ng and hea l t h ca r e suppor t s wou l d be heav i l y subs i -

d ized by publ ic funding in order to ensure i t was an a f fordable

and access ib le opt ion for as m any a s poss ib le .

However , s ince i ts incep t ion, Assis ted Living ha s bran ched out

i n m any l e s s - t han - au t hen t i c d i r ec t i ons i n t he US and Canada .

The te rm i s now appl ied to hous ing s i tua t ions and care models

th a t d o n ot em body th e or igina l ph i losoph y. Regre t tab ly, som e

provinces , l ike Alber ta , wh i le t a lk ing a bout in ves tm ent s in As-

s i s ted Liv ing cent res sur rept i t ious ly wi thdrew funding and cut

direct care st affin g levels from lon g-term residen tial care. Toda y,

Assis ted Living is m ore l ikely to refer to m ult i -uni t ap ar tm en ts

Politicians

and policy

makers have

largely

neglected

reform of the

LTC sector


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with vary ing am oun ts of on-s it e persona l suppor t s an d care ava i l-

a b l e 2 4 - h o u r s - a - d a y , a l l o f w h i c h m u s t b e p u r c h a s e d b y t h e

resident at a he f ty pr ice. The or igina l vis ion h as been largely co-

o p t e d b y c o m m e r c i a l o p e r a t o r s l o o k i n g f o r a h i g h r e t u r n o n

inves tm ent s . According to the Alber ta Chapt er of the Consu m -

ers Association Canada, the reality of Assisted Living in Alberta

is a cr is is in a ccess , costs , fun ding an d a ccoun tabi li ty.

The 1995 f ede r a l budge t a l so changed t he m anne r i n wh i ch

Ot tawa t ransfer red hea l th care money to provinces and te r r i to-

r ies . The Canad a Heal th an d Social Tran sfer (CHST) replaced th e

sepa r a t e , t a r ge t ed t r ans f e r s t ha t had ex i s t ed f o r hea l t h , pos t -

secondary educa t ion and soc ia l programs.13

Af t e r m a k i n g d e e p c u t s t o h e a l t h t r a n s f e r s in t h e 1 99 0s ,

Ot tawa was convinced to use some of i t s burgeoning surp luses

to restore fund ing. In h is 2002 report , he al th care com m issione rRoy Romanow ca l led on the federa l government to increase i t s

funding to the equiva lent of 25% of to ta l provinc ia l - t e r r i tor ia l

s p e n d i n g , a m i n i m u m a m o u n t l o n g d e m a n d e d b y h e a l t h c a r e

advocates . Federa l -provinc ia l agreements have resul ted in fed-

e r a l fun d i ng inc r ea se s t h a t sh ou l d m ee t t hose t a r ge t s . Bu t t h e

discussion of pu bl ic heal th care by var ious governm en t comm is-

s ions ha s been dom inated by the n eeds of the acute care sys tem.

Reform of the LTC sector h as largely been ne glected . Regretta bly,

the Romanow repor t , and the Ki rby repor t before i t , sa id l i t t l e

an d r ecom m end ed l e s s r ega r d i ng LTC.

The 2003 fun ding accord also return ed to th e pract ice of a de di-c a t e d t r a n s f e r p a y m e n t f o r h e a l t h c a r e . Bu t i t m a d e n o

an nou ncem en ts regarding LTC. Ottaw as h eal th care d ollars will

f low to the provinces without any target ing to LTC, or any com-

m it m e n t t h a t p r o v in c e s w i ll u s e n e w m o n e y t o im p r o ve t h e

accessibili ty and quality of LTC.14 Nor was there anyth ing in th e

agreemen t to prevent for -profit com pan ies f rom m aking fur ther

incursions into LTC, and the heal th care sector in general .15

Publicly del ivered care h as p roven to be m ore affordable th an

private care, but even th is opt ion h as becom e too cost ly for m an y

seniors . The issues of affordabi l i ty and accessibi l i ty are closely

related. The re are n ot enou gh LTC spaces a vai lable, an d th e spa ces

tha t do exi s t com e a t a pr ice tha t l im it s access for m an y people .

The lack of affordable LTC erodes the values of equal i ty and

fa i rness tha t a re en t renched in both the Canada Heal th Act and

the Char te r of Rights and Freedoms. Canadians have a r ight to

heal th care as an extension of two sect ions of the Charter . Sec-

t ion 7 guarantees the r ight to l i f e , l iber ty and secur i ty of the

person . Sect ion 15 gua ran tees t ha t every ind ividual is equ al be-

The right to

life, liberty

and security

of the person

Accessibility & Affordability


19/52

Dignity Denied

18

fore and u nder th e l aw and has th e r ight to the equ al pro tec t ion

and equa l bene f i t o f t he l aw wi t hou t d i s c r i m i na t i on based on

race, na tiona l or eth n ic origin , colour, religion , sex, age or m en tal

or physical disability.

Desp i t e a t t em pt s m ade t o p r even t and f o r e s t a l l i l l ne s s , and

effor t s to m ain ta in e lder ly people in the i r own hom es for as long

as possible, a percen tage of sen iors will a lways n eed m ore sup-

port than their famil ies or home care services can provide. Many

of the elderly, inevitably, will need LTC facilities. It is crucial that

the serv ice be ava ilab le to them and tha t a l l Cana dians sh are the

f in an cial burden with th e frail e lder ly and th eir fam ilies .

Personal Costs of LTC

There i s a broad consensu s th a t res idents sh ould , f inan ces per-

m it t ing, contr ibute a p ort ion of th e cost of their LTC. They do s o

by paying a m ont hly fee. In a ddi t ion, provincial governm en ts an d

territories provide license d LTC facili t ies w ith a pe r diem su bsidy

for each resident . There are several policy m odels used by prov-

inces a nd te r r itor ies concerning m onth ly charges to res idents .16

Per diem-based model (Alberta, Yukon Territory, Nunavut Territory)

A per d iem ra te is se t based on publ ic pens ion incom es ava i l-

ab le to ind iv idua ls . Res iden ts a re not subject to a m ean s t es t .

Income-based model (BC, Saskatchewan, Manitoba, Ontario)

I nd i v i dua l s pay a pe r d i em r a t e wh i ch i s ad j us t ed t o ac t ua l

incom e . The r e is a m ean s t e s t bu t i t does no t ap p l y t o fam il y

a s s e t s .

Income/asset-based model (Quebec & Atlantic provinces)

In these provinces , charges to indiv idual s a re based not only

on i ncom e bu t a l so on a s se t s . Be f o r e be i ng adm i t t ed , an i nd i -

vidu al m ust l iquidate a p ercen tage of the fam ilys assets , includ ing

sav i ngs and i nves t m en t s . I n som e ca se s t ha t i nc l udes som e o r

al l of the value of th e fam ily hom e. This pol icy can im poverish

fami l ies wi th modes t incomes , of ten l eaving a spouse who may

not be in a LTC facili ty with very few resources. 17

The charges to res iden ts for s t anda rd accomm odat ion in p ub-

licly-su pp orted LTC inst itution s as of May 2006 ranged from t h e

Yukon Territorys $540 a m on th ($6,480 per yea r) to $3,960 a m on th

in PEI ($47,520 per year).18 These charges applied to th e m inimu m

level of accom m odat ion as de f ine d in each province, wh ich m ay


20/52

19

mean two or more res idents shar ing a room. The charges for a

sem i-pr ivate or pr ivate accom m odat ion were considerably higher .

The rat es in pu blic, not-for-profit LTC facili t ies a re alm ost a l-

ways lower than those charged in for-prof i t faci l i t ies . In Bri t ish

Colum bia, for exam ple, the cost of care in a for-profit facili ty ranged

from an aver age of $44,000 per year t o a h igh o f $67,000.19 In On-

tar io, the average rate for a space in a for-prof i t faci l i ty ranged

from $43,650 to $55,884 pe r year, with s om e exce ed ing $80,000 pe r

year.20 In Alberta, private ca re can cost w ell over $60,000 a ye ar.21

All provinces an d terr i tor ies claim to h ave m echa nism s in p lace

to ensure anyone who requires long-term care wil l receive i t , re-

ga r d l e s s o f ab i li t y t o pay . Th i s m ay be t r ue , bu t t h e w a i t f o r

s tandard accommodat ion can be a long one . And once ins ta l l ed

in a long-te rm care facility, sen iors m ay discover a cost ly list of

services th ey are exp ected to p ay for out-of-pocket . They are u su-a l ly forced to turn over a ll the i r incom e for accom m odat ion an d

care, with t he excep t ion of a pa l t ry person al care allowan ce, wh ich

varies from $88 to just over $200 per m ont h. 22

Monthly Charges to Residents in LTC Facilities in May 2006


Adapted f rom Canad ian Hea l thca re Assoc ia t ion ,

Charges to Residents in Facility-Based Long-Term Care by Province/Territory, May 2006

Province\Territory Minimum MonthlyAccommodation

Rates

Maximum Monthly

Accommodation

Rates

One Charge for

all Residents

British Columbia $864 $2076

Alberta $1188

Saskatchewan $911 $1727

Manitoba $825 $1938

Ontario $862 $1480

Quebec $949 (3 in room) $1277 (2 in room)

Nova Scotia NA $2235

New Brunswick NA $2370

Prince Edward Island $3555 $3960

Newfoundland $2800

Yukon Territory $540 $630

NWT $712

Nunavut Territory NA NA

Combined monthly

OAS\GIS payments

$1079 $1079 $1079


21/52

Dignity Denied

20

Accessibility & Low Income

Alm ost a l l Cana dian s over th e age of 65 rece ive an Old Age

Secur i ty (OAS) ben ef it o f $485 per m ont h . In add i t ion , se n iorswi t h l ow i ncom es a r e e l ig ib le f o r a Gua r a n t e ed I ncom e Supp l e -

m en t (GIS). It i s m ean s - t e s t ed an d t h e m ax i m u m payab l e is $594

pe r m on t h f or a s i ng le s en i or.23

Com bined income f rom OAS and GIS is abou t $1 ,079 per m onth ,

o r $12,948 pe r yea r . Som e p r ov i nce s an d t e r r i t o r ie s u se t h i s

am oun t a s a ba s i s f or t he i r pe r d i em o r m on t h l y cha r ges t o LTC

res iden ts . As of May 2006, cha rges to res iden ts for s t an dard ac-

com m oda t ion in LTC fac il it i es var ied f rom $540 to $3 ,960 per

m ont h . For seniors wh o re ly on pu bl ic pen s ions of $1 ,079 per

m on t h , t he se a r e cos t l y and o f t en i nacces s i b l e op t i ons .

About 35% of seniors rece ived the GIS in 2003.24

This indi -c a t e s t h e y w e r e e i t h e r l i v i n g b e l o w o r j u s t a b o v e a m e a s u r e

th a t i s ca l l ed th e Low In com e Cut -Off (LICO), a m eas ure m en t

used by r e sea r che r s an d po l icy ana l ys t s a s an ind i ca t o r o f e co -

no m ic vulne rabi l ity.

In 2003, close to 7% of a l l Cana dian sen iors lived be low t h a t

Low I ncom e Cu t - Of f . Sen i o r s wi t h l ow i ncom es wer e concen -

t ra te d in cer ta in grou ps , in c lud ing e lder ly v is ib le m inor i t i es and

i m m i gr an t s , and s en i o r s wi t hou t pa r t n e r s . In 2003, 17 .7% o f

u n a t t a c h e d s e n i o rs a n d 1 8 .9 % o f u n a t t a c h e d fe m a l e s e n i or s

fe ll be low th e LICO. In n um er ica l t e rm s , 258,000 sen iors we re

l iv ing be low the a f te r - t ax LICO in 2003, and 154,000 of them

w e r e u n a t t a ch e d w o m e n . 25

Anoth er 19% of seniors in 2001-04 had pre- ta x in com es jus t

s l ight ly above th e LICO. They l ive in n ear pover ty , but m os t of ten

t hey can no t ga i n acces s t o t he ben e f it s o f va r ious i ncom e- t e s t ed

p r o gr a m s a n d t h e y m u s t g e t b y o n e x t r e m e l y t ig h t b u d g e t s .26

Percentage of Seniors with Low After-Tax Income, Canada 2003

Both sexes Men WomenAll seniors 6.8% 4.4% 8.7%

Unattached seniors 17.7% 14.7% 18.9%

So u rce : Sta t i s t ics Can ad a , 2 0 05

All of th ese in div idu al s a re forced , to th e l im i t of th e i r m ea-

g r e r e s o u r c e s , t o p a y f o r t h e c r u s h i n g e x p e n s e s t h a t c a n b e

ass oc ia ted w i th LTC. Saska tch ewa n , for exam ple , i s one of th e

less expens ive provinces for LTC. But a res ident there in 2005


22/52

21

pa i d $875 fo r s t an da r d accom m oda t i on p l us 50% o f t ha t po r -

t i on o f t he i r i ncom e be t ween $1 ,057 and $2 ,621 . Fo r a s en i o r

wi t h a m on t h l y i ncom e o f $2 ,621 t ha t m ean t pay i ng t he ba s i c

cha r ge , p l u s an ex t r a $600 pe r m on t h ( f o r a m ax i m um cha r ge

of $1 ,657). This am oun t d id n ot cover an a r ra y of out -of -pocket

expenses , i nc l ud i ng p r e sc r i p t i on d r ugs , i ncon t i nence supp l i e s

a n d p e r s o n a l it e m s .27

The cha r ges t o ind iv idua ls va r y g rea t l y depend ing up on w he r e

t hey l ive . Som e p r ov i nces an d t e r r it o r ie s p ay f o r t he cos t o f p r e -

s c r ip t i on d r ugs . Ot he r s h ave an i ncom e t e s t ed d r ug p l an , wh i ch

can ha ve t h e e f fec t o f d r am a t i ca l ly i nc r ea s i ng t he r e s i den t s ou t -

of-pocket cos t s . Some jur isd ic t ions a l so cha rge for a var ie ty of

m edica l sup pl ies , wh eelcha i r s , p ros th e t ic devices , even incon -

t i n e n c e s u p p l i e s , n o t t o m e n t i o n l a u n d r y , h o u s e k e e p i n g ,

p e r s o n a l c a r e a n d t r a n s p o r t a t io n .In s o m e c a s e s t h e o u t - o f -p o c k e t c o n t r i b u t i on g o e s f a r b e -

yond t h a t . The Toronto Star r e p o rt e d t h a t a n in c r e a s in g n u m b e r

o f f a m i l i e s a r e h i r i n g p r i v a t e a t t e n d a n t s t o s u p p l e m e n t t h e

care th e i r fam i ly m em ber i s re ce iv ing in a LTC fac il ity . The Star

r epo r t e d e xam pl e s o f f am i li e s spen d i ng $25,000 t o $30 ,000 a

yea r f o r a bed , and ano t he r $40 ,000 a yea r f o r a p r i va t e ca r e

a t t en dan t wh o pe r f o rm s t a sks t h e f ac il it y won t do o r doesn t

pe r f o r m ad equ a t e l y, i nc l ud i ng wa l k in g , f eed i ng , ba t h i ng and

help ing f ra i l seniors go to the to i l e t . 28

Wh at f ina nc i a l bu r den shou ld w e expec t t h e f r a il e lde r l y t o

bear? Th ey do n ot ch oose to en ter a LTC fac il ity on a wh im. Al lapp l ican t s a r e a s s e s sed a nd LTC i s a ll oca t ed based on a need fo r

th a t l eve l of se rv ice .

It i s gen era l ly accepted th a t , incom e perm i t t ing , seniors shou ld

pay for a pa r t of th e i r LTC becau se th e fac i li ty is a l so th e i r res i -

den ce . But th ese ind ividual s a re u su a l ly chron ica l ly il l an d th ey

a l so need hea l t h ca r e . Ye t t he ch a r ges i n p l ace ac r os s Can ada

go f a r beyond t he r ea sonab l e cos t s o f a ccom m oda t i on .

The i rony an d t he i n j u s t i c e i s t ha t s e r v ice s un de r t he Cana da

Hea l t h Ac t a r e no t sub j ec t t o m eans o r a s se t t e s t s .

If a fra i l an d e lder ly person rece ives m edica l ly neces sary serv-

ices in a h ospi ta l , th ose a re p rovided f rom th e pu bl ic purse . Yet

t he s am e pe r son r ece i v i ng e s sen t i a l l y t he s am e s e r v i ce s i n a

LTC fac i li ty i s of ten expe c ted to p ay for i t ou t -of -pocket .

T h i s c a n i n v o l v e a m e a n s t e s t a n d , i n s o m e p r o v i n c e s , a n

as se t t e s t a s we l l .

This d i scr im ina te s aga ins t t h e f ra il e lder ly.

Charges go

far beyond

any

reasonable

costs



23/52

Dignity Denied

22

Funding Formula Inadequate

Licensed LTC faci l i t ies , both not-for-prof i t and for-prof i t , re-

c e i v e a p e r d i e m s u b s i d y f r o m p r o v i n c i a l g o v e r n m e n t s o rte r r i tor ies for each res iden t . For exam ple , the pe r d i em i n On-

t a r i o a s a t M a r c h 3 1 , 2 0 02 w a s $ 1 0 2. 32 . T h a t a m o u n t w a s

com p r is ed o f t he f ol lowi ng com pon en t s :

$ 52 .3 8 fo r n u r s in g a n d p e r s o n a l c a re ;

$ 5.2 4 fo r p r og ra m m in g a n d s u p p o r t s e r vic e s ; a n d

$ 44 .7 0 fo r a c c om m o d a t io n (in c l u d in g a r a w f o o d a m o u n t o f

$4.49 per da y). 29

Per Diem Rates for Ontario Residents, October 1, 2001

So u rce : Ownership Matters: Lessons from Ontarios Long-Term Care Facilities,

Onta r io Hea lth Coali t ion , 2002

T h i s p e r d i e m i s f a r t o o l o w . A n o b v i o u s e x a m p l e i s t h e

i m poss i b i l i t y o f p r ov i d i ng nu t r i t i ous m ea l s on a f ood a l l ow-

ance o f $4 .49 pe r day , an am oun t t ha t ha s i nc r ea sed by on l y

23 cen t s pe r day i n t he p r ev i ous decade . 30

Nor do p r ov i nc i a l- t e r r i t o r ia l fun d i ng f o rm ul a s ad equ a t e l y

t a k e in t o a c c o u n t u n iq u e a n d c h a n g in g c a r e n e e d s . Th e

Nursing and Personal Care $52.38

Programming and Support Services $5.24

Accommodation(Including the "raw food" amount of

$4.49 per day)

$44.70

Total $102.32


24/52

23


n u m b e r o f r e s i d e n t s w i t h d e m e n t i a a n d A l z h e i m e r s , f o r e x -

a m p le , is n o t a d e q u a t e ly c o n s id e r e d w h e n d e t e r m i n i n g fu n d i n g

l eve l s . Res i den t s w i t h dem en t i a r e la t ed i l lne s se s m ake up an

increas ing par t of the LTC popula t ion and requi re h igher s ta f f -

ing leve l s , m ore in ten s ive care an d spe c ia l ly t ra ined s t a f f .

LTC f ac il it i e s o ft en a t t em pt t o m ake u p t h e d i ff e r ence be -

t w e e n t h e p r o v i n c i a l s u b s i d y a n d t h e i r c o s t s b y i n c r e a s i n g

a c c o m m o d a t i o n r a t e s . G o v e r n m e n t s , t h r o u g h u n d e r f u n d i n g ,

ha ve i n e f fec t sh i f t ed cos t s t o r e s iden t s an d t h e i r fam i li e s .

Th i s i s e spec i a l ly a p r ob l em i n p r ov i nces w h e r e f o r - p r o fi t

f ac il it i e s dom i na t e t h e s ec t o r . LTCs a r e ope r a t ed by a m i x o f

p r ov ide r s t ha t i nc l ude r e li gi ous i n s t i t u t i ons , p r ov inc i a l o r m u-

nic ipa l governm en ts , reg ional hea l th boa rds an d , increa s ingly,

by la rge corpora t ions .

For ex am ple, in On tar io 52% of pu bl icly fun de d LTC faci li t iesare for -prof it , as com pa red w i th 15% in Mani toba . 31 If for-p rofit

an d n o t - f o r - p r o fi t fa c i li t ie s r ece i ve t h e s a m e p r ov i nc i a l gov-

e r n m e n t s u b s i d y , c o r p o r a t e p r o f i t s m u s t b e s q u e e z e d o u t o f

t h e m o n i e s in t e n d e d f o r a c co m m o d a t io n , fo o d a n d c a r e .

For-Profit and Not-For-Profit Ownership:

LTC Comparison Across Jurisdictions

Province Public/Not-for-profit*

Private for-profit

British Columbia 68.3% 31.7%

Saskatchewan 96.2% 5.8%

Manitoba 84% 15%

Ontario 48.4% 51.6%

New Brunswick 100% 0%

Nova Scotia 72% 28%

*P u b li c / n o t - f or - p r o fi t i n c l u d e s p r o v i n c ia l a n d m u n i c ip a l g o ve r n m e n t LT Cfac i li t i e s an d f ac i l it i e s p ro v id ed b y n o t - fo r -p ro fi t so c ie t ies . So u rce : OwnershipMatters:Lessons from Ontarios Long-Term Care Facilities, On tar io Hea l th Co a l i t io n ,2002


25/52

Dignity Denied

24

Som e for -prof i t f ac il it i es ha ve a l so been p erm i t ted to se t as ide

a n u m b e r o f p r i v a t e s p a c e s f o r w e a l t h i e r r e s i d e n t s w h o c a n

a f fo r d t o pa y h i ghe r f ee s fo r p r i va t e accom m oda t i on .

Th i s p r ac t i ce r e i n f o r ce s a sys t em i n wh i ch a cces s i b il it y i sbased on ab i l i t y t o pay r a t he r t han need . When spaces a r e r e -

s e r ved f o r wea l t h i e r c l i en t s , t he wa i t i ng l i s t s g r ow f o r t hose

sen i o r s who can t a f f o r d t he p r i va t e accom m oda t i on r a t e s .

S o m e g o v e r n m e n t s , s u c h a s O n t a r i o , h a v e a l s o r e d u c e d o r

e l im in a t e d im p o r t a n t r e g u la t io n s , s u c h a s t h e m in i m u m

nu m ber o f nu r s ing hou r s t o be p r ovi ded each day , o r t he m i n i -

m u m n u m b e r o f r e s id e n t b a t h s p e r w e e k . In e ffe c t , c o s t s a r e

be ing sh i ft ed f r om t he pub l ic pu r se t o i nd i v idua l s in t he f or m

of a r edu ced qu a l it y o f ca r e .

Long Wait Times

Gover nm en t cu t backs and t he r educ t i on o f LTC spaces , e s -

p e c i a ll y in t h e m i d - t o- la t e 1 9 9 0s , o c cu r r e d a t a t i m e w h e n

w a i t i n g l i s t s w e r e a l r e a d y a p r o b l e m a n d a l a r g e n u m b e r o f

baby boom er s we r e m ov i ng t owar d r e t i r em en t .

It i s d i ff icu l t t o ga t he r p r ec i s e an d cu r r en t i n f o r m a t i on on

wa i t i ng l i s t s i n p r ov i nces and t e r r i t o r i e s . Macleans m a g a z i n e

a r r ived a t t h e f o ll owing w a i t ing l is t n um ber s i n t h e yea r 2000:

Ont ar io, 10,000; Bri t ish Colum bia, 7,000; Que bec, 3,000; Man i-

t oba , 1 ,100 . Wa i t i ng l i s t s i n New Br unswi ck , P r i nce Edwar d

I s l a n d a n d N e w f o u n d l a n d w e r e s m a l l e r , b o t h i n r e a l a n d p e r

cap i t a t e r m s . The i n f o r m a t i on was no t ava i lab l e fr om Al be r t a ,

S a s k a t c h e w a n a n d N o v a S c o t i a . 32

In 2003, The Ottawa Citizen repor te d th a t w ai t t ime s for LTC

spaces i n On t a r i o we r e app r oach i ng t wo yea r s .33 A signif ican t

nu m ber o f Can ad i an s a r e s ea r ch i ng fo r space in l ong - t e r m ca r e

fac il it i es . Thos e nu m bers w i ll inevi tab ly grow a s th e absolu t e

nu m ber o f fr a i l e l de r ly Can ad i an s g r ows i n t h e com i ng yea r s .

In 2002, there were 157,500 beds in LTC faci l i t ies throughout

C a n a d a .34 Est im ates a re th a t be tw een 560,000 and 740,000 sen-

iors wil l need LTC by the year 2031.35

T h i s i s a d a u n t i n g g a p a n d i t d e m a n d s l o n g - t e r m p l a n n i n ga n d in v e s t m e n t o n t h e p a r t o f go v er n m e n t s . T h e C a n a d i a n

Hea lt hca r e Assoc ia t i on h as conc l uded t h a t t he r e is an u r gen t

ne ed for in crease d fun ding for fac il ity-based long- te rm care in

a l m os t eve r y p r ov i nce .36

NUPGE agrees wholehear tedly .


26/52

25

Difficult Decisions

Wh en LTC spa ces do becom e ava i lab le , fam i lies a re forced to

m a k e a n i m m e d i a t e d e c i s io n o u t o f f e a r t h e b e d s w il l g o t osom eone e l s e in a f ew h our s . In som e j u r isd i c t ions , i f a f am i ly

r e f u s e s a s p a c e i n a s p e c i f i c f a c i l i t y , t h e y a r e m o v e d t o t h e

bo t t om o f t he w a i t li s t and i t m ay t ake m on t h s , pos s ib ly yea r s ,

be fo r e an o t he r sp ace becom es ava i lab l e .

S o m e f a m i l i e s a r e f o r c e d t o b o r r o w m o n e y t o p a y f o r t h e

ca r e t h e i r loved one s n eed . Those w ho can t a f fo r d t o bo r r ow

ar e f o r ced t o p r ov ide t h e ca r e t h em se l ves . Wh i le t h e ir l ove an d

c o m m i t m e n t a r e t o b e p r a i s e d , t h e e c o n o m i c c o n s e q u e n c e s

c a n b e d i s a s t r ou s . It c a n r e s u l t in s t r e s s a n d l o s t w o r k t i m e ,

i n c o m e a n d f u t u r e p e n s i o n b e n e f i t s o n t h e p a r t o f t h e p r o -

v i de r . I n som e ca se s , f am i l y m em ber s , m os t o f t en wom en , a r e

forced t o l eave th e i r jobs to care for loved on es .

Those frai l seniors who cant afford access to a LTC faci l i ty,

an d w ho d ont h ave i n f o rm a l fam i ly supp or t , w il l m os t o f t en

expe r i ence de t e r i o r a t ing h ea l t h . They w il l r equ i r e m or e expen -

s i ve i n t e r ven t i ons d own t he r oad , le ad i ng t o h i ghe r ove r a ll cos t s

fo r t h e h e a l th c a r e s ys t e m .

Ca n a d a , d e s p i t e i t s r e p u t a t i o n f o r c om p a s s i o n a t e s o c ia l

po l i cy , i s o f f e r i ng LTC t ha t pa r a l l e l s wha t t he Un i t ed S t a t e s

o f f e r s f o r hea l t h ca r e i n gene r a l : a m i x o f pub l i c and p r i va t e

paym en t and de l i ve r y i n s t ead o f a pub l i c l y adm i n i s t e r ed , s i n -

g le-payer , un iversa l sys tem .

N UPGE b e l ie v e s t h a t c o m p r e h e n s i ve n e s s , c om p a s s i o n a n dcom m un it y, t he va l ues up on w h i ch ou r pu b li c hea l t h ca r e sys -

t em i s bu i l t , m us t be ex t ended t o t he way we p r ov i de ca r e f o r

th e e lder ly.

Political & Corporate Cronyism

The LTC sec tor h as a long h i s tory of com pas s iona t e involve-

m en t by com m un i t y an d r e l ig ious g r oups an d t h e pub l ic s ec t o r.

Bu t r ecen t l y , i n s eve r a l p r ov i nces such a s BC and On t a r i o , i t

ha s becom e i nc r ea s i ng ly p r o fit - o r ien t ed , and t he co r po r a t e s ec -tor i s cons ol ida t ing q uickly.

In Br it i sh Co lum bia t h e gove r nm en t o f Gor don Cam pbe l l em -

ba r ked on a m uch - t ou t e d r en ew a l o f LTC i n t ha t p r ov ince .

But m os t of the LTC beds op en ed be tw een 2001 and 2004 were

in the expens ive for -prof i t sec tor .



27/52

Dignity Denied

26

The Consu m ers Associat ion of Cana da (CAC) stu died LTC in

Albertas 17 regional heal th authori t ies in 2002. Alberta drast i -

ca lly reduced the nu m ber of acute care h ospi ta l beds in th e 1990s .

Private real estate developers picked up the gap in service pro-

viding ass isted livin g facili t ies w ith varyin g am ou n ts of on-site

personal supports and care, al l for a hef ty pr ice. The CAC report

described LTC care for Albertas seniors as being costly and in-

accessible.37

The growth of the pr ivate LTC sector h as bee n dr iven by pol it i -

ca l and co r po r a t e c r ony i sm , and nowher e ha s t he r e l a t i onsh i p

been cozier th an in Ontar io. The Mike Harr is governm en t decided

in 1998 to respond to growing waiting lists for LTC. The govern-

m e n t a n n o u n c e d t h a t m o r e t h a n $ 1 b illio n w o u ld b e s p e n t t o

c r e a t e 2 0 , 0 0 0 n e w s p a c e s b y 2 0 0 4 . W h e n t h e c o n t r a c t s w e r e

awarded for cons t ruc t ion of beds , 67 .7% of them were handedover to the for-profit sector. Three gian t corpora tions , Exten dicare,

Leisureworld and Central Park Lodges, received 39.5% of the con-

t r a c t e d s p a c e s .38 The pu b li c was t o pa y fo r t he cons t r uc t ion o f

LTC facil it ies tha t w ill be own ed a nd operate d by corporat ions to

enr ich the i r shareh olders an d execut ives .

Extend icare ha s its Can adian h eadq uarters in Markham , Ontar io,

and counts among i t s d i rec tors former Libera l Senator Michae l

Kirby. He led a Sen ate inqu iry int o th e s ta te of Canad as h eal th care

system wh ich, not s urpr is ingly, recom m en ded a larger role for th e

private s ector.

The w eal thy Reichm an n fam ily own s Central Park Lodges. Theyha ve sold m ill ions of sh ares in th eir Ret i rem en t Residen ces Real

Estate Inves tm en t Trust (REITs) to e ager invest ors . The com pan y

has an aggress ive expans ion p lan , wh ich inc ludes the t akeover and

construct ion of new propert ies in Canada and the US. A subsidi-

a r y known a s Cen t r a l Ca r e Cor p . i s t he veh i c l e f o r new LTC

facilities.39 Form er Ont ario prem iers Bill Davis an d Ern ie Eves h ave

both been t rus tees for the corpora t ion .

Ontar io elect ion finan ce records ind icate th at betw een 1995 an d

1999 for-profit LTC com pa n ies don ate d over $336,000 to th e On-

tario Conservative Party.40 This does not inc lude th e thousa nds of

dol lars donated to the leadership campaigns of Ernie Eves, Tony

Cleme nt (now th e federal heal th m inister) an d Jim Flah erty (now

th e federa l f ina nce m inister).

Pol it ical an d corpora te cron yism is ha ving se vere imp licat ions

for elder ly Can adian s. Wh en al l costs are cons idered, care in th ese

facil it ies is s imp ly more expen sive th an in th e pu bl ic , not-for-profit

sector. And as we shall see, the quality of care in for-profit facili-

LTC

companies

donated over

$336,000 to

the Ontario

Conservative

Party


28/52

27

t ies is s imply not as good as that in the not-for-prof i t faci l i t ies .

These a re th e consequ ences of p lac ing corpora te greed ah ead of

ci t izen need.

For -prof it care , by it s very n a tu re , m ean s dra in ing of profi t s

o u t o f r e sid e n t c a r e a n d in t o t h e p o c k e t s o f o w n e r s a n d s h a r e -

ho l de r s . Canad i ans have r epea t ed l y i nd i ca t ed t hey don t wan t

t he i r hea l t h ca r e sys t em gove r ned by t he s am e m ar ke t f o r ce s

t ha t gove rn so ft wa r e d eve lope r s , c ab le com pan ie s an d f a s t f ood

c h a i n s .

A Better Way

Can ad i ans v iew ou r un i ve r sa l , pub l ic hea l t h ca r e sys t em wi t h

pr ide . We sh ould ap ply it beyon d h ospi ta l s an d doctors of fi cesto inc lude t h e serv ices provided t o vulne rable sen iors in LTC fa-

c il it i e s a s w e l l. Gove r nm en t s m us t beg in t ak i ng s t eps , t h r ough

exis t ing funding and l i cens ing levers , to pr iv i l ege publ ic , not -

f o r - p r o f i t f a c i l i t i e s , and i n so do i ng t o phase ou t co r po r a t e l y

own ed LTC faci l it ies .

T h e f ed e r a l g ov e rn m e n t m u s t e x p a n d t h e c o ve r a ge u n d e r t h e

Cana da Heal th Act to in c lud e LTC. It i s a m edica l ly ne cessary

se r v ice fo r t hou san ds o f s en i o r s and i nc lud i ng i t un de r t h e Act i s

an e s sen t i a l s t ep in t he evo lu t i on o f Can ada s pu b lic m ed i ca r e

s y s t e m .

Ot tawa m us t i n t r oduce a t a r ge t ed t r ans f e r t o p r ovinc i a l andter r i tor ia l governments for LTC l inked to the pr inc ip les of the

Canada Heal th Act .

Provincial and terr itor ial governm ents m ust increase pu blic fund-

ing for LTC to a level tha t en sures un iversal access .

Wait t imes a re un acceptably long. Provinces a nd terr i tories mu st

provide the fund s to create m ore pu blic, not-for-profi t faci li t ies a nd

spaces .

Provin cial and terr i tor ial governm en ts m ust a lso establ ish clear

guidel ine s to protect a gain st off- loading of pat ient s f rom a cute-

care h ospi tals to LTC facil it ies tha t m ay n ot h ave sp ace avai lable or

m ay be inad equa te ly s ta f fed to provide a ppropr ia te care .


We can ensure tha t access ib le and af fordable LTC i s equal ly

avai lable to everyone who needs i t .

Our pa r en t s , ou r g r andpa r en t s , ou r ag ing f r iends and ne i gh -

bours deserve no less .


29/52

Dignity Denied

28


30/52

29

Quality of Life,Quality of Care

IN APRIL 2005, 86-year-old Marie Geddes launched a hunger

s t r i ke t o p r o t e s t t he s t a f f i ng sho r t ages i n he r LTC f ac i l i t y i n

Cam r ose , Al be r t a . She s a i d t ha t s en i o r s t he r e had t o wa i t t oo

long for help with everything from going to the bathroom to get-

t ing bathed to going to bed.41

Ms. Gedd es, wh o wa s a d iabet ic, refuse d food for four d ays. She

becam e il l af ter breaking h er fast an d wa s placed in h ospi tal , wh ere

she d ied .42

Canaries in the Mine

Marie Geddes w as l ike a can ary in a coa l mine . Her dea th was

a w arn ing tha t l ife in long-term care is not he al thy. It s t ime w e

al l pa id a t t en t ion .

Lynda Johnson is someone who has. She vis i ted 100 of Alber-

tas LTC facilit ies. Her conclusion w as th at s taff didnt h ave en ough

t ime to g ive pa t ien t s the care they need .43 She presented a pe t i -

tion w ith 5,000 n am es to th e provincial legislatu re calling for higher

staff ing s tandards. Marie Geddes died just a few days later .Num erous oth er new s invest igat ions h ave chron icled a LTC sys-

tem in wh ich m an y e lderly res idents live in despera te s t ra it s w hi le

th eir fam ilies won t com plain for fear of ret r ibut ion. 44

The revelat ions included: seniors who were i l l or had broken

bones an d inadeq uate food an d f lu id in take for res iden ts a t r i sk

of n utr i t ional def icien cies . Subst an dard dietary pract ices include d:

syn t he t i c c r ys t a l s i n s t ead o f r ea l f r u i t j u i ce s , powder ed po t a -

t o e s a n d p r o ce s s e d v e g e t a b le s i n s t e a d o f fr e s h o n e s , s m a l le r

p o r t i o n s a n d , i n s o m e c a s e s , m i cr o w a v e d le ft o v e r a i rp l a n e

food.45

Government & Academic Reports

The va r i ous m ed i a inves t i ga t ions h ave been va l i da t ed by a

num ber o f gove rnm en t an d academ ic r epo rt s .


31/52

Dignity Denied

30

PriceWaterhouseCoopers

Pr icewaterhouseCoopers comple ted a repor t in 2001 pa id for

by the Ontar io governm en t . The project comp ared LTC in 11 jur is-d ic t ion s across Nor th Am er ica and Europe , in c lud ing Ont ar io ,

Saskatch ewa n, Manitoba, Michigan, Maine, South Dakota, Missis-

s i pp i, t he Ne t he r l and s an d Scand i nav i an coun t r ie s . The s t udy

concluded that Ontar io offered the lowest levels of professional

nu rs ing care a nd therapy leve ls am ong th e jur isd ict ions reviewed.

The stu dy foun d, for exam ple, tha t Onta rios LTC facilit ies pro-

vided 2.04 nursing hou rs per resident p er day, the lowest am ong

the jur isdict ions s tud ied. Saskatch ewa n, by contra st , provided 3.06

hours per day an d th e s ta te of Maine , 4.40 hours .46

Ontarios poor record of care exten ded to a lack of program s for

exercise, ph ysical reh abilitation se rvices an d coun seling for dep res-

s ion an d o ther men ta l hea lth problem s.

This neglect has ta ken i ts toll on the qu al ity of l ife and h eal th of

LTC residents. There is a convincing body of research indicating

tha t higher s taffing levels and th e provision of app ropriate thera -

p i e s a ll ow o l de r c it iz ens t o be m or e ac t ive , m or e i ndepen den t

and to remain hea l th ie r .

Provincial Auditor of Ontario

Ontarios Provincial Auditor reported on LTC facilities in 2002.

The repor t foun d there was n o evidence tha t the governm ent h ad

addressed the resul ts of the 2001 PricewaterhouseCoopers s tudy.

In fact , the Auditor Gen eral foun d th at a tea m ded icated solely tonu rs ing hom e insp ec t ions h ad ac tua l ly been d isband ed, and tha t

ann ual inspec t ions of hom es h ad dropped dram at ica l ly. The repor t

a l so found there was no way to ident i fy tha t provinc ia l monies

promised for seniors care were ac tua l ly be ing a l loca ted as in-

t e n d e d .

The Aud itors report conclud ed th at 68 nu rsing hom es with m ore

tha n 7,000 beds n eeded to be ent i rely ret rof it ted becau se th ey were

decrepi t . Faci l i t ies with a fur ther 9,000 beds were found to need

subs tan t ia l r enovat ions .47

Clinical Nutrition Studies

A 2003 study in Saskatoon showed that over half of LTC resi-

d e n t s a s s e s s e d w e r e a t le a s t m o d e r a t e ly m a ln o u r i s h e d .48 This

r e su l t i s s i m i l a r t o o t he r i n t e r na t i ona l s t ud i e s t ha t show t ha t

dehydra t ion an d m alnut r it ion a re becoming endem ic in the LTC

secto r, esp ecially in for-profit facili t ies.49

A team

dedicated

solely to

nursing home

inspections

had actually

been

disbanded


32/52

31

CUPE Survey of LTC Workers

A su rvey of mor e th an 900 LTC work ers com pleted in 2004 for

the Ontar io divis ion of the Canadian Union of Publ ic Employees(CUPE) concluded th at , Heavy workloads m ean th at th ere is not

enou gh t im e to com ple te t asks in a w ay tha t com pl ies wi th s tand -

ards . . .There is too much work and too l i t t le t ime to care. 50

Ownership Matters

D r . M i c h a e l R a c h l i s , a r e s p e c t e d C a n a d i a n h e a l t h c a r e r e -

searcher , i s one of a growing number of academics to f ind tha t

not-for-prof i t faci l i t ies provide bet ter LTC than for-prof i t busi-

ne s se s . Rach l is obse r ved i n 2001 t ha t t he r e was m uch r ecen t

rhe tor ic c la iming th a t in t rodu cing m ore pr iva te m arke t s in h ea l th

care f ina nce an d del ivery would lead to m ore efficient h eal th care.

The reality, Rachlis concluded, is exactly the opposite.

Rach l is pe r f o rm ed an ex t ens i ve exam i na t ion o f t he i n t e r na -

t ional research l iteratu re com paring th e perform an ce of for-profit

an d n ot-for-profi t cont inuing care organizat ions. Within h is s tudy,

Rach lis re viewed th e li teratu re for 39 LTC facili t ies.51 The follow-

ing are som e of h i s conclus ions :

Source: Dr. Michael Rachlis, The Hidden Costs of Privatization:

An International Comparison of Community Care

Quality of life / Quality of Care

For-Profit LTC providers

Impact of for-profit services on continuing care

Long-term Care Institutions Home Care Services

Health care costsGovernment costs reduced initiallythen may well increaseOverall costs increased

Health care costs

Government costs likely to be increasedOverall costs increased

Quality of care

Patient outcomes worseStaff turnover increased

Quality of care

Patient outcomes worsePatient/family satisfaction worseStaff turnover increased

Intangibles

Continuing education decreasedVolunteers decreasedCivil society decreased

Intangibles

Continuing education decreasedVolunteers decreasedCivil society decreased


33/52

Dignity Denied

32

Not-for-profit LTC providers

Not - for -prof it LTC ins t i tu t ions provided h igher or

equ al qu al ity of care. St ud ie s o f in f ra s t r uct u r e and env ir onm en t a l cha r-

acteristics all found in favour of not-for-profits.

Not -for -profit s had m ore s ta f f and provided h igher

salar ies and ben efits .

Not -for -profit s had lower s ta ff turnover ra tes .

Not-for-profi ts were less likely to be cited for def i-

cien cies th an for profi ts .

Not -for -profit s were m uch less like ly to use phys i-

ca l res tra in t s on res iden ts .

Ontar io not - for -profit s had h igher expendi tures per

res ident -day than for -profit h om es , spending m ore

on nu rs ing care but less on overa ll adm inis t ra t ion .

No t -f or - p ro fit s a t t r ac t ed m or e vo lun t ee r s , p l ayed

the m ajor ro le in p lann ing comm un ity ne tworks of

se rv ices and provided more suppor t for research

and educa t ion .

Canadian Medical Association Journal

In 2005, a group of five rese arch ers from th e University of To-

ronto condu cted an extens ive l it e ra ture rev iew of nurs ing hom es

in North Am erica. They concluded th at :

Em pir ica l r e s ea r ch i n t he p a s t 12 yea r s ha s f ound t ha t

system atic differen ces exist between for-profi t an d not-for-prof it nu rsing hom es.

For -profit nurs ing hom es appear to provide lower qua l -

i t y o f ca r e i n m any i m por t an t a r ea s o f p r oces s and

outcome. 52

Micha el Hil lm er , the lead a uth or on the Toronto s tu dy, said th at

the reason not - for -prof i t homes per form be t te r may be because

the y put an y profi ts back into care. 53

I n a s econd s t udy pub l i shed i n t he Canadian Medical Associa-

tion Journal in March 2005, researchers obtained staff ing data for

167 LTC faci li t ies in Brit ish Colum bia, and l inke d th at informa -

t ion to the type of faci l i ty and i ts ownership.The s t udy found t ha t :

Th e n u m b e r o f h o u r s p r ov id e d p e r re s id e n t - d a y w a s

higher in not-for-profit than in the for-profit facili t ies

for both d irect-care an d sup port s taff .

Not -for -profi t own ership was assoc ia ted wi th an es t i-

mated 0 .34 more hours per res ident -day provided by

The reason

not-for-profit

homes

perform

better may

be because

they put any

profits back

into care


34/52

33

direct-care s taff , an d 0.23 more h ours pe r resident-da y

provided by support s taff .

The s tu dy conclud ed th at : Publ ic mon ey used to provide care

to frai l e lder ly people purchases s ignif icant ly fewer direct care

an d sup port s taff hou rs p er residen t-day in for-profit LTC faci li -

t ies than in not-for-profit facili t ies.54

American Journal of Public Health

A s t udy pub l i shed i n t he American Journal of Public Health in

2001 an alyzed data f rom state ins pect ions of almost 14,000 nurs-

i n g f a c il it i e s , b o t h i n v e s t o r - o w n e d a n d n o t - fo r - p r o fi t . T h e

research ers , draw n from th e University of Cal ifornia, Harvard an d

other educa t iona l ins t i tu t ions , concluded tha t :

Inves t or -owned nu r s ing hom es p r ovide wor se ca re and

less nurs ing care th an n ot-for-profi t or publ ic hom es. Ch a i n o w n e r s h i p of h o m e s is a s s o cia t e d w i th a fu r-

ther deter iorat ion in qual i ty.

Skim ping on s ta f fing by for -profit hom es m ay expla in

their lower quality.

Pr o fi t s eek i ng d i ve rt s fun ds an d focus fr om c l in i ca l

care.55

The Aspen Institute

The Aspen In stitute in Wa sh ington, D.C. pu blish ed a st ud y in 2005

t i t led, Why Nonprofits Matter in American Medicine. The au t ho r s

exam ined over 250 em pir ical s tudies , covering a dozen typ es of hea l th serv ices , inc luding h ospita l s and n urs ing hom es , and com -

pare d th e perform an ce of for-profit an d n ot-for-profit organizations.

They concluded th a t :

N o t -f or - p ro fit n u r s i n g h o m e s h a v e lo w e r co s t s a n d

greate r efficiency.

Not -for -profit s have ma rked pa t te rns of h igher qua lity

care tha n th eir for-prof it counte rpar ts .

Not-for-profi ts are less likely to ma ke m isleading claims,

to have com plaints lodged against th em by pat ients , an d

less l ike ly to t rea t l ess -em powered pa t ien t s in a m ann er

different f rom oth er clientele .

The p r e sence o f no t - fo r -p r o fit com pe t it o r s in a com -

munity is associated with increased qual i ty of care in

for-prof it nu rsing hom es. 56

There i s a lways room for more research , but i t can safe ly be

concluded that not-for-profit LTC facili t ies provide better care to

the frail e lder ly, and do so m ore efficient ly than for-profi t hom es.



35/52

Dignity Denied

34

The pr ivat izat ion of LTC leads to the neglect of our most f rai l

elderly citizens. The profit-seeking behaviour of private facili t ies

d iver t s funds a nd focus f rom provid ing care and leads to cu t t ing

corn ers in st affin g. For-profit facili t ies purs ue p rofit by cuttin g staff

or spen ding on services an d care. Every dol lar in sha reholders divi-

dend s represent s m oney tha t is not be ing spent on care for e lder ly

residents . It is our m ost vulnerable cit izens wh o pay th e pr ice.

T h e p u b l ic a n d n o t - fo r -p r o fit s e c t o r s h a v e d e m o n s t r a t e d a

m arked res i lience in th e face of the d i s t ress caused by governm ent

cutbacks and th e m ove to pr iva t iza t ion . Governm ents m us t , in the

pu bl ic interest , invest m ore in pu bl ic an d not-for-profi t facil it ies

while using public policy levers to phase out for-profit facili t ies

over t im e.

Monitoring, Inspection & Quality Care

I t i s e a s i e r i n s o m e C a n a d i a n p r o v i n c e s a n d t e r r i t o r i e s t o

r e li ab ly pu r cha se a q ua l i t y ca r o r k it chen app l ian ce t ha n a r oom

for a loved on e in a LTC faci li ty. Fam ilies of ten h ave n o w ay of

knowi ng whe t he r a f ac i l i t y ha s a h i s t o r y o f subs t anda r d ca r e .

Pol ic ies for regula t ion , overs ight and inspec t ion a re incons i s t -

e n t a n d w e a k . Oft e n t h e r e a r e n o c le a r s t a n d a r d s a n d g u i d e lin e s

o n w h a t c o n s t it u t e s a n a d e q u a t e q u a l it y o f c a r e .

Res i den t s , f am i l i e s , wor ke r s , un i ons and com m uni t y advo-

cacy groups a re forced to p lay a watchdog ro le . Res idents , inpa r t i cu l a r , a r e o f t en a f r a i d t o r a i s e conce r ns abou t ques t i on -

ab l e p r ac t i ce s o r t o r epo r t s e r ious i nc iden t s a nd v io la t i ons f o r

fear of repercuss ions . This i s c lear ly unacceptable .

I n A l b e r t a , a n e w d i r e c t i o n w a s a n n o u n c e d o n l y a f t e r t h e

dea t h o f t he 86 - yea r - o l d hunge r s t r i ke r M ar y Geddes . I n t ha t

province , the Consu m ers Assoc ia t ion o f Can ad a de scr ibed LTC

as exi s t ing in a regula tory void .57

In Apr il 2005, CBC News us ed th e Right to Inform at ion Act to

ob t a in cop ie s o f in sp ec t ion r ep o r t s be t ween Jan ua r y an d Novem -

ber 2004, for a l l 61 nurs ing hom es in New Brun sw ick .

T h e n e w s i n v e s t ig a t io n f o u n d t h a t o n a v e ra g e n u r s i n g h o m e s

i n t he p r ov i nce had f ou r hea l t h and s ecu r i t y v i o l a t i ons i n t he

p r e v i o u s y e a r , a n d t h a t w a s w i t h i n s p e c t o r s g i v i n g t h e m a d -

vance no t i ce t hey wer e com i ng . F i nd i ngs f r om t he i n spec t i on

r epo r t i nc l uded :

1 9 h o m e s b ro k e t h e r u le s o n s t o r in g o r se r vin g fo o d a t

p r o p e r t e m p e r a t u r e s .

1 3 h o m e s d i d n t f ollo w t h e p r o c e d u r e s o n f ir e d r ills .

It is often

easier to

purchase a

quality car

or kitchen

appliance

than a room

for a loved

one in a LTC

facility


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17 h om e s d id n o t p r op e r ly d oc u m e n t h o w t h e y w e re

s t o r i n g m e d i c a t i o n , h a z a r d o u s m a t e r i a l s a n d e l e c -

t r i c a l app l i ances . 58

The minis te r of hea l th promised to put an end to advance no-

t i ce of inspec t ions , and to change the l i cens ing sys tem so tha t

hom es with violat ions receive only a tem porary l icence.59

In Ontar io, the m edia exp osed a for-profi t chain, cal led Royal

Crest , wh ich ha d a record of ban kruptcies , finan cial negl igence an d

f r aud aga i ns t vu l ne r ab l e r e s i den t s i n Canada and t he US . The

Royal Crest facil it ies were sh ut d own af ter the ir owners d eclared

b a n k r u p t c y a n d v a n i s h e d . T h e c o m p a n y o w e d t h e p r o v in c i a l

wor ke r s i n su r ance p r og r am $3 .2 m i l l i on and m oney was a l so

repor ted miss ing f rom res idents bank accounts . 60

The governments of Ontar io, New Brunswick and Alberta have

comm it ted recent ly to increas ing the n um ber of surpr ise inspec-t i on s o f fa c i li t ie s , b u t t h e s e c o m m i t m e n t s c a m e o n l y a f t e r

increased publ ic pressure a nd m edia scru t iny.

In Manitoba, th e govern m en t crea ted a Bil l of Righ ts for LTC

res idents conta in ing a long l i s t of s t andards for care , personal

a t t en t ion an d p r ivacy r ight s , but on ly a f te r in ten se pu blic pres -

s u r e .61

These exam ples a ll demon s t ra te the im por tance of p lac ing con-

t inued pressu re on pol it icians an d pol icy m akers . It requ ired th e

courageou s act ions of ind ividuals , m edia scru t iny, or grassroots

m obil iza t ion by comm un ity-based organiza t ions in each of these

cases to p rod governm ents in to ac t ion . But res iden ts , the i r fam i-l i es , workers and the communi ty have only a l imi ted amount of

t ime a nd en ergy to devote to vigi lan ce.

Governm en ts ha ve a respon sibil ity to enforce opt im al s taff ra-

t ios an d LTC stan dard s to en sure the frai l e lder ly receive good care

and tha t they do n ot becom e the v ic t im s of neglec t . There m us t be

t h o r o u g h b a c k gr o u n d c h e c k s o n o w n e r s a n d o p e r a t o rs b e f or e

awarding them a l i cence . Res idents mus t res t assured tha t they

will not lose th eir person al savings i f a faci li ty goes ban krupt .

Governm ents m us t m oni tor fac il it ies an d en force tough m eas-

u r e s aga i ns t t hose t ha t do no t com pl y wi t h op t i m a l s t anda r ds .

Governm ents m us t p rovide th e tools n ecessary to prevent finan c ia l

abuse a nd m isman agem ent an d en sure f isca l in tegr ity a t f ac ili ti es .

All of these m easures a re imp or tant , but they are n ot enough.

Ult ima tely the a ns wer to Canad as cr is is in LTC m ust be th e rec-

ogni t ion th at i t is an essen t ial par t of our h eal th care syste m . LTC

m ust become an ensu red service under the u m bre lla of the Canada

Heal th Act . It i s t ime for Can ada to provide i ts m ost vulne rable

c it izens wi th th e qu a l ity of lif e and care they n eed an d d eserve .

Ultimately

the answer to

Canadas

crisis in LTC

must be the

recognition

that it is an

essential

part of our

health care

system



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Workers WhoCare for the Elderly

THOUSANDS OF wom en an d m en work in Can ada s long- te rm

ca r e sys t em and a r e t r y i ng t o p r ov i de h i gh qua l i t y ca r e i n an

environm ent of respect an d digni ty. Today, thes e p eople are working

ha rder th an ever before u nd er incredibly s t ressful cond i t ions. There

can be no doubt about i t : s taff are the backbone of qual i ty long-

term care. And let s be clear th at e very occupat ional category, not

just doctors and nurses, is cr i t ical to care, including: therapists ,

ph arm acis t s , soc ia l workers , d ie t ic ian s , hea l th care a ides , per -

sonal su ppor t w orkers , c lean ers , cooks an d adm inis t ra t ive s ta f f.Bui ld ing a f i r s t -c lass long- te rm care sys tem depends on an ad-

equate supply of al l types of ski l led workers .

I t takes a special kind of person to work in LTC and the vast

m ajority of workers d o i t because th ey are de dicated to car ing for

the e lder ly . Due to the very f ra i l na ture of many res idents and

h i gh r a t e s o f dem en t i a , t he wor k dem ands m or e t han j u s t pa -

t ience and compassion. I t a lso takes special t raining and a high

degree of skil l an d com m itme nt . But , m ost imp ortan t ly, i t takes

t im e. Sadly, there a re n ot enou gh workers and not en ough t ime.

LTC workers know th ere is a gap be tween the care they wan t to

provide, and the care they can give. Low levels of funding, s taff

sh ortages, poor working cond i t ions , pay in equ i t ies an d prof it tak-

ing have create d a h um an resources cr is is in th e LTC sector .

Privatization & Low Pay

One m ight expec t the workers wh o care for the e lder ly would

be va lued an d com pen sa ted a ccordingly, but th i s i s not th e case .

Wages and benef i t s in LTC fac i l i t i es l ag behind those in o ther

hea l th ins t i tu t ions . For exam ple , governm ents have d ec ided tha t

more heal th services should be del ivered in LTC establ ishments ,

but n urses a nd o ther hea l th care profess iona l s in th ose fac ilit ies

earn l ess than they would in hospi ta l s .62

Some governm en ts ha ve sought i llusory savings by shift ing re-

sources to the for-prof i t sector . These faci l i t ies chase prof i ts by

reducing staff ing levels , pushing down wages and compromising

t he qua l it y o f ca r e . Reha b ili t a t ion s e r v ice s such a s m us i c and


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recreat ion the rapy are of ten viewe d as f r il ls an d, as a consequ en ce,

serv ices a re reduced and e l imina ted , hur t ing res idents qua l i ty

of li fe an d increa sing th e r isk of injury a n d i llness , including de-

pression. There is also a growing t rend to contract out anci l lary

serv ices such as c leaning , main ten ance , food prepa ra t ion , secu-

r i t y a n d l a u n d r y t o l a r g e m u l t i n a t i o n a l c o m p a n i e s s u c h a s

Aramark , Sodexho and Compass Group.

Once jobs a re cont rac ted ou t to compa nies such as these , pre-

v ious co l lec t ive ag r eem en t s a r e s c r appe d , wages an d ben e f it s

reduced, s t a f f ing l eve l s lowered , t ra in ing programs gut ted and

service levels m inimized. Cont ract ing out a lso lowers th e cont i -

nu i ty an d qu al ity of care. Residen ts receive me als del ivered by

trucks. Cleaning, securi ty and other s taff may work for a myriad

of d i ffe rent com pan ies , r a th er tha n f rom a cohes ive workforce

uni ted in the common goal of provid ing qual i ty care and serv-

ices. The cutba cks and fragm en tat ion are d is t ressing for residen ts ,

but are also difficult for LTC workers.63

Stress, Burnout & Turnover

The average num ber of days of work tha t Canadians in h ea l th

occupat ions lost due to i l lness or disabi l i ty s ince 1987 has been

at least 1.5 t im es greate r th an th at for al l workers . In 2004, ful l-

t i m e wor ke r s i n hea l t h occupa t i ons ac r os s Canada m i s sed an

average of 12.8 days of work due to il lness or disabili ty. 64

Dr. Margaret Ross, a profess or at th e University of Ottaw a School

o f N u r s i n g , l e d a r e s e a r c h t e a m s t u d y i n g s t r e s s a n d b u r n o u t

am on g staff in nin e LTC facilit ies in th e Ottaw a-Carleton Region .

The resul ts were reported in Geriatrics Today in Septem ber 2002.65

The team pol led 275 registered nu rses (RNs), registered pract i -

ca l nu r se s (RPNs) an d h ea l t h ca r e a i de s ( HCAs). They f ou n d

sign ifican t levels of em otional exh au st ion, pa r t icular ly am ong

heal th care a ides . They concluded tha t em ot iona l exhau s t ion could

ne gat ively affect the qu al ity of care. The tea m bel ieved th at em o-

t ional exhaust ion leads s taff to look for work elsewhere.

Such considerat ions, Dr. Ross wrote, do not auger wel l forresidents of LTC faci l i t ies , who are dependent upon heal th pro-

fessionals for many aspects of their care and wel l -being.

High ra tes of turnover can have negat ive e f fec t s on working

condi t ions, s taff m orale and th e qu al ity of care. There is an im-

pac t on res idents because th ey develop a comfor t leve l wi th th e

ind iv idual s wh o ass is t them wi th he a l th care and person al t asks

an d th is requ ires a cer tain com fort level .

Providing

health care

is precarious

work


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Hearing from the Workers

Several unions represen t ing workers in th e LTC facil it ies ha ve

surveyed th eir m em bers, asking about w orkload, qua l ity of care,working condi t ions a nd safe ty in the workplace .

ONTARIO PUBLIC SERVICE EMPLOYEES UNION (OPSEU/NUPGE)

Decem ber 2002, Lon g-Term Care Sector Survey

O PS EU / N UP GE r e p r e s e n t e d a p p r o x i m a t e l y 1 ,0 0 0 m e m b e r s

working in LTC facili t ies in Ontario in 2002. Surveys were sent

t o un i on m em ber s , m os t o f t hem f r on t - l i ne wor ke r s , a sk i ng

about pressures they faced on the job, especial ly in the areas

of hea l th a nd safe ty. 66

Here a re some of the resu l t s :

84% of workers sa id they work a lone a lways or often . 65% wor k a lways o r o ft en wi t h c lien t s wh o m ay be -

com e aggressive.

7 8% r e p o rt e d c o m i n g in t o c o n t a c t w i t h b o d y flu i d s ,

m any on a da i ly bas is .

62% reported w orking in facili t ies with p oor air qua lity.

1 9% lo s t t im e a t w o r k d u e t o a w o rk r e la t e d in j u r y

wi th in the pas t year .

84% sa id the i r workload h ad increased leve ls of s t ress

a t wor k .

Quotes from OPSEU Survey Respondents

Our wor kload has a lm os t doub led .

We are shor t of s t a ff. Two people have to do the work

of three people.

Mo ra le is d o w n .

Peoples bodies a re ge t t ing sore and t ired as w ell as

sick.

CANADIAN UNION OF PUBLIC EMPLOYEES (CUPE)

In March 2004, the Canad ian Un ion of Public Em ployees, On-

tar io Division com m issione d an indep en den t s tud y of Ontar ios

LTC workplaces represented by CUPE. 67 Here a re som e of the

r e su l t s :

Workload

10% o f t he r e sponden t s r epo rt ed wor k ing wi th be t ween

40 and 60 res iden ts on the i r usua l morn ing sh i ft .

Workers Who Care for the Elderly


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44.1% ca r ed

Dignity Denied

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