Ten years ago, Pat Armstrong, a sociology professor at Toronto’s York University, released a study of long-term care of the elderly in Canada.
She exposed the abysmal lack of staffing required to provide quality care. “Residents sit in soiled diapers because there are no workers available to answer their call. They often miss regular baths, and sit alone in their rooms without exercise or conversation.
“Underpaid and overworked staff often come to work while sick. They work unpaid hours to make up for the care deficit. They go home physically and emotionally exhausted because they have to look after far too many residents.
“Some residents become violent towards care providers because they are frustrated beyond endurance by the lack of care. Workers fail to report this violence, mainly because they feel their complaints will not be heeded — or, worse, that they themselves will be blamed. Their limited training, inadequate pay and benefits reflect the low value attached to this female-dominated occupation.”
Professor Armstrong’s critique of the appalling conditions in mostly private long-term care homes was just one of dozens of such complaints aired by health-care specialists, care-givers and their unions over the past several decades.
Revelations of such colossal mistreatment were not overlooked by the media, where they were published and sometimes even headlined. But, after a few days, when Canadian political leaders failed time and again to react, the plight of the ill-treated elderly faded back to obscurity.
So it wasn’t until members of the Canadian Armed Forces released scathing reports of the terrible conditions rampant in some long-term care homes in Ontario and Quebec that our federal and provincial governments finally expressed outrage and pledged to soon take proper corrective measures.
As if they had previously never been informed of such blatant mistreatment of the country’s retired citizens!
Will governments keep reform promises?
It’s far too soon, of course, to applaud this belated political pledge. To actually implement urgently needed reforms of the privately-operated homes will necessitate upsetting their business owners. Owners whose abuse of their residents our political leaders have up to now dutifully overlooked by ignoring staff shortages and making very few inspections.
Whether the politicians will really deprive themselves of the financial campaign support and other benefits they derive from the private care owners is far from certain. They certainly won’t insist that all such private care homes be converted to public care operations, which would be the ideal reform.
But the alternative, to be effective, would be to impose far better levels of care and staffing for residents, along with frequent oversight and enforcement. These measures, of course, would force owners to increase services and reduce profits — which in turn would undoubtedly cut or even stop their political donations.
Either way, our governments will have to accept such a decline in private sector approval if they seriously undertake the necessary home-care reforms they now so vigorously guarantee.
In her 2009 dissertation on Canada’s barbaric home-care system, Professor Armstrong referred to the far superior service retirees receive in the Scandinavian countries and the Netherlands.
“Even with significantly more dependent elderly,” she noted, “these countries are able to provide higher staffing levels and more time for social support, as well as more choice and autonomy for both workers and residents.”
Not surprisingly, in the Netherlands, Norway and Sweden, spending on long-term care is between 3.7% and 3.2% of GDP. This is about double the OECD average of 1.7%. Canada spends just 1.3% of GDP. In some other European countries where private care facilities are permitted, such as Latvia and Estonia, the amount drops as low as 0.2%.
It should be kept in mind, however, that in Europe a large share of spending on LTC services is covered by government or compulsory insurance schemes. In Germany, for example, although its LTC spending is listed at just 1.5% of GDP on the OECD scale, it actually provides the highest and most comprehensive long-term care system in Europe. Germany’s mandatory social insurance plan covers virtually the country’s entire population, with the remainder covered by a funded mandatory private insurance plan.
Private operators must comply
However, even the European countries with the lowest long-term care spending have enacted laws and policies that compel private operators to adhere to high standards of service. These governments feel they have an obligation to monitor levels of care that ensure their elders are properly fed, socially engaged, and free to have regular visits by family and friends.
A systemic cross-country collaboration in Europe helps professional experts and researchers in the ageing health-care field to provide the best available training and care services.
Europeans are understandably horrified by the extent of the mistreatment and neglect of the elderly that they have recently seen on TV and read in their newspapers. How could an allegedly progressive country like Canada allow such malignant abuse of its oldest and most vulnerable citizens to fester for so long?
That’s a question Canada’s political leaders can’t possibly answer, a stain on our country’s reputation they can neither erase nor explain. Their only recourse is to live up to their promise to take prompt remedial action.
Let’s fervently hope and pray that they do.