By Karen Kelly
Canada’s long-term care homes have been devastated by COVID-19. According to a report from the Canadian Institute for Health Information, 81% of Canadian deaths due to COVID-19 were in facilities that house our most vulnerable populations. That compares to an average of 42 percent among all OECD countries.
Even more disturbing are the problems this crisis has uncovered. The Canadian Armed Forces issued a damning report in May after members were called in to support five long-term care homes in Ontario. They found facilities were understaffed and residents were living in horrible conditions.
Canadians have reacted with shock and outrage. But for Social Work Professor Susan Braedley and her fellow researchers, the findings were not surprising.
“We have been writing about this, speaking at conferences, and meeting with policymakers for years,” explains Braedley. “But everyone is acting like this is brand new, which is pretty alarming.”
While government agencies promise to address these issues, Braedley and her colleagues are working overtime to share their insights as widely as possible, with the intention of informing the public discussion.
“This has opened a moment for mobilizing ten years of research findings,” she explains. “The public is incensed and concerned. Older people and their caregivers have been treated as disposable. We finally have a moment with political will.”
Braedley’s involvement in long-term care research is substantial. She has been a co-investigator on four Tri-Council funded projects that continue to produce national and international comparisons to identify promising practices in long-term residential care. Currently, her projects are focused on community long-term care and services to seniors, including a Partnership Grant funded by the Social Science and Humanities Research Council (SSHRC) entitled, “Imagining Age-Friendly Communities within Communities: A Partnership for International Promising Practices 2018-2025.”
“We are asking how ‘age-friendliness’ can support conditions in which all older adults can not only maintain healthy active lives, but can participate and create meaning in later life,” explains Braedley, who serves as associate project director. “How do we find the things that work and how do we share that news?”
Braedley, her co-researchers and students have developed “rapid team-based ethnography”, a method that brings researchers from disciplines such as social work, architecture, nursing, humanities, health sciences, and sociology to train and work together.
“We come to a site with a team of people who spend about 10 days shadowing workers, chatting with residents, participating in activities, and interviewing staff, family members and volunteers,” she explains. “We are there all hours of the day and night to get a snapshot in time.”
The team then brings together their varying perspectives in a rich dataset based on their documentation and interviews. Drawing on their findings in long-term residential care over ten years of research, the team has developed recommendations to improve the quality of long-term residential care and contain COVID-19. These include:
- Provide a minimum standard of 4.1 hours of direct care every day per long-term care resident.
“The sheer fact that there aren’t enough people to do the work means that residents won’t have quality care,” explains Braedley, who found residents receive 3.45 hours per day on average for eating, toileting, and other care. “For-profit companies offer the lowest hours of care, and the biggest expense in nursing home care is staff.”
- Stop relying on outside contractors.
“When cleaning is contracted out, you have cleaners who may clean in other facilities, potentially spreading infection. When laundry is contracted out, it means linens being transported and potentially cross-contaminating other linens. When food is cooked off-site, brought in and reheated, once again, there are potential risks. Further, all of these practices are problematic in terms of quality,” says Braedley. “You might gain a small amount of cost savings, but the risks are enormous and the quality is usually worse.”
- Provide residents with more personal space.
“The more separations and individual washrooms you can have, the better for infection control and sleep quality. You have to find the sweet spot between privacy and ensuring there is an opportunity for residents to get together.”
A Broader Scope
While her public outreach is focused on COVID-19 right now, Braedley and her colleagues are studying many other sides of the long-term care system, as well.
For instance, she is the principal investigator on a SSHRC Insight Grant that focuses on immigration and its relation to care: “It’s abundantly clear that the long-term care workforce is incredibly dependent on immigrants, especially women.”
She also leads a team investigating how COVID-19 is affecting seniors who live at home and typically rely on home care and community organizations to meet their needs.
Braedley also oversees the work of SSHRC post-doctoral researcher Lauren Brooks-Cleator, who is studying the health of Indigenous seniors, as well as a number of doctoral students such as Christine Streeter, whose doctoral work focuses on the changing conditions of work for care workers, especially in the time of COVID.
One of the aims of these various research projects is to ensure research findings get into the hands of those who can use them as quickly as possible. Braedley and her colleagues have been using means such as short videos to share promising practices that had come out of the research.
“It’s a great way to easily share findings with the general public, and organizations like the Alzheimer’s Society have used them widely. We also publish short downloadable books in plain language about promising practices,” explains Braedley. “We want to get findings into people’s hands in a timely way as we work on projects that take many years to complete.”
While Braedley, her team members, community partners, and students continue to produce this research, it is up to government policymakers to make change. She, and many others, are calling on the federal government to include long-term care in federal legislation, such as in the Canada Health Act.
“There is no equity in terms of access to long-term care across Canada. The costs and the conditions vary,” Braedley has found. “Much would be accomplished by having the federal government take a lead role in something so important.”
She argues all levels of government need to take substantial measures.
“In Ontario, we don’t need an inquiry. I worry that an inquiry is merely a political exercise to put off taking action,” she says. “We know what’s wrong, we know how it can be corrected, and there seems to be a political push from a wide range of stakeholders right now. For our part, we will keep trying to make sure the people who need research findings have them.”
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