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OPINION: Transformative change needed in care for seniors

A review of facility-based continuing care in the province was recently released, calling for incremental change to a system that requires a fundamental cultural shift in how Albertans provide care for seniors. This month, Engaged Citizen columnist Vamini Selvandandan explores what providing care with dignity, purpose and the opportunity to thrive looks like.

In the wake of horrors laid bare by the COVID-19 pandemic in our senior care facilities, the government of Alberta commissioned a review of facility-based continuing care in the province.

Recommendations from the government-appointed panel were released at the end of last month. The report makes several important recommendations on improving quality of life for residents, public reporting of audit results, keeping couples together and providing more choice in community-based continuing care services. It also addresses the importance of treating those working in care homes better by improving staffing levels, wages and work conditions.

These recommendations will be a huge improvement from the current state of affairs and Albertans should hold the government accountable for implementing these changes fully and expediently. For too long, seniors have endured unacceptable conditions that don’t meet basic human rights – the right to privacy, the right to nutritious food, and the right to live with their life partner.

Where the report misses the mark is in calling for incremental rather than transformative change. What is needed is a fundamental cultural shift in how we envision and provide care for the elderly.

We have to create living environments that support a meaningful life filled with purpose, dignity and opportunity to thrive for our seniors. This should be the minimum set of expectations for senior care. It is not enough to provide care that avoids violations of human rights.

Senior homes today are based on medical models that over-emphasize safety and physical well-being to the detriment of mental, social and spiritual well-being. Health and safety are important considerations but we need to shift the focus to providing a home where seniors can continue to live purposefully and with dignity and autonomy.

Dignity requires that seniors are not forced to share a room and a washroom with a stranger. Autonomy requires that seniors decide when they wake up, when they get dressed and when they eat. And most importantly, a meaningful life requires purpose and opportunity to make a contribution.

Seniors need opportunities to care for themselves and others according to their physical and cognitive abilities. Where residents are expected to be passive recipients of services, they lose their sense of purpose and are unable to maintain their physical and cognitive abilities.

Similarly, we need a cultural shift in how work is organized in continuing care facilities. In addition to good pay, work conditions and training, workers need more time to develop relationships with patients and autonomy to provide customized care.

Given flexibility, they can focus on relationship-building and meeting needs for social interaction.  Injecting joy and life into the residents’ days becomes the key objective instead of providing medical care to merely extend days of life.

The report also does not address the commercialization of seniors’ homes. For-profit businesses are obliged first and foremost to maximize profits for shareholders and to turn a profit, they have to reduce what they spend on staff and residents. During the COVID-19 pandemic, we have seen this business model result in higher death rates in private long-term care facilities. These businesses cut corners by having lower staff levels and overcrowding of residents. Contracting out of cleaning, laundry and food services also created unnecessary portals of entry for the virus.

Primacy of profit margins makes the private operation of senior homes mathematically incompatible with quality care and decent work conditions. This simple fact seems to have escaped MNP, the accounting firm commissioned by the government of Alberta to author the report.

The report also highlights the operational and capital cost savings that can be achieved by increasing home-based services for seniors. But aging in-place has benefits that go well beyond economic considerations. For most people, there is no place like home and home is where they want to live in their final years.

With more home-based continuing care, we will need to be innovative in combating the pandemic of loneliness that pre-dated the COVID-19 pandemic. Creating appealing indoor and outdoor community spaces; increasing intergenerational connectivity where children, working-aged adults and seniors interact regularly; and improving mobility for seniors through accessible public transportation and walkways will need to be key adjuncts to increasing home care supports in the community.

Care for seniors is far too important to be left in the hands of medical doctors and accountants. We all need to step up and call for a system that will allow our seniors (and our future selves) to thrive physically, mentally, socially and spiritually in the golden years.

Vamini Selvanandan is a family physician and public health practitioner in Alberta.