Nov 2023 Thank you for your participation in our Letter Campaign for Reform

Improving Quality of Life in LTC Report

Ageism Kills – Time for Change

Published October 1, 2022

Today, October 1, marks the “International Day of the Older Adult”, established by the United Nations General Assembly in 1990, to counteract ageism, the pervasive discrimination against older people, by calling on all countries to recognize and celebrate the value of older people everywhere.

Sadly, ageism and ageist attitudes in our society – personal, in organizations and in policy– are alive and well today in Canada. And nowhere is this more evident than in health care and long-term care where ageism paved the way for Canada’s shame – the worst record by far for COVID-19 deaths in long-term care homes (69% of deaths) compared to that of other wealthy countries (an average of 41%).

Although COVID was the cause of so many deaths in long-term care, it was the years of ageist-based policy decisions that created the conditions --- all justified by discussions about “bed blockers, a “gray tsunami” and runaway costs of elder care burdening younger workers, etc. The result: more than two decades of decisions to reduce funding for seniors’ programming, cuts to programs, lack of stable staffing with adequate training and outdated physical environments, have eroded quality of care and quality of life for seniors. All these issues and their impact on residents in long-term care have been well known for many years by decision makers and allowed to continue and even worsen. That these issues have remained unaddressed for so many years – despite how they have undermined the quality of care and quality of life for residents and families, and the working conditions for staff – reveal the lack of value placed on older adults living in long-term care. This must change.

Here in British Columbia, ARRC (Action for Reform of Residential Care), a citizen’s group supported by families as well as care providers, union and seniors’ organizations, and researchers, together with extensive in-depth experience of long-term care, is demanding a complete reform of the long-term care system with the goal of improved quality of care and life for residents.

Policy decisions that have turned long-term care residents into commodities on the international stock market reflect a devaluing and dehumanizing of older adults and have fueled “business” decisions over care. Inadequate monitoring of public monies provided for care have incentivised and enabled for-profit care facilities to cut staff, hours of care, recreation and other resident-focussed programs, food, and housekeeping in favour of shareholder profit. Astonishingly, the profits of these facilities reached record heights during the pandemic while residents languished, and families were powerless, and grief stricken looking in from the outside.

During the pandemic, government decisions made also revealed the devaluing of not only the residents in long-term care, but their families and staff as well. Although it was recognized early on that those living in care were at high risk for COVID, staff and facilities were not given the training, PPE or other resources to mitigate risk. Residents, families, and the public were told that lockdowns would protect residents with no acknowledgement of the well-known consequences of social isolation on seniors’ mental health and on mortality. A less publicized goal of the lock downs was to protect the hospital system from being over-run by care facility residents, many of whom died alone. Long-term care residents’ wellbeing, and that of their families and staff, many who experienced mental health issues and moral distress, was in fact sacrificed for the good of the health care system and the needs of more valued younger populations, without consultation or their consent.

COVID has made the public aware that the long-term care system is broken and about the domino effect of ageist policies on the wellbeing, care, and quality of life of residents and on those who care about and for them. Since then, numerous surveys have shown that most people do not now believe that they would be well cared for if admitted to long-term care and dread that possibility. This is shameful.

ARRC is calling upon the public to demand that our government, with input from families, residents, and those who provide or are concerned about care, examine the impact of ageist policies, practices, and attitudes on the quality of life of seniors in our long-term care system. Additionally, we demand that the government address these issues, prioritizing quality of life, through regulations, effective monitoring, and sufficient funding, and by empowering and supporting families and family councils to advocate for residents’ well being. We all, seniors and seniors-to-be, must join to create a better present and future where fear of aging and of the care we might need is eliminated.

Penny MacCourt, MSW, PhD

Action for Reform of Residential Care (ARRC) BC - Chair

ARRC held a meeting with supporting organizations on May 19, 2022

Present

ARRC BC Association of Social Workers; BC Health Coalition; BC Nurses’ Union; BC Retired Teachers Association; BC Rural Health Network (BCRHN); Canadian Association Occupational Therapy BC; Council of Senior Citizen’s Organizations of BC; Crying Out Loud; Dignity Seniors Society; Family Caregivers of British Columbia; Family Councils of BC; Fraser Association of Family Councils; Gerontological Nurses Association of BC; Gerontology Nutrition Society; Hospital Employee’s Union; Health Sciences Association; Interior Association of Family Councils; Jewish Seniors Alliance of Greater Vancouver; Langara Social Services Department; Lionsview Seniors’ Planning Society; Municipal Pension Retiree’s Association; National Pensioners’ Federation; Northern Feminist institute for Research and Evaluation (FIRE); Parkinson Society BC; Save Our Northern Seniors (SONS); Seniors Serving Seniors; Simon Fraser University, Department of Gerontology; Simon Fraser University, Gerontology Research Centre; University of Northern BC School of Social Work; Vancouver Coastal Association of Family Councils; Vancouver Island Association of Family Councils.

The purpose of the meeting was to consider:

- what strategies could be used to motivate government to reform LTC
- what roles organization could take
- what resources (human, money, contact, skills) organizations could share

It was decided that we need to develop a multi pronged strategy to mobilize the public to motivate government to reform LTC. To develop and inform the strategy, ARRC has distributed a questionnaire to supporting organizations, asking about their areas of interest, resources, strengths, connections etc. The results will provide a big picture, identify themes for Hubs, inform content, and identify the collective skills and resources etc. that can be contributed to implementing strategies.

A representative from each sector (i.e., Family, Unions, Seniors Organizations, Professional Associations, Academic/Research) will be appointed to attend the June 15 meeting with Mable Elmore, Parliamentary Secretary for Seniors Services and Long-Term Care. ARRC’s proposal for a provincial action plan to reform LTC, led by a multi-sectoral Advisory Forum will be the focus of the meeting.

ARRC LTC Advisory Forum Proposal Submitted to Ms. Elmore and Minister Dix February 2022

LTC Advisory Forum Proposal

ARRC has been meeting quarterly with Ms. Elmore, Parliamentary Secretary for Seniors Services and Long-Term Care, for the past year, discussing our ongoing concerns about conditions and issues in the quality of life for residents in Long-Term Care facilities. Positive changes such as wage leveling, placing dietary and housekeeping under the public umbrella, funding for 3.36 hours direct care, and training health care aides have occurred. Nevertheless, since the ARRC report was released the capacity of LTC facilities to support resident quality of life has worsened due to the impact of the pandemic on an under-resourced system with long-standing unaddressed systemic problems. An urgent and holistic response is needed.

In February 2022 we submitted a proposal to Ms Elmore and Minister Dix asking them to strike a diverse and inclusive multi-sectoral Long-term Care Advisory Forum to assist with the development of a comprehensive and evidence informed action plan to reform BC’s long-term care system. This will be discussed at our next meeting, scheduled for June.

Please stay tuned.

Improving Quality of Life in LTC Report Updated May 2022

Improving Quality of Life in LTC

ARRC 2nd Petition Tabled in Parliament

Our second petition to the federal government advocating for national standards has been tabled in Parliament Petition e-3206 - Petitions which obliges the Minister of Seniors to respond to us in the next month or so. We will share her response when received.

ARRCBC Petition e-3206 Tabled in Parliament

ARRCBC Meeting with BC Government January 2022

ARRC met with Mable Elmore, Parliamentary Secretary for Seniors Services and Long Term Care in January. The focus of the meeting was the need for a comprehensive holistic provincial action plan to reform LTC, rather than piece meal fragmented action. Omicron has worsened staff shortages and therefore continuity of care, and there is a danger that the short cuts being taken will become entrenched, making things worse at the end of the pandemic than previously.

ARRC is proposing that the Minister of Health create a multi sectoral Advisory Forum to assist them to create plan that addresses the systemic issues identified in the ARRC report. We are gathering endorsements for the proposal prior to sending to Ms. Elmore at the end of the month. At that time the proposal will be posted on the ARRC site with suggestions for how members can encourage government to develop the Advisory Forum. Our next meeting with Ms. Elmore is April.

ARRCBC Meeting with BC Government September 2021

ARRC met with Mabel Elmore Parliamentary Secretary for Seniors and Long Term Care and the Executive Director, Seniors Services on September 3, 2021. Prior to our meeting we polled some of the stakeholder organizations and key influencers who support the ARRC report about what issues they felt we should emphasize at the meeting. Staff ratio, staff training, independent Family Councils, and a task force to develop a provincial strategy for LTC were identified as primary issues. (thanks to all who were able to provide input).

We again raised the issue of ongoing short staffing on the front line in LTC and the need for a provincial initiative. We were told that funding has been made available for 3.36 per resident per day which is an improvement over the average of 3.11. We reminded them that 3.6 was identified as staffing required over 10 years ago and since then complexity has increased. Further, the evidence indicates the minimum should be 4.1 hours. We were told that neither Ms. Elmore or Mr. Dix see 3.6 as the end of addressing staff ratios.

Ms. Elmore recognizes numbers alone are not enough and spoke of the need for complete transformation of the system and for transformational leadership. We discussed changing the discourse about LTC to one of care as a human right. She thought that shifting the way we talk about seniors (ageist, burden, etc.) very important and that the Human Rights argument to the public and to politicians could be effective and has been made to her by seniors group and others.

We were told that there is a funding model for LTC under development that will apply to all facilities (profit and non-profit) and will consist of envelopes for specific purposes (raw food, direct care etc.) that can only be used for this purpose, otherwise returned. This is intended to increase transparency and accountability and to limit areas where profit can be made.

We discussed the heat wave and the chaos that followed for some facilities/residents and that the evident lack of planning is concerning given there will be more heat waves, floods, fires etc. We were told that there is an overall provincial emergency plan that includes LTC (which they will share with us and we will post on our website) and that each facility is required to have its own plan.

We discussed the need to stabilize the workforce and link between supported front line and quality of life (which they appear to understand). They reported they have recruited 3,000 people to train as care aides and have just graduated an initial small class. Given the ongoing future needs they are looking at other ideas to build the frontline and are in discussions with Immigration officials.

We pointed out a practice in some facilities of not hiring allied professionals for which they are funded, often saying they are unable to recruit. We understand that often the number of hours offered are small making it difficult for professionals to piece together enough work, and sometimes salaries offered are poor. We discussed the idea of government hiring allied professionals directly and deploying them to facilities which would be billed for their services. We noticed they made a note of this idea.

We asked if there were plans to bring back laundry, dietary, housekeeping etc. under the public umbrella for LTC as they have for acute care. We were told that as each contract opens up this option will be considered for LTC. One issue is infrastructure—e.g. in-house laundry facilities that existed previously may have been dismantled.

We reiterated the importance of families and Family Councils, highlighted during COVID lock downs, and specifically need for independent Family Councils to be mandated for every facility. We discussed the uneven implementation of public orders about visiting family and the stress and pain caused to residents and families. Likewise, the designation of essential visitor status which seemed focussed only on feeding, not on mental health or social needs. Also discussed offensiveness of describing family as visitors which surprised them. We suggested they legislate implementation of independent Family Councils to ensure facility compliance. We referred them to the Vancouver Island Association of Family Councils proposal in the ARRC report appendices.

We advised them ARRC continues to grow the membership and its supporters, and that the ARRC report has added several new appendices about specific issues, (OT/PT, Recreation Therapy, Geriatric Medicine and a process for building consensus and will be shared with them (and with ARRC members and supporters) this month. Also reminded them of the curated collection of media resources we have compiled (over 100 pages of links) on the ARRC BC website -see COVID and Long Term Care Media and Resource Links

We again requested they convene a multi stakeholder task force to develop the vision and provincial strategy for LTC in BC, building on the ARRC report. We were told they have been thinking about some sort of Advisory or other group for LTC and have been musing about a mandate if such a group were created. We referred them back to the ARRC report and reminded them that we could bring people/groups with deep knowledge, experience, and passion to the table. We touched on the idea of forming a formal coalition, recognizing the number of groups (often ARRC supporters) advocating to government for LTC. They expressed some interest in the idea which we will explore further.

To sum up, we think that Ms. Elmore “gets it” and is well meaning, that there are things going on behind the scenes, and they may be beginning to think about some sort of stakeholder group. We will be continuing quarterly meetings.

ARRCBC Meeting with BC Government May 2021

ARRC has met again with Mable Elmore Parliamentary Secretary for Seniors Services and Long Term Care, and Teri Collins Assistant Deputy Minister, to share information and to continue our advocacy for residents in LTC.

We made Ms Elmore aware of additional support for the ARRC report from organizations and key influencers, and to growth in the ARRC membership. We also advised her of additions to the ARRC report re addressing needs of residents with behavioural challenges, and of LGBTQ2S+ residents. We continued to advocate for a multi- stakeholder task force to develop a provincial action plan for LTC building on the ARRC recommendations.

Ms Elmore advised that much of the monies announced by the provincial government for LTC has been allocated for new beds in the public sector. We were told that the Health Care Access program is underway with 350 applicants. We were told that the government welcomes national standards for LTC and that conversations with other provincial governments and the federal government are underway.

There are other groups advocating for improvements in LTC to Ms Elmore and others in government. We suggested that a resource hub be established where we could explore ways of working together to support this government in making the necessary changes in LTC to facilitate quality of care and of life for residents. Ms Elmore did not see a resource hub as feasible but encouraged us to collaborate with other groups and to continue to build support for change.

We will continue with quarterly meetings and hope as vaccinations increase the focus of government may be able to broaden to focus on improving structural and systemic issues in LTC.

ARRCBC Meeting with BC Government January 2021

ARRCBC Meeting with BC Government

See full report presented to the BC Government January 12, 2021 above

Letter-Writing Campaign - Task Force LTC Reform

February 2021

ARRC has asked government to strike a multi-stakeholder Task Force, chaired by the Seniors Advocate, to create a post-COVID provincial action plan focusing on resident quality of life, a supportive work environment, independent Family Councils, strengthened standards, and increased accountability for care and for public funds.

Email Health Minister Dix and your MLA (using our template) to ask the government to meet its moral obligation to the very vulnerable residents in LTC, and to all of us who may need LTC in the future, by urgently striking a Task Force to redesign LTC.

Go to:
It’s time to reform older adult care

Some of our Recent Activities

We have sent all MLAs and Health Authority EDs for LTC the ARRC report "Improving Long-Term Care - A Way Forward" requesting support for the recommendations and proposal for a task force to implement them. (see note we sent to MLAs, below).

We have discussed the report with the Seniors Advocate who would be ideal to chair the task force and is willing to do so.

Write Your MLA About the Heatwave

Perhaps after the experience of this recent heat wave it is time for every one of us to write our MLA, your health authority and the facility owner where you have a loved one residing and stress that with global warming its not sufficient just to have air-conditioning in hallways and common areas. (some facilities have zero air conditioning) This should be in place in every resident's room before next summer.

It is time families and friends and family councils make some noise...there will be more heat waves!!!

Scroll to the bottom of this page for government contacts to send your concerns to.

Heat-Related Illness

Safety, comfort in long-term care homes top priority during heat wave: Interior Health - Williams Lake Tribune

Participate in Vancouver Island Association of Family Councils letter writing campaign to convince the Ministry of Health to create guarantees for the voice of family councils in long term care

Full details and sample letters and decision makers contact information contained in this document:

VIAFC Letter Writing Campaign Sample letters

Position Paper for the BC Minister of Health

We need your support!

We have developed an evidence based position paper for the BC Minister of Health, illustrated by family stories.

A large membership base will strengthen our requests so please ask those in your BC networks to join us.

The position paper recommends a shift from the current institutional/custodial model to a funded person-centred and relational model that is supported by training and adequate staffing numbers.
To this end we have addressed recruitment, training (with a suitability clause) of more care aides; on site RN with team leadership role; full orientation and in-service training for front line staff; higher staff-resident ratio for care aides, RNs and allied professionals (social work, physical therapy, dietician, recreation); front line stabilization with continued wage leveling and one-site rule.

We have also recommended strengthened monitoring of facilities by Licencing; development of process and standards for quality of life monitoring; mandated role for independent Family Councils and development of regional Family Council Coordinators to help families develop Councils and to support them; development of a provincial strategy for LTC; limiting growth of corporate for-profit facilities and developing a buy-back program.

Action

Improving long term care will take many voices.

What can you do to bring quality care to seniors in care?

Report any neglect to the appropriate people, see the handouts under Resources for contact information
Join ARRCBC and support our advocacy (link to join us is at the bottom of this page)
Come to our events
Be an advocate for all seniors in care
Volunteer to help us
Write or email to your MLA with your concerns
Write or email to the Federal/Provincial Government