Dan Levitt

A previous version of this article was published by the Vancouver Sun. You can access the original article here.

Before COVID-19, life inside aged care centers was pretty satisfying. A day filled with routines that made you feel good.

Then in March, everything changed.

The New Normal. Is It Worth It?

Communities banned everyone, except employees, from entering. Outbreaks happened and people died. Staff members were absent because they had symptoms. Employees had to take on new roles, caring for seniors who were isolated in their rooms for days, weeks, and months at a time.

This situation needs to change. We cannot go on like this indefinitely. Simply because a person lives in assisted living or long-term care should not mean they must give up their rights to live the life they want. We label seniors living in communities as “residents” — a label that comes with a disproportionate amount of loss of individuality. With COVID-19, seniors are more vulnerable and we should be taking safety measures to protect them. But at what cost? 

What Seniors Need

What do they need? Seniors (or their substitute decision-makers) need to be able to decide for themselves if they wish to continue residing in the residence under such restricted conditions; they also need timely access to medical and hospital care, regular communication with family members by phone or teleconferencing, and, most importantly, in-person visits, as well as the option to choose a range of advance care planning interventions.

The spotlight of the pandemic has told the story of residents living in care but from the operators and regulators. Many times the seniors themselves do not have a voice. We as a society must do everything to change the aging journey. Just because a senior lives in care does not mean their rights are any different from anyone else.

In Canada, a disproportionate amount of COVID-19 deaths have taken place in nursing homes. Eight in ten COVID-19 related deaths have been in long term care, double the rate of other countries in the Organization for Economic Co-operation and Development (OECD). This has to change!

People and Buildings

Our industry needs changes in two areas: people and buildings. First, while funding in recent years has focused on staffing, we need it more than ever. We need more professional, direct care, and support services staff to address the escalating needs of seniors. Second, capital funding for building replacement and adding new capacity as the current hospital-style institutions (many built a half-century ago) do not meet the standards for infection control nor one’s desire to live in an environment that feels like home. We urgently need single occupancy bedrooms with en suites and small home villages that provide a center for optimal living. 

-As a society, it has taken decades to arrive at the current state in aged care. When moving into care, people, seemingly like magic, take on the role of “resident” – losing not only their independence but giving up much of their individuality. Transforming the aged care industry and the way we, as a society, regard older adults needs our immediate attention. Our future depends on each of us creating a more age-friendly society. What are we doing about it?

Despite the impact on aged care during the first wave of COVID-19, many aged care organizations responded to the devastating consequences of the pandemic in resourceful ways. Providing safety for staff and reducing the risk of the virus entering seniors care homes with the best infection control measures available. Teamwork and resilience have helped front line workers weather through the adversity. As strong as the aged care industry has been to date, the infrastructure in place is chronically under-resourced to go the full distance of a multi-year pandemic.

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A New Aging Population Presents New Challenges

An aging population will present challenges and opportunities for the foreseeable future. The rising tide of seniors is more than a demographic phenomenon. It also impacts public policy and society as a whole. 

How we die has changed with Medical Assistance in Dying (MAiD) legalized. (This is similar to what some US states refer to as Death with Dignity.) Will more palliative care and hospices open up?

Families are facing the steadily increasing social and financial impacts of caregiving. How will family caregivers be supported emotionally and economically?

Seniors’ retirement income and pensions are eventualities everyone who retires will face. Are we willing to save enough for retirement while offering old age security to those in need? Delivering health care and social care is mostly expected to be a government-funded program. In some countries, like Australia, contributing more through a refundable bond for those who can afford to, has resulted in a replacement of much of the outdated nursing home bed stock.

The Elephant in the Room

In the 1962 film Jumbo, a police officer stops Jimmy Durante, who is leading a live elephant. The officer asks him, “What are you doing with that elephant?” Durante’s replies, “What elephant?” It was a show-stopper.

Aged care has been the elephant in the room for generations. It’s an enormous issue that everyone knows about but most people don’t want to discuss. Often because it makes them uncomfortable. We know if we live long enough, eventually we will face the reality of requiring care.

Many of us fear elderhood. How will we manage with activities of daily living either at home or in aged care? Somehow, long term care is not publicly insured under the Canada Health Act and as a result is not a federal policy priority. With the pandemic shining the public policy and political spotlight on old age institutions, now is the time to make a commitment to change from complacency with the status quo and create our preferred future.