In the aftershock of the COVID catastrophe in long-term care homes in Ontario last month, there has been no shortage of commentary on the subject, starting with immediate calls and promises for “no stone will be left unturned” inquiries or a transparent, non-partisan independent commission. While there is no question that we need to investigate what happened in these long-term care facilities and work smartly to fix the institutional models we currently have, there is also a call for what we might describe as a redesign of the entire continuum of care.
However, this call for design change is not new. Over the last ten years, I have shared ideas in conversations with many other professional voices (who know much more than I do) in the aging, longevity and care field. Of course, when we start or re-start conversations we recognize the fact that for too long there has also been no shortage of reports or inquiries into the problems, flaws and other horrible conditions found in long-term care facilities.
For example, as Sue Lantz of Collaborative Aging says in her May 27 Blog post that for years:
“…many alarms have been sounded about the issues in the quality of care, working conditions and safety risks. These issues have been well documented in a series of reviews of the Long Term Care Home System:
- 2008 Commission of Level of Care in LTC Homes
- 2012 Long Term Care Task Force on Resident Care and Safety
- 2019 Public Inquiry Into the Safety and Security of Resident In LTC Homes Systems
While the headlines speak about reducing wait times in hospitals; and the need to ensure that patients are not treated in hallways, we have NEGLECTED the health care outside of hospitals. This has led to various levels of ABUSE; which then prompts a CRISIS, which then leads to REVIEW. We are poised to REPEAT this cycle with the announced LTC Commission in Ontario, unless we boldly do something differently.”
Last week through my network, I also received a link to a February 2016 study by the Canadian non-profit Institute for Research on Public Policy (IRPP) titled Integrating Long-Term Care into a Community-Based Continuum (Shifting from “Beds” to “Places”). It is a worthwhile read and it will give you a historical perspective on how long this topic has been stewing. Here there are references to many more reports on Long-Term Care that go back decades.
At certain points in this IRPP study, there are echoes from the past sounding some of Lantz’s vision around creating: “a parallel track that moves us “upstream” to create alternative and sustainable solutions to help the growing number of seniors wanting to age in in their homes and communities.”
On page four of the study, we speed back in time and circle it all back to now:
“By the late 1980s, it was already well understood that an aging population would put additional strain and a potentially unsustainable burden on the province’s publicly funded health care system. There was also considerable agreement that the solutions should allow people to remain in their own homes and communities and live as independently as possible for as long as possible.”
Then in the very next sentence…“A series of policy papers commissioned by governments of different political stripes (Ontario Ministry of Health 1993; Baranek, Deber and Williams 2004) emphasized the need to build a community-based continuum of care. Yet, in the early 2000s, the province invested in 20,000 LTC beds while constraining funding for H&CC” (Home and Community Care)
We have the collective wisdom of an aging, longevity and care network to work on this redesign, and my work in progress phrase for this forward “upstream” system is a Life Course Continuum of Care. Thinking more broadly, it starts with how we redesign communities in the first place, integrated age inclusive housing models for example, where home care and social connectivity improve healthy living, where smart home technologies and tele-health services bridge distances and support mobility issues.
There are many more options to add to this, and it’s not as if we haven’t imagined variations on the components of a care continuum prior to this current crisis. Hospitals, long-term care facilities, supportive home care and hospice care are all part of the mix; and as the IRPP study submits, there are many home and community care models that have become: “a patchwork quilt of programs and services, each with its own entry point, assessment process, eligibility criteria, service offerings, service caps and users fees.”
So to leave off for now, I believe what we do need to do is elevate this discussion to an actionable community project, fess up to what we’re prepared to upend (or not), invest in and pay for (or not), all while engaging in a process that arouses inter-generational participation. As I have said many times, it is a mistake not to, for whatever we design today is not just for a large aging Boomer population. Over the next decade, all generations that follow are the future recipients and modifiers of any decisions we make now as a society for a better continuum of care.
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