Aging At Home, or In A Home?

December 2004- The program following our annual general meeting on November 16, 2004 was a successful collaboration amongst Point, Care Watch, and Concerned Friends.

Monique Smith, MPP & parliamentary assistant to the minister of health and long-term care, and Sheila Neysmith, professor of social work, University of Toronto, were invited to speak about policies and practices in long-term care, including both facility care and home care. The program was very well attended and the informative and provocative presentations were followed by a lively question and answer session.

Before the speakers started, Lois Dent, president of Concerned Friends, presented Moira Walsh with a plaque recognizing the outstanding investigative reporting in her series The Bitter End, featured in the Toronto Star. Since Moira’s article there has been a “revolution” of activity in long-term care.

Monique Smith described her review of the long-term care homes system, undertaken at the request of Minister of Health and Long-Term Care George Smitherman. Ms. Smith visited 25 long-term care homes, unaccompanied and unannounced, between December 2003 and March 2004, and asked herself, “Would I want to be living here?”

She did an eight-hour shift in a home and met with over 100 stakeholders. As a result of this review the following initiatives are under way.
• Ongoing funding for Family Councils,
• Continued and improved funding for Residents’ Councils,
• Partnering with the activation specialists’ professional organization on a resource document on best practices,
• An action line with the number posted at all LTC facilities, that individuals can call with concerns (1-866-434-0144),
• Unannounced annual facility inspections,
• A public website with basic information about each LTC facility including its most recent inspection report and the number of verified concerns, and a link to the facility’s corporate website, accessed through the ministry of health and long-term care website www.health.gov.on.ca. This information will also be available at the CCACs,
• Revisiting facility compliance standards.

With regard to the compliance standards, Ms. Smith noted that the ministry recently re-instated 24-hour RN coverage in facilities, a minimum of two baths or showers per week for each resident, and required that menu planning be reviewed and approved in writing by the dietitian, effective January 1, 2005. Spousal reunification has also been made a priority. Three areas of standards that are currently being revised are dietary, wound care, and the use of restraints.

Ms. Smith announced that the ministry is asking for feedback on new long-term care legislation that will combine the three Acts regarding charitable, municipal and nursing homes into one Act. A discussion paper, soliciting comments, is called Future Directions for Legislation Governing Long-Term Care Homes. Copies can be obtained by calling
1-866-434-0144 or at www.health.gov.on.ca. Everyone who is interested in commenting on this important new legislation is encouraged to respond.

Ms. Smith acknowledged that home care is, as Romanow called it, “the next essential service”. She stated that the ministry is adding $1.3 billion in the year 2004-2005 for home care and community care access centres that will serve 21,000 more home-care clients. By 2008 CCACs will have funding to serve 100,000 new clients.

The second speaker, Sheila Neysmith, professor of social work at the University of Toronto, focused on current problems and gaps in the home support system. She described home care as the “poor relation” with only 2-6% of the health budget. Home care does not benefit the frail elderly because it has moved from a chronic care system to an acute post-hospital care system. In 2001 CCAC budgets were capped, they were not allowed to run a deficit, and acute care patients became a first priority with the elderly at the bottom of the priority list. In September 2004 the government announced a 10-year, $41-billion home-care plan. Certain home- care clients with chronic care needs will be covered, such as those with mental health needs, but no chronic elder care is included in this plan.

Ms. Neysmith asks, “Why is there no talk of a national home care plan?” Palliative care and national day care are truly important, but the government plays one group against another. She finds that home care is very political. Those needing a home-care system are the ones without funds to pay for their own help. Those with money and the clout can do just fine, so the issue is quiet. People with resources will buy their home care and thus interest in a public home-care support system is lessened. She also noted that the contracting out of home care does not work. There is a great need to expand the home-care system to include chronic supportive care, so that people with minimum incomes will have access to the services they need to stay in their own homes.

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