Warehousing the old
As Edward Monaghan walked the cracked pathway leading to his wife’s nursing home on that drizzly spring day a year ago, he was trying to quell the riot of emotions racing through him. It was his first visit to the Toronto area nursing home his wife, Jackie, will call home for the rest of her life, and he had no idea what to expect.
Three years ago, Jackie, then 67, had been diagnosed with dementia. Her mental and physical capabilities continued to spiral downward at alarming speed to the point where it became impossible for Monaghan to care for her at home. After the medical system had exhausted all attempts to treat Jackie’s condition, his only option was to place her in a nursing home. Monaghan eventually settled on a municipally run facility near his home.
Now, as he made his way past the unstaffed information desk and rode the creaky elevator to the third floor where Jackie lived, Monaghan was about to get his first glimpse of the strange way of life that prevails in many of Canada’s long-term care facilities.
Stepping off the elevator, Monaghan approached a small common room, crowded with upwards of 30 elderly people. These residents — the majority women appeared to be in a highly disheveled state, with unkempt hair and mismatched or ill-fitting clothing. Most were propped up on couches or restrained in wheelchairs, either staring off into space or gazing blankly at Dr. Phil yammering away on television. An unpleasant odour of urine and institutional cooking permeated this drab ward, and a thick fog of gloom, loneliness and boredom seemed to engulf the place.
A year later, Monaghan still winces when recalling this grim scene. “It was just how I pictured a Victorian madhouse to be,” he says. “At that point I thought, if this is the best we can do for her, then we’re in deep trouble.”
Nursing homes, homes for the aged, seniors’ homes all fall under the umbrella of long-term care facilities. Regulated and licensed by provinces and run by private, municipal or charitable entities, nursing homes are mandated to provide 24-hour nursing and personal care for frail elderly, who have mental or physical conditions that prevent them from living independently.
With more than 200,000 Canadians — one third of the entire 85-plus population – now residing in LTC facilities, families are often dumbfounded by countless problems and abuses that exist in many homes. Of course, there are numerous good nursing homes that provide top quality personal and nursing care to their residents. But these are overshadowed by a shocking number of subpar homes, those that not only fail to provide adequate medical and personal care but also don’t even try to create dignified and nurturing living space for the frail seniors who need them most. Our mothers and fathers deserve better.
Over the next several weeks we will explore the nursing home predicament that besets our country and see the second-rate living conditions that are common in too many homes. In such a wealthy country, why are we warehousing our loved ones in substandard institutions where their dignity and quality of life are routinely ignored? This week: A warehouse for the elderly. Continued next week: Nursing homes unsafe for residents?
Not enough help
The most apparent shortcoming Edward Monaghan noticed during his visits to Jackie’s nursing home was that there were alarmingly few nurses. His wife’s floor has 80 patients, many of whom have complex medical needs, such as diabetes, advanced dementia or a variety of physical ailments that needed constant medical attention and monitoring. Yet on a typical evening, there is only one registered nurse (RN) to look after all of medical needs of the 80 residents on Jackie’s floor.
Next page: A factory assembly line
Initially, Monaghan thought one nurse for 80 people was a ridiculous ratio. Later, he learned he was fortunate — at nights, many Canadian facilities have an even lower ratio, some bottoming out at one RN to 100 residents. Smaller homes may not even bother to have an RN in the building at night. It almost seems ludicrous to call them nursing homes.
Long-term care nurses answer many demands, and it’s difficult to imagine how nursing homes function with so few of them. Besides overseeing the running of their ward, RNs must look after all of the medical needs for patients, such as administering medications, changing wound dressings and monitoring the health of all residents. Obviously, with too few RNs, quality nursing care is being sacrificed. One survey found that 80 per cent of nurses working in Ontario LTC facilities say their units are understaffed and they couldn’t perform all their duties. In a 1997 survey of Manitoba LTC nurses, 50 per cent felt that low staff levels meant basic nursing care was being neglected, and a shocking 59 per cent reported suffering burnout because of excessive work demands.
Nurses in long-term care wards are assisted by health-care aides, low-waged workers who perform menial duties such as feeding, bathing, toileting, dressing and lifting patients in and out of bed. There are six aides on Jackie’s floor, which means each aide must look after all the daily living activities of more than 13 residents. With such a low staff-to-resident ratio, something is bound to get lost in the shuffle. And often dignity is sacrificed in favour of getting the job done.
“At meal- and bedtimes, the place resembles a factory assembly line,” says Monaghan, watching the aides wheel patients into the dining room two at a time. They speed up the dinner process by feeding two people at once, sitting on swivel chairs, spinning back and forth with spoonfuls for the respective residents.
With so few health-care aides, it’s also impossible to maintain good hygiene practices. Monaghan noted that Jackie’s personal appearance began to slip once she entered the home. Sometimes her hair was so greasy, he barely recognized her. “It seemed she wasn’t being bathed regularly,” he said. So he asked the staff if she could receive an extra bath a week. The answer was a curt no — each patient was allotted one bath a week, and the home didn’t have the staff to provide anything extra. If Monaghan wanted Jackie to have another bath, he would have to organize and pay for outside help to come in and administer it.
Because wages and salaries can typically consume up to 80 per cent of a nursing home’s operating costs, there’s not much money left to provide the little extras that make live bearable. Most homes simply are simply too cash-strapped that they can’t afford to hire additional staff to perform the personal duties, such as getting residents out of their chairs for daily exercise, taking them outside on a sunny day, providing extra baths or just sitting down and having a friendly chat.
Not possible to meet needs
“With current staffing levels, it’s not possible for facilities to look after everyone’s needs,” says Donna Rubin, chief executive officer of the Ontario Association of Non-Profit Homes and Services for Seniors (OANHSS), a group that lobbies government to increase funding to non-profit LTC facilities. “Look at Ontario, where homes need only provide residents with one bath a week. It’s not acceptable, and it’s a sad statement about long-term care.”
To save money, many homes have cut their activities programs, meaning patients spend their days lying in bed or in front of an ever-blaring television. “Whenever I go there, the residents flock to me,” Monaghan says. “They’re bored and lonely. They’ll even ask me to take them to the bathroom or wheel them outside for a smoke.” In many homes, it’s left up to the families or volunteers to provide these services.
Rubin says the problems go beyond a shortage of nurses and health-care aides. It seems medical specialists, psychiatrists and therapists are also scarce in these institutions. “Over half of residents in LTC have cognivitive impairment. Yet only six per cent of these ever get seen by a psychiatrist or psychologist,” says Rubin. “Plus, a lot of our residents have had a fall or suffer from arthritic conditions. Yet only 10 per cent of those ever receive any physical therapy.” By law, provincially covered medically necessary services must be made available to everyone. For some reason, the frail elderly living in LTC facilities are being excluded from these services.
This series continues in our Health section next week.