The coronavirus pandemic has had a far-reaching impact on health-care systems – it also has highlighted substantial gaps.
For example, Canada’s long-term care sector was already struggling when COVID-19 hit. The consequences have been heart-wrenching – and included residents with dementia who couldn’t understand why their loved ones stopped visiting and children who couldn’t be by the sides of their dying parents.
“It’s so tragic,” says Janice Keefe, who chairs the family studies and gerontology department at Nova Scotia’s Mount Saint Vincent University.
Dr. Keefe is well positioned to encourage change. She knows decision-makers need robust data to understand the scope of the problem and craft effective policies. That’s why she launched the Maritime Data Centre for Aging Research and Policy Analysis as part of the internationally recognized Nova Scotia Centre on Aging in 2003, with funding from the Canada Foundation for Innovation.
Dr. Keefe’s goal was to consolidate existing data in one place and add to it her team’s research, including surveys, focus groups and interviews.
Over the past 17 years, the centre’s research has shaped evidence-based policies on aging in Nova Scotia, New Brunswick and Prince Edward Island. For example, the research helped inform the creation of Nova Scotia’s family caregiver allowance; and analysis of wait times for long-term care homes led to a shift in provincial policy.
Meanwhile, a study on factors that affect residents' quality of life convinced several homes to change how they measure staff performance.
In 2018, the Nova Scotia government invited Dr. Keefe to chair an expert advisory panel on long-term care. The resulting report painted a picture of a system under stress. According to Dr. Keefe, the sector is the Cinderella of healthcare. “There’s a lot more attention, funding, support, preparation given to acute care than long-term care,” she says.
So when COVID-19 hit, many facilities struggled to cope. “[It] really just caused those cracks in the systems to become major chasms,” says Dr. Keefe. Over the first two months of the pandemic, 81 per cent of Canadian COVID-19 deaths occurred in long-term care – double the average of other OECD countries, she adds.
“People say, well, it’s only old people,” Dr. Keefe notes. Those ageist attitudes, she argues, have contributed to a system where facilities are under-resourced and careers in the field lack prestige.
Indeed, some of the biggest weaknesses revolve around staffing: too few people – many juggling casual jobs at multiple facilities – who are overworked, undertrained and underpaid.
Dr. Keefe describes other problems as well. The Canada Health Act doesn’t ensure universal long-term care. There are no national standards, and accountability structures can be fragmented. In Nova Scotia, for example, one branch of government sets policies for long-term care, while a different branch delivers services.
Dr. Keefe contributed to the Royal Society of Canada’s COVID-19 working group on long-term care, which made a number of recommendations to solve the workforce crisis in nursing homes, including implementing national standards for things like training and resources for infectious disease control in nursing homes and sick leave for personal support workers. But there are more questions she wants to tackle.
One is how to balance risk of infectious disease against residents' quality of life. “How do we manage that? How do we ensure that their loved ones, the people who give them joy, are somehow able to continue to have a presence in their lives during this time?” she asks. “That’s critical.”
According to Dr. Keefe, examining how we care for our older citizens is going to be more important than ever as the number of seniors in Canada continues to grow and demand for long-term care rises.
She hopes the attention that COVID-19 has focused on long-term care will lead to improvements. “I think it’s very helpful to have attention placed on the sector,” Dr. Keefe says. “But it’s only helpful if some positive changes are made.”
In the meantime, the Maritime Data Centre and the Nova Scotia Centre on Aging will continue providing much-needed insights and statistics with the aim to shift attitudes about our elderly populations and how we care for them as well as shape policies that will help improve the system.
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Produced by Randall Anthony Communications. The Globe’s editorial department was not involved in its creation.