There’s a crisis in hands-on care in Ontario’s long term care homes. And it’s having a devastating effect not just on residents but on those who care for them
IMAGINE YOU ARE A SENIOR living in a long term care facility, hands gnarled with arthritis and mind clouded by dementia. Each morning, you are woken by a bright light. You aren’t sure where you are, or why the light hurts your eyes so much.
You might hear a voice before someone begins to wash your face and pull your shirt off. Before you can figure out what’s going on, people roll you around in bed. Your pants are off. You’re exposed. You try but you can’t remember where you are or who these people are, but it triggers painful childhood memories. Then your pants are on and you are in the air, and then descending into a chair.
Your clothes aren’t on right, and you wish you could just shift a little to get more comfortable. Then the chair starts to move, and you have no idea where you are going.
You want to know where you are, what happened to your family, and why you feel so sad today. You ask, but the words just won’t come out.
As you’re whisked off to the meal room in your wheelchair, you have a vague impression of having once walked around these halls, of being able to brush and style your own hair with pride. The caregiver wheels you to your spot at the table and leaves to help the next person. Before she goes, she gives your shoulder a gentle squeeze, a look of desperate guilt crossing her face.
This is the reality in long term care homes across Ontario. Unfortunately, homes trying to tighten the purse strings due to funding shortfalls unwittingly squeeze people on both sides of care. Residents do not receive the hands-on care they need. Caregivers are rushed and hindered from giving the care they want to give.
The results are predictable. Residents deteriorate more rapidly. Caregivers burn out.
ASK HEALTHCARE WORKERS WHY they do what they do, and the answer is always the same: I love the people. But new regulations in recent years requiring increased charting only add to the time crunch front-line caregivers face. Charting is an endless task that takes precious time away from the seniors they love.
Tracy Comeau is a member, steward, and president of Local 302. She’s been a registered practical nurse (RPN) for 20 years and works at both Crescent Park Lodge and Maple Park Lodge in Fort Erie.
Tracy recalls an incident with a resident who could have been treated more effectively if he had been given more attention.
“He was very loud and yelling out, so he was being incorrectly treated for behavioural issues,” she says. “After a lot of trial and error, we discovered that the root issue was that he was in a lot of pain. But nobody knew that because we didn’t have enough time to spend with him to get to know him well enough to understand him. With more time, we would’ve figured it out because we would know what got him agitated and why. We’d be able to talk to the family and get more detailed information about him. But time is always an issue.
“In the last few years, we’re required to fill out more and more paperwork. There’s little time for anything else. We’re lucky if we can even say hello to a resident anymore because there’s no time. We hand them their pills and that’s the only time in the day we can talk to them. It’s really sad.”
As an RPN, a great deal of Tracy’s time is spent charting, something she finds frustrating and needlessly time-consuming. The computerized charting system (PointClickCare) is supposed to streamline the documentation process, but most homes cannot afford the whole system, resulting in hours of busy work.
“The system we use is inadequate and not user-friendly,” says Tracy. “I wish it would auto-populate certain fields so I’m not charting the same things over and over in so many different places. If it did, I know I’d have more time with the residents.”
“We have to record everything,” adds Amanda Forney, a personal support worker (PSW) and steward at Crescent Park Lodge. “Every time the resident has a drink, we record it. Every time they use the washroom, we record it.”
All of this recording takes time away from interacting with residents.
“There’s actually a lot of us who do our paperwork on our breaks,” says Amanda. “There’s literally no other time to do it. Our breaks are supposed to be our mental relief— that 15 or 30 minutes off the floor. But it’s not like that. The second we get to work, we’re constantly going. If we take any more time away from the residents, then they’re getting even less time from us.”
Adding to the time crunch are residents with more complex behavioural issues. Seniors are living longer, staying in their own homes longer, and entering long term care in advanced stages of dementia. Many homes, such as Crescent Park Lodge, are taking in more and more adults with special needs. These people require particular attention, but the PSWs haven’t been given the training to effectively address their needs.
“We do the best we can,” says Amanda. “We run around and don’t stop. Then we get home and we’re completely mentally and physically exhausted, because we’re never sure if we forgot something. I’ll be at home trying to relax, and I’ll keep thinking, did I do this? Did I forget that? Did I put this person’s bed rail up? Does that person have their call bell? It’s nonstop mental stress because we’re working with human beings. It’s not like you’re leaving a factory, and if you forgot something, you can get it next shift. This is someone’s life.”
THOSE LIVES, ALREADY IN THEIR last days, are rapidly deteriorating.
“I’m seeing a lot more seniors with depression, and there are a lot more behavioural issues,” says Amanda. “They become depressed and immobile because we just don’t have the time to spend with them, and we have to rush them through their day. It’s hard to see, especially when they come into the home walking and able to do their hair, and within months they’re wheelchair-bound and can’t do their hair anymore.”
“They’ve lost a lot of independence,” says Jennifer Aitcheson, a PSW and steward at Crescent Park Lodge. “It’s difficult knowing that extra interaction and socialization would go a long way for them.”
When Jennifer started work as a PSW, she knew every resident’s likes, dislikes, and whether they were in pain or irritated in any way.
“I’d know if there was an anniversary of their spouse’s death” she says. “Then I’d know that I’d have to really be there for them that day. Now, we barely know any of that. When we could spend more time and sit with the residents, we’d be able to establish what kind of pain they’re in and what’s going on.”
And for the low-maintenance residents with no behavioural issues, they often fall through the cracks of the fractured system.
“The quiet ones think that the people who scream and yell get all the care, and they get none,” says Jennifer.
“We’ll ask them, ’why didn’t you ring if you needed us?’ ” adds Amanda. “And they’ll say, ’Oh, I didn’t want to bother you. I saw you running around like crazy.’ They see that no matter how hard we try, we cannot get our job done. It’s hurtful to the residents—both the ones who have behavioural issues and the ones who don’t want to be a bother.”
Not only do the residents notice when their caregivers are stretched thin, but the residents’ families see it too. Many homes in recent years have been on the receiving end of negative press due to families noticing neglect or alleged abuse, with the workers the ones under fire.
“When you’re so busy, a resident might just go to bed with their dentures in because you were called away to help with a transfer, or someone fell and you have to help them up,” says Tracy. “Those little things get forgotten sometimes, but that’s what the resident’s family sees. They don’t see all of the good you’ve done—only the bad.”
“You’re being pulled in a million different directions, and just once you forget to take someone’s dentures out,” says Jennifer. “But at least that resident is in bed and safe. Or maybe it’s because they bite and you’re just not able to take their dentures out so you skip them because you have a thousand other little things to get done.”
IT COMES BACK TO TIME. Increased government funding and simpler charting systems would mean more workers on the floor with more time to provide hands-on care. More time to care would ease the squeeze on both ends. Seniors would experience fewer physical and mental ailments and not deteriorate so rapidly, and healthcare workers wouldn’t be so prone to burnout.
But getting the Ontario government to listen hasn’t been easy. CLAC has been lobbying the government for decades, speaking with politicians and supporting initiatives such as Bill 188, the Time to Care Act. The bill requires long term care homes to provide each resident with at least four hours per day of hands-on nursing and personal support services.
In April, Local 302 members from Crescent Park Lodge and Maple Park Lodge held a special meeting with Wayne Gates, MPP for Niagara Falls, to voice their concerns about the impact of inadequate healthcare funding. Wayne has just put his father-in-law into a home and knows firsthand the crisis in long term care.
“I don’t think there’s not enough money for healthcare; I think it’s all about how the [funding] envelope gets spent,” he says. “By the time it gets to the front-line workers, there’s not enough for them to do their jobs properly.”
Wayne has been petitioning on this issue and is currently working on a position paper to present to Queen’s Park. He agrees that the amount of time given to residents has to increase substantially, and that the staffing levels have to be appropriate to residents’ needs.
“The one thing I notice in any facility I visit is that the staff love their patients,” he says. “They want what’s best for them; they’re the resident’s family. They’re the ones who see them and the only smile they see some days. And to have only seven minutes of their time is unacceptable. Is this what we want for our seniors who built our province, our country? Is this the treatment they deserve?”
“It would be great if we could have 10 or 15 minutes with the residents,” says Jennifer. “Then we could get them up, move their legs around, get them sitting. But if we did that with 10 residents, there would be people who we wouldn’t be able to get to the bathroom.”
In the meantime, CLAC members are doing the best they can with the time they’ve been given. For Jennifer, that means trying to connect with each person on a personal level. It’s the simplest things that often make a world of difference.
“If someone’s having a behavioural issue or a down day, I’ll ask them about their kids or grandkids,” she says. “Just something simple like that can take them out of their bad spot. Their face lights up and they’re a totally different person."