Dignity Denied: Long-term care and Canada

(Apr 15, 2008) -- 'No longer can governments be allowed to ignore the deepening crisis in our nursing home sector. The care of Canada’s seniors, now so shamefully neglected, must become a top priority for all of us.'



There is a gaping hole in Canada’s health care system. For tens of thousands of Canada’s seniors today — and for many thousands more in the years ahead — the universality of our health care system ends at the doors of nursing homes.

Some of these facilities are excellent, but, sadly, they seem to be the exception. As a result of government cutbacks and corporate profit-taking, the needs of many seniors have been swept under the carpet, abandoned and ignored by health care commissions, politicians, and policy-makers alike.

For far too many Canadian seniors, nursing home care is inaccessible or unaffordable. In some provinces, wait lists for nursing home beds are excruciatingly long — up to two years. Most beds become available only when residents die.

In addition to lengthening wait lists, affordable options have been disappearing for many seniors. Private nursing home care can cost between $40,000 and $70,000 a year, depending on the community. This is clearly not a viable option for most seniors.

In the patchwork system that has evolved, it is apparent that public and non-profit nursing home care provides the most affordable solution. But even this option is becoming unaffordable for many seniors as these facilities struggle to fill the funding gap left by government funding cuts.

Low government funding has also forced seniors and their families to pay a high price in unacceptable staff-resident ratios, diminishing quality and quantity of care, crumbling infrastructure, outdated equipment, poor dietary practices, and inadequate therapy and recreation and services.

As well, the ugly spectre of for-profit health care has cast a dark shadow across parts of Canada’s health care system in recent years. Nowhere is this shadow darker than in nursing home care, where seniors have already borne the brunt of the short-cuts that corporate profit-taking generates.

It is no coincidence that the decline in the quality of nursing home care in Canada is happening with the rise of privatization and for-profit care. The profit-taking nursing home industry, having established a dismal track record of lower standards in the U.S., is now exporting these same shortcomings to Canada.

The negative impact of diminished funding, corporate greed, lower standards, and weak regulation is also felt by the thousands of women and men who work in Canada’s nursing home sector. These workers are too often undervalued, underpaid, and overstressed. They are injured at work more often than any other occupational sector. In far too many cases, the industry amasses lucrative returns for investors by denying fair wages for the back-breaking work performed by front-line workers.

The annual turnover rate among direct care nursing home staff typically runs at 20% for nurses and 40% for health care aides. Health science professionals such as dieticians, therapists and social workers are often treated as frills and the first to be disposed of when budget cuts are implemented.

High turnover rates, and the absence of a team of health care providers, have a devastating effect on the working environment, staff morale, and quality of care. Nursing home workers know better than anyone the gap between the care they want to give and the care they are able to provide.

Governments are not only failing seniors today, but they are also woefully unprepared to meet the challenges of tomorrow — despite the demographic crisis now looming. Three important trends are occurring:

  • Canada has had a relatively low birth rate for the past 30 years, a trend that shows no sign of changing.
  • The baby boom generation is nearing retirement age and the first shock will be felt around 2010. Five years from now, one Canadian resident will turn 65 every two minutes. Within 15 years, the rate will be one a minute.
  • Canadians are living longer. Today, there are some 430,000 Canadians over 85 years old, twice as many as in 1981 and 20 times the number in 1921.

With this profound demographic shock just around the corner, and the increasingly unique and complex health services required by seniors, the need for a cogent, national nursing home strategy is becoming even more pressing.

Canada’s universal public health care system was designed to ensure that the health care needs of the most vulnerable would never be sacrificed for the benefit of the wealthy and powerful. Yet in nursing home care, that is exactly what is happening. Our most vulnerable citizens are suffering while governments tolerate, even foster, an inadequate system that favours the wealthy while allowing profits to be drained away by giant corporations.

It is time for bold and fundamental change. Canada has the resources to provide better nursing home care for the elderly, and Canadians want to see it happen. Creating a high-quality nursing home care system requires stable, sufficient public funding. It requires more staff. It requires legislated optimal standards of care. It requires more public scrutiny and better enforcement of standards. It requires adding nursing home care to the Canada Health Act. Most of all, it requires political leadership.

No longer can governments be allowed to ignore the inaccessibility, unaffordability, inferior care levels, and the deepening human resources crisis in our nursing home sector. The care of Canada’s seniors, now so shamefully neglected, must become a top priority for all of us.

James Clancy
National President