How Nursing Homes Fail: The Perspective of Family

I asked Jenn Jilks, a long time reader and commenter here, to write a few words on nursing homes, and the sometimes disgraceful care they provide for residents. The problem isn’t that nursing home operators “try hard”, or “do the best they can with limited resources”; the real issue is the lack of accountability inherent in the system, whether its unlicenced and unregulated care providers, the lack of stringent provincial standards for nursing home care, or the larger questions of a government which believes the minimal standards are good enough, or of  taxpayer subsidies to a profitable industry.

Jenn maintains and writes several blogs: Cottage Country Reflections, Thank Your Teachers and Ontario health Care — For Those Over 50.

My mother died at home and my father died in a long-term care (LTC) facility. I became heavily involved, as I wanted to have some influence. As things progressed I did a bit more research. Having been a caregiver in Mom’s home, I saw both sides of the coin. I have many issues with for-profit LTC.

  • In Ontario, over 500 of the 600 LTC institutions are FOR-PROFIT.
  • Food in LTC is appalling.
  • Most of the care in LTC is provided by unregulated, non-professionals with a gr. 12 degree. Some have a training certificate.
  • The disparities between rural and urban care continues.
  • The highly-touted Aging at Home Project did not create many jobs, and failed to find more staff for under-staffed institutions.

I met a lot of people in these homes. Calling the patients residents is a bit disingenuous. Those with strokes, or comatose, spend their days horizontal. Many I met were unable to make their way around their homes any more. Some were tired. With incredible life stories, now wheelchair bound, they spend their days waiting by the dining room in preparation for the next meal. Many use the retherm method, simply reheating food you cannot recognize as food.  Spareribs with no bones and veggies with no life. If you’ve ever fed pureed food to a frail senior, you will know how difficult this is. What I wouldn’t have given to see my father eat an apple or a banana.

In the meantime dividends are sent to shareholders of the for-profits.

Now, these places have intense programs, with activity directors who set up many activities. There are volunteers who spend time feeding, fundraising, or entertaining those in the residence. For the most part, the homes I visited in Muskoka were places where a harried crew of people worked hard to ensure that these people, who are loved by someone, can spend their days clean, busy, well-fed and engaged. Many are in pain, however, and lonely.

Personal support workers (PSWs) are involved in the intimate care of these people who cannot care for themselves.  Some call them Health Care Personnel (HCPs), to my mind they are interchangeable, but not all are equal. Caregivers can range from the very competent, to those incapable of finding a kind word for a resident and barely literate. They are running, most of the time, trying to find another staffer to move a resident from bed to wheelchair or toileting. Some work for private agencies, some work for profit agencies, called in to LTC or retirement homes to supplement staff. There are huge inconsistencies. Who dares complain?

With only a minimum grade 12 education, a short number of months at a college, PSWs find themselves wiping the most intimate of areas, and doing things for our elders that was formerly done by themselves independently and alone. Some try to diagnose for resident’s families. The college certificate required by some for-profit institutions is inconsistently provided. None are followed long-term by the nursing departments who supervise them. Especially in the north, where workers are in high demand, the poor ones quit and go private. In the meantime, we spend big bucks advertising to promote an awareness of elder abuse.

We cannot call them nursing homes much anymore, as much of the ‘nursing’ is done by non-professionals. I’m not talking about medications, or more complex care. Most of the time there is a Charge Nurse on the floor. She spends time handing out meds or sorting out treatment plans and the paperwork that engulfs all professionals. There are never enough PSWs to do the lifting, transfers, changing of incontinence products or feeding required. As for physicians.  .  . they are few and far between. It took me two months to get adequate pain meds for Dad. No one recognized his signs of pain: singing, fussing with clothes, agitation, and it is my endless regret that I did not fight harder.

In my experience poverty leads to institutionalization, rather than disabling diseases. Many seniors would rather die in filth, alone, than suffer the embarrassment of giving up their independence of their own homes. The government does not pay enough to truly support our elders. Nursing homes are staffed according to the number of residents, not the severity of their illnesses, those with chronic disorders and/or mental illnesses cannot get the individual care they merit. Our tax dollars go to subsidize the residency of the old and frail in LTC who cannot support themselves in their homes due to failing health, failing eyesight, or failing bank accounts. The shame of it is we do it so poorly.


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  1. #1 by Boris on Wednesday 20 October 2010 - 1230

    Thank you for posting this. My family is working to place my grandmother in a LTC. She had dementia and has progressed to the point where it is too severe for the retirement home she’s in now. She simply requires too much care and supervision for the staff in her current facility (Two years or so ago she was in her own home in the country, laughing and badgering.) The problem is that there are waiting lists for the better facilities. We think the place she is in now is waiting for an excuse to call an ambulance so the hospital can hold her and they can declare her too severe; she doesn’t do well in hospitals and they are clearly not nursing homes. So it is a bit of race between finding a place for her or having her end up in the hospital, which I understand creates a whole new set of obstacles to finding LTC positions. And this with family members who have worked within the system and can advocate for her by section and clause. I can’t imagine what it must be like for families who don’t know the system or don’t know how to fight it.

  2. #2 by Cheryl on Wednesday 20 October 2010 - 1838

    “Many seniors would rather die in filth, alone, than suffer the embarrassment of giving up their independence of their own homes” – your quote. Until my recent experience with my mother, this was my mantra (I am 62). I have changed it because of what my (selfish?) desire could do to my children’s lives. I also changed it because it only works if I do not have dementia; in which case, I could become a danger to my neighbours (burning the house down) and a neighbourhood nuisance (wandering, hoarding, going into their homes, causing traffic hazards). It is a balance between my own desire and my responsibility to my family and community. So I am working at cultivating an adult relationship with my kids that will include nuanced conversatison about my wishes and what their care of me will mean to them. I may even try to put it in writing. Thank you for this blog which says a lot of true things about the nursing/retirement home system

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