On talk shows, in news headlines, and in speaking with seniors, nurses hear the same stories: seniors who need care don't know where to turn. Most seniors want to "age in place," maintaining their independence for as long as possible. Home care is in short supply, and there are long wait times for long-term care. Access, expense, and safety are significant concerns for seniors seeking care.
As the number of seniors in the Canadian population continues to grow, the crisis of care is set to worsen. Data from Statistics Canada and the Canadian Institute for Health Information confirm that seniors are living longer than ever, with increasingly complex conditions.
And yet, Canada's spending on long-term care as a percentage of GDP remains stagnant, lagging behind the OECD average.
The result: when the CFNU polled 1,116 nurses working in long-term care and home care, a large majority said current staffing is insufficient to get the job done. About two-thirds of home-care nurses polled work involuntary overtime on a weekly basis. More than half of long-term care nurses say they usually don't have enough time at work to do their job well.
The reality is that improvements in home care and long-term care cannot be achieved without additional staffing to meet increasing demand.
Staffing shortages have a direct impact on seniors' care. The CFNU's poll results show that on a monthly basis, essential care is being left undone "frequently" or "sometimes." About half, or more than half, of nurses working in long-term care reported omitting vital tasks such as toileting, foot care, and assistance with walking over the previous month. Other tasks often or intermittently left undone during the month included turning residents so that they don't get bed sores (44 per cent), bathing (35 per cent) and feeding (24 per cent). Falling — which often precipitates seniors' declines — was identified by close to 60 per cent of nurses as a "major problem" in long-term care, followed by lack of timely care.
What message are we sending to our parents — our loved ones — if we as a society neglect such basic human needs?
Minimum standards of care, such as those in Ontario's Bill 33 (Time to Care Act) which won all-party support in second reading, as well as the provincial average proposed by the Ontario government, would be a good start. While a minimum provincial average of 4.0 hours of direct care per resident per day would be an improvement, as nurses we feel that this standard serves as a minimum threshold, not a ceiling. Indeed, almost two decades ago, the U.S. Centers for Medicare and Medicaid determined that 4.1 hours per resident-day (including 2.8 hours for non-licensed and 1.3 hours for licensed) was the threshold below which negative outcomes such as weight loss and pressure ulcers were more likely to occur.
Given the increase in both the numbers and intensity of home care and long-term care needs, the CFNU supports the expert recommendation of 4.5 hours of direct care per resident each day (with a minimum percentage provided by regulated nurses, including registered nurses), if the goal is to improve seniors' quality of life.
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The reality is that improvements in home care and long-term care cannot be achieved without additional staffing to meet increasing demand. Provinces need to stop issuing platitudes about seniors' care and invest in seniors as a priority.
Seniors in both home care and long-term care with increasingly unstable and complex conditions require the clinical assessments that a registered nurse can provide to ensure that necessary care services can be identified, coordinated and delivered seamlessly to seniors in a timely fashion.
Investments in education and training for all members of the health care team are also essential to better serve seniors' care needs.
Seniors deserve safe, quality care. To achieve this, we need the right staff mix, the right numbers of staff, increased education and training, and minimum standards of care to ensure our parents and loved ones receive the care they need, and the dignity we all deserve.
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