Julianne Belzile 7/15/2011

Transcription

1 A Growing Problem The Impacts of the Privatization of Long- Term Care Facilities on Residents and Families Julianne Belzile 7/15/ Words

2 It is an undisputable and inevitable fact: progressive leaps in medical technologies that have extended human longevity far beyond anything the human race has ever seen before combined with a population that is growing larger but becoming less fertile (United Nations ) is resulting in a greater percentage of the world s population than ever witnessed before aged sixty years or older. Add into this formula the massive baby boomers generation continuing to age beyond sixty years, and the global percentage of those aged sixty or more will jump beyond the current global standing of 11% to a projected 22% in This trend will also be seen in Canada, where the national population aged sixty years or older is currently 20% and is anticipated to jump to approximately 32% by 2050 (United Nations, 2009.). As more of the population of Canada ages, it is imperative that seniors are able to afford access to the highest quality of care in order to continue their lives in relative comfort and happiness. Long-term care facilities, which are government-funded facilities that provide 24-hour nursing care to seniors, provide this care (Jansen, 2009.), and their importance is growing with the population. In the near future, more and more people are going to require the services that these facilities offer, and long-term care facilities must be able to not only keep up with the growing demands of an aging population, but to also offer the highest quality of care at the lowest possible cost in order to ensure that seniors can have equal access to happiness, comfort, and quality care. The privatization of long-term care facilities is threatening this goal, and is therefore becoming a growing concern for both residents and their families; once privatized, the facility is primarily a business and is therefore no longer concerned with providing high quality care to all who require it at an affordable cost. The goal of a private long-term care facility is ultimately to attain the highest possible profit, often at the expense of the health of its residents. The shift from non-

3 profit to for-profit facilities is being witnessed all over Canada, with Newfoundland and Labrador as the only exception (Jansen, 2009.). and it is negatively impacting both residents and families. The biggest impact for residents due to the privatization of long-term care facilities is a lower quality of care. This has been shown in film, including in director Dennis Dugan s comedy Happy Gilmore. Due to an unfortunate monetary problem, the title character s grandmother loses her house and is forced to stay in a long-term care facility while Happy tries to win the money to buy back her house in golfing tournaments. Unbeknownst to Happy Gilmore, his grandmother has really been placed in a dictatorship-like labour house for seniors, and the residents are unable to stand up against their mustachioed supervisor as he forces them to make quilts for his profit. Although the scenario is extremely exaggerated for comedic effect, these scenes from Happy Gilmore do represent the lack of care that residents receive in private long-term care facilities in Canada. This lack of care includes an increased risk of hospitalization from preventive ailments, such as pneumonia, anaemia, dehydration, fractures, and falls (Shapiro and Tate, 1995.), and is primarily due to lower staffing levels (McGregor et al., 2005.). There is noteworthy research showing that for-profit long-term care facilities have a significantly smaller staff than public long-term care facilities and that this lack of service negatively impacts the mental, emotional, and physical health of residents (Harrington, 2008.). With fewer nurses, a resident is less likely to spend a sufficient amount of time with a nurse for actual rehabilitation, dietary, and nursing reasons. This will result in decreased physical and mental health of the residents. Unfortunately, lower staffing levels do not apply solely to the nurses; the support staff is decreased as well. The support staff is usually responsible for providing food, personal care, a healthy and safe environment, and socialization opportunities, including planned events, to the residents. With

4 fewer support staff, the nurses are forced to help cover these responsibilities in addition to their regular nursing duties, and the only way that they can accomplish this is to provide quick, generally low-quality care. This further decreases the amount of time a resident has with a nurse each day and also results in residents receiving fewer meals, baths, and other personal care. This will negatively affect the physical health of residents. The lower staffing levels also result in residents spending less time socializing with other people, which negatively affects resident mental and emotional health. In cases of extreme under-staffing, residents could be left in soiled underwear for hours, unable to receive any help because there is no one available to assist them. The effect of decreasing staffing levels on residents is similar to going to a fast food restaurant during its busiest hours when there are not enough staff working: no one gets their food quickly, and the food and service are often of absolutely terrible quality. It s not just the residents who are at risk in these situations, either: worker health is also at stake. The staff are rushed to get tremendous amounts of work done with too few people to do everything that must be done, and this often results in staff injuries. Rushing about to do as much work as possible in as short a time as possible also results in sacrificing high quality work, and therefore high quality care, for residents. Also, due to the low staffing levels, most staff members usually continue working despite injuries or illness because there is no one to cover their work for them; if they do not show up, the residents will receive even less care. However, this needlessly puts the residents at risk, as they are often in frail conditions; the common cold could be potentially fatal to them. In addition, research has shown that residents in private long-term care facilities often rely on the unpaid help of family members for everyday necessities. Nearly 30 per cent of residents in longterm care facilities receive assistance from unpaid caregivers with meal preparation, cleaning, and laundry, while one in 10 receive personal care (such as bathing) from family members

5 (Statistics Canada, 2008.). Due to decreased staffing levels, the overall health of residents will unfortunately deteriorate, increasing the risks of hospitalization and death. Lower staffing levels are seen more in for-profit long term care facilities than in public facilities due to the profitdriven nature of private facility: in order to make a larger profit, the facility can cut wages and staffing levels. As explained above, this has the ripple-effect of poorer quality care for residents. These low staffing levels due to privatization are hurting the residents in numerous ways that could be easily avoided. Another impact of the privatization of long-term care facilities on residents that also affects their families is the unavoidably higher costs of the private facilities. For-profit facilities are essentially run as a business; therefore, the residents are charged more for services that would be significantly less, or in some cases completely free, in a non-profit facility (Baumbusch, 2008.). Because the out-of-pocket expenses are higher, many seniors are unable to afford private long-term care facilities; they are being denied access to healthcare, which violates the universality concept of Canadian healthcare (Jansen, 2009.). They are forced to turn to their families for help, which puts tremendous pressure and stress on the family. The family becomes overburdened from providing unpaid care-giving services to their aging relatives, which results in stressful and tense relationships within the family. This stress can put the mental health of the family at stake and can seep into all other parts of the family s life, including work, school, and relationships with friends. As well, income to the family is lost as hours are devoted to unpaid care-giving instead of working. This loss of work not only hurts the family economically, but damages society as a whole as labour is lost. Despite the high costs, seniors with any way to pay will do so in order to guarantee a spot, referred to as a bed, in a long-term care facility. This is because of the bed shortage in Canada. The current trend across the nation is to either decrease

6 the number of beds in long-term care facilities or to increase them disproportionately to the amount of the population aged sixty or older, resulting in not enough beds (Jansen, 2009.). For example, in Alberta there were 20.8% fewer beds available in 2008 than there were available in 2001 for seniors aged seventy-five years and older. Despite having increased the total amount of beds available in the province by 1.2%, this increase was disproportionate to the increase in population of the age group (a 27.7% increase in the province), resulting in the discrepancy (Cohen et al., 2009.). In addition to this, the few beds that are added to long-term care facilities are usually solely for-profit, making them more expensive and therefore less accessible. The provinces are limiting instead of expanding access to long-term care facility beds. There are not enough beds for everyone who needs one, so anyone who has a bed is going to hold onto it for as long as they can, even if the service is terrible and the costs are high. The waiting lists for a bed, even a non-profit one, are extremely long, and refusing a bed in a facility that is too far away from friends and loved ones or that doesn t provide certain services usually results in the person being sent to the bottom of the waiting list. The resulting wait-time is measured in years (Jansen, 2009.). During this time, the family must step-up to care for the senior, bringing about all of the problems mentioned above. The privatization of long-term care facilities is creating all manners of problems for residents and their families, ranging from financial issues to relationship stresses that breach out into all of their other aspects of life. The high costs are greatly impacting the lives of residents and families. The ideas of growing old and living in a long-term care facility aren t exactly at the forefront of a young mind; most adolescents are so caught up with living in the moment and being young that anyone who mentions long-term care facilities, death, or growing old is considered either suicidal or pessimistic. It s just not something young adults think about. I am

7 just a young student, fresh out of high school, and the furthest ahead I have planned is just two years down the road; the rest is a complete mystery to me. I will admit that I wasn t all that thrilled to start this essay because I simply couldn t relate to the topic. What do long-term care facilities have to do with me? None of my grandparents or other immediate family members live there. But then I realized that I and people I know and love are not going to be young forever. Someday, I or someone I know may be left with no choice but to pay for a private long-term care facility, and we may be subjected to the same humiliating and disgraceful care that seniors are receiving now in these facilities. If I don t speak out for them now, who will speak out for us in the future? The world s population is becoming older at a rate never before witnessed, and the issue of quality care and access to that care for seniors in long-term care facilities is becoming more important than ever. The senior population of Canada should not have to be subjected to poor quality care and limited access to health services. They should be able to happily live out the rest of their lives in an environment that is well-staffed, affordable, and comfortable to their lifestyles. The privatization of long-term care facilities results in many problems, including unaffordable care and under-staffing, resulting in poor quality service, that deeply impact residents and their families.

8 References Cited Baumbusch, J.L Decommissioning citizenship: The organization of long-term residential care. Unpublished Doctoral Thesis. Vancouver: University of British Columbia. Cohen, M., Tate, J. and Baumbusch, J An Uncertain Future for Seniors: BC s Restructuring of Home and Community Health Care, Vancouver. Canadian Centre for Policy Alternatives BC Office. April. Retrieved at Harrington, C Public vs. Private Nursing Homes: Lessons from the US. Conference presentation, Economic Security Project, Reimagining Health Services: Innovations in Community Health, Vancouver, BC, November 6 8, McGregor, M.J., Cohen, M., McGrail, K., Broemeling, A.M., Adler, R.N., Schulzer, M., Ronald, L. Cvitkovich, Y. and Beck, M Staffing levels in not-for-profit and for-profit long-term care facilities: Does type of ownership matter? CMAJ, 172(5): Jansen, I Residential Long-Term Care in Canada: Our Vision for Better Seniors Care. Canadian Union of Public Employees, October Shapiro, E. and Tate, R Monitoring the outcomes of quality of care in nursing homes using administrative data. Canadian Journal on Aging/La Revue canadienne du vieillissement, 14: Statistics Canada Eldercare: What we know today. Catalogue no Canadian Social Trends. October 21. United Nations Population Ageing and Development United Nations Department of Economic and Social Affairs, Population Division, Retrieved at United Nations World Population Ageing: United Nations Department of Economic and Social Affairs, Population Division, Retrieved at