Long Term Care in Crisis

S	eniors' Issues Today

November 2000

Long Term Care in Crisis

Highlights:

The Ontario government is underfunding LTC facilities by at least $230 million a year

Two conflicting trends – this continued underfunding, and an older and sicker resident population – are causing major stresses in the system

The short-term solution is to raise the province’s share of the per diem from $60 to $71

Long Term Care in Ontario is in Crisis

Government funding for the operation of municipal and charitable homes for the aged and nursing homes is not keeping pace with the changing requirements of residents who today are being admitted with far more complex health care needs. As a result, these facilities are now finding that their ability to provide adequate, appropriate, quality care is being compromised.

These two conflicting trends -- continued underfunding by the provincial government, and an older and sicker resident population with increasingly complex needs -- are causing major stresses in the system.

"Something has to give, and it shouldn't be the residents," says Donna Rubin, CEO of the Ontario Association of Non-Profit Homes and Services for Seniors (OANHSS).

"We're doing everything we can to try and keep the system from coming apart completely. But we're rapidly approaching the point where our facilities can no longer cope," says Rubin.

OANHSS estimates that the Ontario government is now underfunding long-term care by at least $230 million a year. That's the minimum amount of new funding required to meet current demands. Significantly more will be needed to address future demands.

Currently, Ontario long-term care facilities receive an average of about $100 a day for each resident. Of this, about $60 is paid by the province -- one of the lowest rates in the country -- with the balance coming from client payments.

Over the past two decades, the average age of long-term care residents has increased from about 73 to 86. The typical resident today is not only older, but also sicker (often having multiple chronic illnesses) and in need of more care (such as intravenous feedings, wound dressings, palliative care, psycho-geriatric care, behaviour intervention, and special support).

As well, about half of all residents today suffer from Alzheimer disease and other dementias, and mental illnesses.

So while the need for more intensive nursing and specialized support services has risen dramatically, facilities have been unable to adequately respond because government funding has been insufficient.

Without an immediate annual increase of $230 million in operating funding for long-term care facilities, the many problems in the system will only get worse. These are:

Service/Program Cutbacks

In the face of these mounting problems, long-term care facilities have had little choice but to cut back on programs and services.

The most common response to the crisis has been to reduce the level of individual attention.

For example, residents with dementia/Alzheimer disease and behavioural needs may not get the special attention they require. Also, residents may not receive the level of personal support or help with daily living they need. For example, routine baths may be given once a week.

"What care they do receive is of the highest quality, but the level of care is not what it should be. Residents and their families are telling us it is not enough, and we have to agree. But we simply don't have the staffing or funds that are necessary," says Rubin.

Staff Stretched to the Limit

Nursing staff and health care aides are stretched to the limit because of inadequate funding.

For example, each Registered Nurse now looks after an average of 60 residents during the day shifts, and 100 residents during the night shifts.

Staff providing resident care are looking after more people with higher care needs.

In many facilities, all employees including administrative personnel are having to help out with certain duties, such as feeding the residents, because of staff shortages.

The Ontario Association of Residents Councils reports that many residents are commenting on the fact that the nurses are now working so hard that they have less time than they used to for social contact and they really miss it.

Long Waiting Lists

According to Ministry statistics, there are about 14,000 people waiting for placement in long-term care facilities.

Wait times vary by location, with some having waiting lists of up to four years.

The Ontario government has announced the creation of an additional 20,000 beds, but most of these will not be available for several years.

In the meantime, many facilities are having to turn away people who need long-term care.

Even when the 20,000 new beds are added, the problem of under-staffing and inadequate levels of care will continue to plague the system as long as the province fails to provide the necessary operating funding.

Impact on Hospitals

The province's acute-care hospitals are crowded with elderly patients requiring long-term care.

These individuals cannot be discharged because often there is nowhere for them to go (long waiting lists at facilities). So they remain inappropriately placed in hospitals rather than home-like settings.

Also, the impacts are:

additional and unnecessary costs to the health system ... hospital stays ($400 and more a day) are about four times more expensive than long-term care

crowded emergency rooms, patients laying in gurneys in hospital hallways, people in need being turned away

Long-term care facilities, if properly funded, could help alleviate this problem. A majority of these patients could be cared for in LTC with an increase in funding per diems that is still a fraction of what it costs in hospitals.

Only Going to Get Worse

These trends will only accelerate in the future.

In Ontario, the 85+ age group is expected to increase four-fold by 2028.

Currently, there are some 100,000 people in Ontario who have Alzheimer disease. This number is expected to triple over the next 30 years.

According to the Ontario Ministry of Health and Long-Term Care (MOHLTC), the number of people with dementia will increase 85 per cent by 2010. Dementia is one of the main reasons for LTC facility placement.

Conclusion

Ontario Premier Mike Harris has issued a letter stating that "protecting seniors and the most vulnerable in our society remains a key priority" and that his government is committed to ensuring "the very highest quality health services" for all residents of long-term care facilities.

Yet sadly, in spite of the good intentions and some measures to address funding concerns, long-term care is in crisis in Ontario.

With an older and sicker resident population, staff stretched to the limit, long waiting lists, people being turned away from facilities, and lack of proper funding from the government, is it any wonder that long-term care facilities are in crisis?

MOHLTC has a budget of more than $22 billion, yet it is spending only $1.5 billion or about 7 per cent of the total on the operations of these facilities.

OANHSS is calling on government to urgently address this crisis by immediately raising the government’s share of the per diem by $11 (from $60 to $71) ... increasing provincial operating funding for long-term care facilities by about $230 million a year.

While this is only a stop-gap measure, it will help us deal with the most pressing demands. Longer-term, the province must invest significant new money in community services, home care, supportive housing, and long-term care.

OANHSS and other provincial associations are working with government, as part of the MOHLTC's budgeting process, to identify the need.

Donna Rubin
Chief Executive Officer, OANHSS
(P) 905-851-8821 extension 230
drubin@oanhss.org

C	ontact OANHSS

Ontario Association of Non-Profit Homes & Services for Seniors
7050 Weston Road, Suite 700, Woodbridge, Ontario L4L 8G7
(P) 905-851-8821
(F) 905-851-0744

OANHSS Privacy Policy

OANHSS members include not-for-profit providers of long term care, services and housing for seniors in Ontario.
Members include municipal and charitable long term care homes, non-profit nursing homes,
seniors' housing projects and community service agencies.