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Community Living Ontario / Aging in Place  / An Illusion of Care

An Illusion of Care

Linda Till in her role as a policy advisor to Seniors for Social Action Ontario (SSAO) is quite qualified to comment on the illusion of care in the long-term care sector. Linda witnessed first-hand the effects of institutionalization in the 1980s on children with disabilities in Homes for Special Care when she worked for CLO. Linda deconstructs the myth of high-intensity nursing and medical care in long-term care facilities and brings home the point that all people with disabilities are better off aging in place. Linda’s article is a brief introduction to her SSAO policy paper that is referenced in the article.

Glowing descriptors of comprehensive person-centred care are promised by long-term care facilities (nursing homes), creating a compelling sense of assurance that residents in these facilities will receive exceptional care. Yet the realities, as clearly documented in multiple investigative media reports, task forces and advisory panels, uncover the extent of the illusion within those promises.

A comprehensive review of the extent of this illusion shows that certain groups of people are disproportionately impacted, most notably people who have a developmental disability, whose devaluation within society is magnified in these congregate facilities.

The harm of institutionalization is inherent in the model itself. Control, standardization, regimentation, loss of personality and diminished connection to community and family have deeply affected those whose support depends on institutional care. Advocacy efforts over the previous 50 years contributed to closing all government-run institutions for people who have a developmental disability by 2009. Since then, government-led policy and procedure has resulted in the institutionalization of thousands of people with developmental disabilities into LTC facilities.

Well before the COVID-19 pandemic shed an increased amount of scrutiny on these settings, the failures within the sector were abundant. The pandemic exacerbated those failures, laying bare the fact that the institutional (congregate) model of care simply cannot meet their stated and mandated responsibilities towards their residents.

Efforts to mitigate the harms have been largely unsuccessful – extra staffing from outside organizations has proven to be very problematic. Residents are often perceived to be the responsibility of outside staff placement agencies. The failure of dignified, skilled care and support is exacerbated due to a revolving door of strangers called in to assist with people’s most intimate support requirements.

Many within community living know the rigours of Ministry Compliance reviews, and might justifiably presume similar attention would exist within the LTC sector through Ministry of Health inspection processes. However, therein lies another illusion within this system. As geriatrician Dr. Samir Sinha has bluntly stated, “the inspection process is broken.” Failures to meet the standards set out in the governing legislation have been extensively documented, along with a high frequency of neglect, abuse, and assault. The needs of the resident population often exceed the capacity of the facility staff, and chemical restraints in the form of inappropriately prescribed drugs to achieve a level of compliance and sedation abound. While the sedative side-effects achieve the desired facility-driven goals of control, corresponding side-effects often lead to severe health threats.

Linda Till, Social Policy Analyst, Seniors for Social Action Ontario