Last week (end of April 2021), two reports were released that should influence the way government fixes its dysfunctional long-term care (LTC) system. The Office of the Auditor General of Ontario and Ontario’s Long-Term Care COVID-19 Commission laid out their conclusions and recommendations to fix the broken system that severely affected those citizens and staff who rely on the 625 care facilities and resulted in mass deaths (4,000) and infections.
Pandemic Readiness and Response in Long-Term Care 2021
LTC Commission Transmittal Letter to Minister Fullerton
Thousands of people with disabilities, including those who have an intellectual disability, of various ages have been placed in these facilities and have experienced the tragedy’s full effects.
What is clear is that the Auditor General’s 16 recommendations and the Commission’s 85 recommendations will not truly transform the eldercare system. Both sets of recommendations narrowly focus on the immediate causes and effects that contributed to mass deaths and infections. The reports highlight well-known and documented issues such as poor infection prevention and control procedures (IPAC), staffing deficits, underfunding, building design faults, and communication and planning problems. Both reports emphasize the lack of readiness by the government for such an epidemic even though regulations require government and LTC operators to be prepared. A litany of long-standing dysfunctions in this institutional-based system was confirmed – once again.
The hope of social justice advocates and many seniors themselves was that the reports would highlight the need and point in the direction of a 21st-century elder care system, one that would emphasize what progressive jurisdictions in other parts of the world have done. Instead, these reports focused on the operational improvements that keep the current institutional/medical model of care in place for elders and those with disabilities.
The Commission, for example, ignored testimony about the experience of Denmark, a country that has not built a single nursing home bed in 25 years after committing to a policy priority that emphasizes a robust home care system. Instead, the Commission recommends tens of thousands of new institutional beds as a solution to the pending tsunami of disabled and unwell baby boomers sure to fill the spaces.
In the early 1970s, Walter Williston, QC was instructed by the PC government of the day to investigate the death and injury of two residents at the Smiths Falls institution (Rideau Regional Centre) for those who have a developmental disability. My friend Gordon Ferguson was there at the time. Williston was also charged with plotting the future of developmental services and the role of institutions in the scheme. The outcome of Williston’s work was a complete reform of the system of services for people who have an intellectual disability. The plan focused on the development of a comprehensive community-based system of services and phasing out the institutional model, which eventually led to the closing of all institutions. The developmental services system today is rooted in Walter Williston’s work.
The COVID-19 Commission heard testimony about the work of Williston and the development of a better community-based accommodation system for people with disabilities but chose to ignore these lessons. The LTC institutional approach is deeply embedded in the landscape of eldercare and is seen by many as a normative feature even if no one actually aspires to be admitted. This familiarity prevents the vision that says everyone can live in their community lifelong with support as needed, either at home or in a supportive living situation nearby. Those working in developmental services know this to be true.
The 20th century systems thinker Russell Ackoff said that “it is better to do the right thing wrong than to do the wrong thing right”. Trying to improve the dysfunctional long-term care institution-based system for elders and people with disabilities is a clear example of Ackoff’s wisdom.