Letter from a retired RN to Premier Ford: The problems with LTC were evident long before COVID

Dear Premier Ford,

As a retired RN of 28 years, I’d like to provide some perspective on the Long-Term Care crisis. Although I speak of nurses and nursing, my comments also apply to personal support workers, who provide most of the daily care. Nurses do care planning, medications, and treatments.

Although your speech focused mostly on testing, that is a bit of a red herring. The fact is that the homes have been poorly staffed for years. This has nothing to do with COVID.

Nurses work in LTC because they find working with the elderly, with complex needs, intellectually stimulating, and emotionally rewarding. It is one of the highest ways to pay tribute to the people who have made our country such a wonderful place to live.  Unfortunately, any nurse who went into that branch of nursing because they enjoyed working with the elderly were quickly disabused of the notion of any meaningful contact with the residents. They leave because the working conditions are so bad. And there is no relief sight. They are physically and emotionally drained.

When one RN cares for 30 residents, interactions for both parties are disappointing and frustrating. When pressed for time, it is too tempting to take shortcuts and provide sub-optimal care. Nurses take pride in the quality of care they provide. It is disheartening to provide care that isn’t as good as you know it could be. This contributes to moving to a more rewarding situation.

The staffing ratios for PSWs are very low. PSWs care for people who need frequent and extended contacts. These are often people who can’t dress, toilet or feed themselves, and sometimes don’t understand why you won’t just leave them alone.  Caring for them takes long periods of time and a patient manner.  Both are in short supply when rushed. I’m sure before COVID there were people sitting in soiled diapers for extended periods. The elderly have complex needs and aren’t always able to articulate their needs.  Violence towards other residents and staff is high.

I suspect that before COVID many elderly died in part from being understaffed. A good experienced nurse will recognize the early onset of symptoms and take actions accordingly. This saves lives.

When few experienced nurses work in a situation, there is no-one to pass on knowledge, judgement and skill to novice nurses. There is no-one to remember how things were done during SARS, or no-one with the experience and skill to stand up to management to insist that things be done safely.

The lack of full-time positions in the LTC homes also plays a role. When a nurse/PSW sees the same resident for several days in a row, s/he can recognize when something is wrong, and take action. When a resident is seen occasionally by part-time or casual staff, subtle clues to health are not recognized.

Nursing involves teamwork.  You rely on your team to anticipate and respond to situations in a predictable way. When you don’t have a team because the staff keep changing, it is hard to feel safe and have confidence that situations can be handled well. This also leads to nurses leaving.

I won’t discuss the ethics of avoiding paying for benefits by keeping people in part-time positions. I will say it helps people feel unappreciated.

What is appalling, and verging on criminal, is that we knew from Italy and elsewhere that this virus was especially harsh to the elderly. And yet no resources were put in place – where were the allowances for extra space, protection of staff, segregation of people with the virus, and movement of the ill to the hospital for treatment? They were left to die. Shame on Ontario – at least Italy admitted they had to make tough decisions about who got care.

And care for the ones that didn’t have the virus - was extra equipment brought in for Skyping or Zooming with relatives?  Were extra volunteers vetted to be available to provide recreation and emotional support to the residents? There are ways for family to safely visit – it just takes the required staff and supplies. What emotional support was given as they watched their friends die and had no one to turn to? What a horrible way to spend your final years. Experienced nurses could have helped to suggest and implement these interventions.

By right, the for-profit homes should be sued for failure to provide care. But they would say their standard of care was the same as the public homes. Shame again.

In your speech, you made it sound as though these are problems that no-one knew about, that the problems are because of COVID. The problems with LTC were evident long before COVID. Nurses have known for at least 20 years how bad it is to work in LTC. The Ontario Nurses Association and The Registered Nurses Association of Ontario have been raising red flags for years. The newspapers reported on conditions in the homes. The violence, the rapes, the neglect – preventing these things all require good staffing. But somehow the LTC homes thought the care was good enough. It is especially appalling when a for-profit company says they don’t have the money to hire more staff.

So yes, Ontario has a big task ahead of itself.  A drastic change is required - one that will make nurses stay in their jobs. It starts with a good work environment.

Nurses need to see that:

• there are good, dependable, staffing levels,
• they won’t rush all day or night without a break,
• they won’t be consistently asked to work overtime,
• they won’t go home feeling bad about their quality of work,
• they are part of a team and can rely on that the team,
• they are valued, and
• they will be able to provide the level of emotional care that elderly residents require.

I suggest that you sit down and listen to the nursing associations mentioned above. They have Ontarians best interests at heart. After all, we will all be there someday.

Sincerely,

Diana Sebera