It has taken me awhile to gather my thoughts following the ‘Crying out for Care’ episode (http://www.cbc.ca/marketpla…/…/2017-2018/crying-out-for-care) aired on Marketplace. “What makes you an expert?” you may ask.
Here’s the reader’s digest version of MY story in point form.
- My Mother, at the age of 63, was diagnosed with early on-set Alzheimer’s disease in 1997. By the year 1999 I had to place her into long-term care in a Municipally funded home in a specific area for Dementia residents. At that time she could still walk, but no longer could speak (other than gibberish), nor could she make decisions, dress herself, shower or even remember to go to the bathroom. She exhibited many outbursts and behaviours at the time, which was handled with medications to sedate her.
- Throughout the 8 years in long-term care she declined rapidly mainly due to the age she developed Alzheimer’s disease – the younger a person develops the disease, the quicker the decline.
- She experienced 2 falls that required medical attention (one being a broken pelvis). Following the fracture she never walked again. I can only assume it was because her brain wouldn’t allow her to relearn the task at hand. Add in a wheelchair combined with her disease made her more vulnerable to neglect and resident on resident adverse behaviours; one being a resident entering her room to try to sexually assault her. A family member witnessed this and immediately ran to the nursing station. My mother was examined and it was determined that she had not been sexually assaulted (they had caught the other resident right before he tried anything). As a daughter I was outraged, disgusted, and told the home that I didn’t want my mother in the same wing as the other resident, otherwise I would call the police. Within an hour my Mother was transferred to another floor and placed in a respite room until a bed arose on that floor. Following a few weeks, she had her own room, and lived the remainder of her life on the second floor receiving outstanding care.
- Jump to the year 2005. I decided at the age of 41 to return to school full-time and study activation in gerontology at the downtown Toronto George Brown campus. I graduated in 2007 with honours. I found a full-time activation aide job almost immediately at a privately run home in Bolton (King Nursing Home). Eager and excited to be working with residents and staff where I could bring both my personal and schooling experience to was a dream come true. How was I to know, at that time, and years later throughout my career at different facilities, it would become a nightmare?
Your story on Marketplace was correct in the lack of staffing in the nursing department, but what you never touched on was the lack of staffing and sometimes education of staff in the recreation department.
- Recreational and Social Activities
(a) have a post-secondary diploma or degree in recreation and leisure studies, therapeutic recreation, kinesiology or other related field from a community college or university; or(b) are enrolled in a community college or university in a diploma or degree program in such a field.
* You will notice that the issues with the designated lead and staff qualifications is that individuals who have a social worker diploma or OTHER can also work in long-term care in the recreation department. It takes special education to deliver holistic programs to work with individuals who are elderly, suffer from different forms of dementia, and those who are cognitively alert yet physically challenged. In comparison, I ask that you refer to the LTC act for the personal support worker qualifications.
Every licensee of a long-term care home shall ensure that on and after the first anniversary of the coming into force of this section, every person hired by the licensee as a personal support worker or to provide personal support services, regardless of title, has successfully completed a personal support worker program that meets the requirements in subsection (2).
(2) The personal support worker program,
(a) must meet,
(i) the vocational standards established by the Ministry of Training, Colleges and Universities,
(ii) the standards established by the National Association of Career Colleges, or
(iii) the standards established by the Ontario Community Support Association; and
(b) must be a minimum of 600 hours in duration, counting both class time and practical experience time.
I have to question why is there a difference in qualifications/education for personal support workers versus the recreation/activation/life enrichment/programs department? I believe that many people are unaware of the on-going training needed to work in long-term care and with residents. Recreation staff makes up an integral part of the residents lives, but sadly is many times overlooked in the homes by the MOHLTC and management.
- PSW’s deliver ADL (activities of daily living for e.g.: getting resident up out of bed, dressing, bathing, bathroom duties, brief changes, feeding, etc.)
- Recreation takes over from there.
The Recreation department endeavours to run small, large and one-on-one programs tailored to the specific needs, abilities and challenges of each and all residents. Yet once again, as in the staffing for PSW’s, there is no ratio of recreation per resident set out in the LTC act.
- For example, when I was Program Manager at Eatonville Care Centre that housed 247 residents set out on four floors, I had one full-time recreation staff member per 60 residents. How can one person meet the different needs of 60+ people every day? How can recreation complete paperwork in a timely manner when they are being pulled in different directions on the floor? Recreation staff is constantly called upon by nursing when resident behaviours get out of hand. “Take Mary with you into the program, she keeps yelling out in the hallway”, “We need something for Harry to do, can you do something with him?” etc. etc. etc. With the reduction of prescription use of antipsychotics in long-term care (which should have occurred years ago), I have to say that I have witnessed more challenging behaviours exhibited by some residents ergo more trained recreation staff is needed. Recreation staff who have been specifically educated in recreation in gerontology are trained to diffuse unwanted behaviours such as: delusions, hallucinations, fear, anxiety, depression, anger, etc., but it takes time (diffusing unwanted behaviours doesn’t happen in two minutes).
One of the questions you asked in your expose was: Is long-term care in Ontario in crisis? No, we are beyond crisis, and we are failing each resident residing in a long-term care facility. Whether it’s a thirty-nine year old MS resident, a fifty-nine year old schizophrenic resident, a seventy-five year old massive stroke resident, a sixty-five year old Alzheimer resident, or an eighty-seven year old resident – should it matter? Hell YES, it matters! We as a society and province OWE it to each and everyone of them to properly care for their needs, and more importantly care for them as a ‘person’ with dignity and empathy, not as an inconvenience or annoyance…Our system grades an F for fail on all accounts; failing staff and more importantly failing residents, their families and loved ones. I only hope that with more conversation and education our system can be rebuilt as soon as possible, otherwise just ship me out on an iceberg when it’s my time.