Bet on better care to beget more beds

In his recent homily at the National Eucharistic Congress in Matera, Pope Francis described the dangers of this world. “The abuses perpetrated by the powerful against the weak, indifference to the cry of the poor, the abyss we dig every day, generating marginalization… all these things cannot leave us indifferent,” Francis said. 

Ontario’s Bill 7, the More Beds, Better Care Ace, is all about indifference — indifference to the wellbeing of people in acute-care beds while awaiting placement in long-term care facilities.

Let me acknowledge that alternate level of care (ALC) patients are not solely seniors. Many are younger and living with disabilities that prevent them returning home. They, too, are affected by the indifference of Bill 7. However, much of my research with the Canadian Catholic Bioethics Institute has focused on elders and social justice, so I will view Bill 7 through that lens.

The Bill’s priority is clear: attend to the needs of the acute care sector by forcing ALC patients out of acute care beds and into long-term care facilities. Those who refuse will be charged $400 a day, starting Nov. 20. Otherwise, they must go, at least temporarily, to wherever the discharge planner sends them — perhaps as far as 70 km away from home in southern Ontario, or 150 km in northern Ontario. Such distances can be hard for families of loved ones consigned to distant LTC homes.

Bill 7 is a “More Beds Act.” But here’s the question: is it also a “Better Care Act?” And if so, for whom? Here we must address the elephant in the room — the state of long-term care facilities for seniors in Ontario.

My work as a clinical ethicist many years ago took me into long-term care facilities for a mostly senior patient population. Residents and staff were together for the long haul and invested in each other. We worked on quality of life issues, humane restraint policies, education about elder abuse, practices to involve residents and families in care decisions. I moved into academia just as LTC began to change. Residents with more complex care needs became the norm while government funding of LTC failed to support this reality. The seeds were planted in the 1990s for the disaster that was to occur in LTC when COVID hit, particularly in the privately owned, for-profit LTC facilities. Thousands of seniors living in LTC facilities in Ontario died. Those who didn’t die often suffered grievously. Canadian military personnel were called to assist in the operation of five facilities found horrifying filth, infestations of vermin, residents suffering from malnutrition, dehydration and other neglect. The military’s report was written mere months into the pandemic, making one wonder what conditions were like in those facilities prior to COVID.

Even now, I have a friend who tells me her mother was allowed two diapers a day in a LTC facility.

The Ontario government’s plan to increase the number of long-term beds is laudable but “Better Care” is not about quantity. It is about the quality of care residents will receive in those new beds. It’s about understanding that residents of nursing homes and other LTC facilities are human beings in need of compassion, companionship and care. It is about knowing that, created in the image and likeness of God, they are of inestimable dignity and worth exactly as they are. They are gifts to the world and deserve “Better Care.”

There is a practical side. If LTC facilities across the board provided the compassionate care for residents to thrive in LTC, I’ll bet it would be much easier to convince ALC patients to vacate acute care beds. In other words, “Better Care” for all residents of all long-term care facilities would lead to “More Beds” being available for acute care patients.

In his homily, our Pope continued: “Let us dream … of a Eucharistic Church. Made up of women and men who offer themselves as bread for all those who are fed loneliness and poverty, for those who hunger for tenderness and compassion, for those whose lives are crumbling because the good leaven of hope has been lacking.”

This would be my dream for long-term care in Ontario. 

(Campion is Assistant Professor in Assumption University’s new Graduate Diploma Program in Catholic Studies, teaching Catholicism and Social Justice online. She is also an occasional contributor to the Canadian Catholic Bioethics Institute’s publications, including the CCBI News Bulletin.)