Sunday, May 15, 2011

Assessing and evaluating long-term care

Read any good studies lately? Most of us don't. We have the media for this, and we know how much we can trust the media, or other groups that seek headlines, not facts.

In a new study, forewarning us about the dangerous statistics, LTC, and the Silver Tsunami, the authors cite another fear we have to face:
Crowded long-term care and the dangers of for-profit residences.
 Now, for those unwilling or unable to read this 40-page study, several groups have been interpreting it for us. Bless them. I think. 

CARP, for example, (sister lobby group for the US-based AARP), is comprised of mostly vocal senior Ontarians who don't want to pay taxes. CARP looked at this study. Not with a critical eye. CARP says, 'The authors admit, however, that there are considerable methodological challenges associated with measuring the quality of care in LTC facilities.'
Then why promote the study in the first place???

The study uses references from CBC News! The study quotes 'a number of high-profile reports':
 CUPE? Really? A policy paper from a union/lobby group...
Here is one paragraph...

Many facility residents have dementia, and the majority are women with low incomes (Cohen et al. 2005). This population is therefore highly vulnerable and has relatively little voice. Decision-makers (Medicare 2010; Ontario MOHLTC 2009; Sharkey 2008), members of the public (CBC News 2009) and academics (Harrington 2001; Kerrison and Pollock 2001) have all expressed concerns about the quality of care in residential care facilities. A number of high-profile reports addressing the quality of care (CHA 2009; CUPE 2009; Sharkey 2008), residents’ rights and public oversight of residential care (K. Carter 2009) have been published in the last two years, reflecting Canadians’ concern for the well-being of this frail population.

However, I looked at the references. This study is a US study based on US statistics from a pretty flaky looking study.

Castle, N.G., and J. Engberg. 2005. “Staff Turnover and Quality of Care in Nursing Homes.” Medical Care 43 (6): 616-26.
'IMPLICATIONS: These findings are significant because the belief that staff turnover influences quality is pervasive. The cross-sectional results are only able to show associations, nonetheless, few empirical studies in the literature have shown this relationship.'

Long-term care in Canada is publicly funded, whether the home is public, nonprofit or for-profit. It is not so in the US. To use this data in such a report is faulty. Not only that, but most of the LTC in
Ontario are for-profit. The for-profit homes operating in Canada, have head offices in the US. Scandals, lawsuits, and horrific tales of neglect - like those we have seen in Ontario, dominate the news and lead political will, and this is frightening.

 Violence, Insufficient Care, and Downloading of Heavy Care Patients (PDF)
An evaluation of increasing need and inadequate standards in Ontario’s nursing homes      

Keith (left) at the Remembrance Day Ceremony, 2008
A relatively small proportion of elders currently requires residential care: one in five individuals aged 85 years and older. Although making projections as to future needs based on current rates may be somewhat inaccurate [Do you think you should avoid it, then?], we estimate that by 2041, 120,000 beds will be needed in addition to the current 200,000 beds across the country (Statistics Canada 2008).

I continue to work with and see a great number of seniors helping other seniors. The paratroopers seem to be the most vibrant. My favourite is Keith Metcalfe, who was delivering Meals on Wheels at age 85, while president of his Legion. 

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