Wednesday, November 16, 2011

Stakeholders in Long-Term Care

In doing research for my book, I began to be concerned about the various stakeholders in long-term care, and the responsibility they may take for improving the healthcare system in Canada. I have recommendations in my book.


  • seek lower taxes with more efficient services: financial and physical resources for residents and LTC homes
  • unrealistic expectations of a system that is being stretched, without accountability and demanding more services with fewer dollars
  • must understand the system before they an comment on it.
  • seek to find what is working, and work with the system.

    Business / Media / Pharmaceuticals

      • holding a positive perception of LTC issues: mind, body, spirit
      • laud what is right with LTC and health
      • improve what is wrong
      • create unfettered partnerships

        • Yet media continue to use pejorative terms, like 'bed blockers', and tout a 'broken' system. They fearmonger, without pinpointing the solutions.
        • Pharmaceuticals, especially those in the US, control generic drugs, control drug testing, and do not test drugs on seniors with multiple co-morbidities. Drug interactions abound. Drugs pass testing standards that should not be on the market.

        Professional Associations:

        Canadian Nurses Association: Nurse Practitioners, RPNs, RNs, & College of Physicians 

        • make connections between family members, resident and health care teams, i.e. geriatric assessments
        • PD opportunities: keep on top of new research and research-based exemplary practices, especially geriatrics, pain management, complex co-morbidities
        • create a collaborative environment
        • facilitate the immigration of trained physicians to Canada
        • fufill the ethics of their profession and provincial governing bodies
        • fulfill the obligations of the Health Care Consent Act  
        Above all, they must be accountable to patients, residents and family members. Take ownership of the flaws in the system. We are desperately short geriatricians in Canada. Many GPs, people are told, reject complex cases, which is why many do not have a physician in Canada. An 'orphan' patient.

          Lobbying, media-based groups:

          • US-based AARP, Canadian CARP (owned by Moses Znaimer), 

          Now, how CARP can claim to be non-profit, while CARP is part of a media network group, is beyond me. "CARP is part of the ZoomerMedia interactive network."

          Non-Profit Societies: Hospice and Caregiver Support Groups 

          Support Groups:

          New lobby groups have arisen from this angst we all face.
          For each illness you and your family faces (e.g., Alzheimer's Disease, Hospice, MS, MD, cancer, palliative care), there is a society that lobbies for those facing such an illness, and will provide information, support, often services.

          Government Agencies:

          • provide stable funding indexed to inflation and population growth
          • provide a stable adequate source of funding
          • work on prevention, rather than cures
          • provide a framework for stakeholder interactions and strategies for such discourse
          • Ministers of health should undertake a dialogue
          • provide adequate resources to stakeholders
          • develop needs based budgets
          • provide more P.D. activity opportunities
          • publicize projects.


          Non-Profit LTC Associations | For-Profit LTC Corporations

          • create top-down policies, protocols and procedures
          • monitors their individual homes, take complaints (not that this worked for me as a hospice volunteer!)
           Elder neglect continues to thrive in the cold, dark recesses of for-profit institutions. PSWs can only go to Health & Safety legislation to complain, but fear for their jobs. Family members are caught up in fighting for adequate care, attention, supports in less standard institutions, and fear retribution for their loved ones. The excellent for-profits (and there are many out of the 600 or so in Ontario, alone) are so busy making a living, doing PR, doing their work, they do not advocate for higher industry standards and accountability. Omni has been hired to celebrate the good work, they publish industry news, and highlight the good things going on in LTC. An excellent PR move, but it does little to improve the delivery of senior healthcare.

            Personal Support Workers 

            PSWs do the intimate care our loved ones deserve. But they are not regulated, and are in the process of being registered. The registry itself is a flawed system, run by the PSNO, and progress is slow. I am not confident in its ability to be accountable. They work under a nurse in many institutions: LTC, retirement homes, and are employed by for-profit private home care agencies, including transfer payment agencies, like Red Cross.

            (PSW) - have two groups representing them in Ontario:

             A new association: OPSWA /  and one LTC industry-based: PSNO,
            Now, the former OPSWA, provides registration, representation, education, accountability. The latter purports to do the same, but is run by the for-profits, and does not check backgrounds when registering PSWs.
            • provide province-wide acceptable practices for counsellors
            • make library sources , books, articles, journals accessible
            • publish reports

            Family members, Caregivers and Family Councils

                Family Councils

                • make a decision when a LTC home placement is right for your loved one, as well as yourself
                • understand ADLs and manage them accordingly
                • be realistic about caregiver burden and understand that failure to thrive is not your fault
                • convey a commitment to LTC to make it work, in conjunction with the LTC home
                • work with like-minded caregivers and advocates, staff, provincial office, Ministry of Health and LTC
                • see the big picture
                • lobby for supports: medical practitioners, better nutritional standards, better qualified staff, more staff
                • become informed and encourage dialogue between stakeholders
                • sustain hope in presence of adversity, i.e. we can make a difference
                • provide time, support, financial resources
                • provide motive and opportunity
                • financial and physical resources for residents and LTC homes
                • ask the questions that encourage reflection by all parties involved: there are no WRONG questions
                • make complaints to improve LTC situations
                • get support from groups like Concerned Friends, or Hospice organizations, 
                • ACE | Welcome to ACE
            The Advocacy Centre for the Elderly is a community based (Toronto) legal clinic

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