A Dramatic Increase In Resident Complexity

Over the past five years there has been a dramatic increase in the complexity of Ontario’s long-term care resident population. In fact, only 10% of long-term care residents today have full cognitive ability. More seniors today require support with activities of daily living than ever before, and a growing number suffer from more than one chronic illness, not to mention underlying psychiatric conditions.

Dementia in our senior population has been on the rise for the last decade and more than 60% demonstrate some degree of aggressive behaviours. In many cases, the lack of privacy afforded in older homes, particularly those with three- and four-bed wards, results in more seniors displaying responsive behaviours.

Nonetheless, Ontario’s long-term care sector is adapting and
evolving. All homes have a clear focus on quality and staff members
are becoming increasingly skilled at managing complex needs and
 behaviours. Since 2010, the sector experienced a 35% decrease in the
inappropriate use of anti-psychotics, a more than 60% reduction in the number of residents in restraints such as lap belts, and a 50% decline in the number of residents experiencing pain.

These are significant gains that must not only be safeguarded but also bolstered with the laying of a course that ensures these gains are sustained for generations to come.

To meet the demands that come with caring for an increasingly complex resident population, the Association believes the government must provide a greater level of stability and predictability to funding. Moreover, future funding should ensure that access to specialized resources is afforded to every home so that residents grappling with dementia and complex behaviours can see their conditions improve, or at very least stabilize.

Maria needs and in-house BSO team in her long-term home to better manage her dementia. Read Maria’s story here.

New design standards provide the appropriate privacy, security and comfort for the residents we are caring for today. These homes have the right sleeping, living, and dining environments – roughly twice the square footage per resident than older homes. But they cost considerably more to build and operate.

Specialized Services That Make A Difference To Dementia Patients

To provide the individualized care required to manage the steady growth in resident complexity, particularly as it pertains to responsive behaviours, the government initiated Behavioural Supports Ontario (BSO) in 2010. BSO is a multi-faceted program focused on helping seniors and their caregivers better manage responsive behaviours resulting from complex mental health, addictions, dementia, and other neurological conditions.

Ontario long-term care homes benefit from both mobile and in-home BSO teams, but research indicates in-home BSO teams are two to four times more likely than mobile teams to help reduce challenging behaviours. In-home BSO teams provide round-the-clock support, 24 hours a day, seven days a week. They are an incredible resource, equipped to gain a deeper understanding of behavioural traits. They consistently review and assess care approaches in the long- term care home and help residents carry out activities of daily living. Teams use a coaching approach to teach staff in the home how to better communicate with residents and family members, and identify ways to reduce resident distress.

In many areas of the province, particularly in northern and rural communities, mobile teams are frequently substituting the role of in-home BSO programs due to their affordability. The challenge with this approach is that mobile teams are not available to provide meaningful, round-the-clock support to an increasingly complex resident population. For example, in the north, homes that support indigenous populations are increasingly challenged to provide culturally sensitive approaches to managing responsive behaviours. These challenges could be met head on if in-home resources were afforded specialized resources focused on addressing these shortcomings.

To ensure seniors in all long-term care homes receive the care they need, the sector must grow its specialized in-home resources and ensure every home is provided some level of support.

The Association believes that to continue addressing the needs of residents with complex conditions and to ensure greater stability, the government must increase the availability of 24/7 specialized staff across all long-term care homes, focused on improving transitions into long-term care homes. In doing so, it would improve the ability for the sector to meet the growing needs of seniors with dementia and other cognitive behaviours and enhance the sector’s approach to capacity, ensuring homes are better equipped to provide individualized care, each and every day, for the frailest residents in our system.

Predictable Funding Ensures Quality Care And Services Can Continue To Evolve

The province sets the current funding environment for Ontario’s long-term care sector, and it does so exclusively. This approach to funding makes it very challenging for long-term care homes to work on their budgets in advance to ensure they can provide the best quality care and service to their residents.

Adopting a more predictable approach to funding will contribute to greater stability for all homes while supporting efforts to continue enhancing resident quality, sector wide. It would also follow a pre-existing formula that accounts for inflationary trends related to the annual rate of price change for goods and services, creating a more accurate view on what is required to maintain operations and ensure quality continues to evolve.

Stable funding that respects the growth in cost of living would also contribute to safeguarding the stability of long- term care homes staffing. Front-line staff forms the bedrock of our system and their wages must grow with the
cost of living.

What We Can Do About It

The Association believes a more stable and predictable approach to funding and resource allocation can bring about significant gains in long-term care homes, to the benefit of seniors and their families across Ontario. By guaranteeing all homes have access to more specialized resources that are focused in-home and ensuring annual funding is determined by provincial inflation growth, the province could provide greater stability, which would help ensure operators could meet the needs of the frailest seniors in Ontario.

Requirements to improve sector stability for residents and caregivers in Ontario’s long-term care sector:

  • Improve the ability for all long-term care homes to meet the growing needs of seniors with dementia and other cognitive behaviours by providing new investments for dedicated, specialized resources focused on improving transitions to long-term care while strengthening the sector’s capacity to provide individualized care, each and every day, for the frailest residents in our system.
  • Enhance stability for all long-term care homes that they can better meet the growing impact associated with operating pressures, by ensuring that annual funding pertaining to the Other Accommodation and Raw Food funding envelopes is predictable and, at a minimum, growing at a rate of inflation as demonstrated by the Ontario Consumer Price Index.

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