In Sweden, long-term care workers often have time to take patients outside for a walk. In Canada, having a patient shuffle from their room down the corridor to the dining hall is frequently considered “a walk”. It is this kind of difference in the nature of long-term care facilities from one country to the next that has prompted York sociology Professor Pat Armstrong to launch a global study on long-term residential care.
"There are better ways of doing many things regarding long-term residential care, more creative ways,” says Armstong. She is confident that the study will come up with ideas on how to improve conditions for workers and residents. “Long-term residences need to be a positive option, not the last resort as it now seems to be in Canada."
Armstrong says people feel shame when they have to admit a family member to a long-term care facility. “People see long-term care as a failure of themselves, their family and the health-care system. The main goal is always to keep them out of long-term care homes, rather than saying how can we make them attractive interesting places to be and work.” People are apologetic for not being able to care for their loved ones at home, but home care is not necessarily ideal either, Armstrong says. There can be issues with caregiver burnout and elder abuse, and it’s often just not a viable option as many women – still the main caregivers – work full time.
Right: Pat Armstrong
“How we treat this vulnerable population and those who provide their care is a critical indicator of our approach to equity and social justice, as well as to care,” says Armstrong. “Long-term residential care is a barometer of values and practices.” It raises questions regarding fundamental human and social rights, the role of the state, as well as the responsibilities of individuals, families and governments.
"Reimagining Long-Term Residential Care: An International Study of Promising Practices" is a seven-year project with $2.5 million in funding from the Social Sciences & Humanities Research Council of Canada’s Major Collaborative Research Initiatives program. Armstrong will lead an international team of researchers seeking to identify the most promising practices for long-term residential care, ones that treat both providers and residents with dignity and respect. The team is less interested in pointing out what’s broken in the system, than in coming up with promising practices to improve it.
Up until now, there has been little research on residential care in Canada or elsewhere that has taken this kind of approach, says Armstrong. What has been done tends to focus on issues such as patient abuse and under-staffing rather than on issues related to gender and diversity, the relationship between the conditions of work and conditions of care or on policies that will lead to quality care. Meanwhile, the need for long-term residential care in Canada is expected to grow in the face of psychiatric, chronic care and rehabilitation hospital closures, the shift in hospital focus to short-term acute care and outpatient services, and with an aging population, she says.
The research team, which includes physicians, architects, sociologists, philosophers, social workers, historians, political scientists and economists, along with representatives of competing interests, such as employers and unions, will compare practices in Canada, the United Kingdom, the United States, Norway, Sweden and Germany. They will look at four different themes – work organization, accountability, approaches to care, and financing and ownership.
Left: An elderly woman sits by a window. Photo by Chalmers Butterfield.
In the area of work organization, researchers hope to find care models that better meet the needs and balance the rights of residents, providers, managers, families and communities. Under accountability, they are looking for structures which nurture care and inspire quality workplace relations. They will also investigate financing and ownership models to identify the contexts, regulations, funding and conditions that allow residents and providers to flourish and that ensure equitable access to quality long-term residential care.
“We’re hoping to get the pieces of a kind of mosaic to guide us to a better place for all the countries…to producing an integrated picture of long-term residential care and how to do things differently,” says Armstrong. “In many ways, the approaches to care are the most important.” In this country, the emphasis seems to be more on finances, but it is imperative that approaches to care provide a viable, desirable and equitable option for individuals, families and those who provide care. Both providers and residents need to be treated with dignity and respect in the approaches to care, she adds.
The plan is to have researchers work in all four thematic areas, not just their area of expertise, to help generate new ideas and novel ways of approaching problems. “I emphasize the ideas because we're not just thinking about the residents, but the families, the workers and the governments,” Armstrong says.
Long-term care raises many complex issues dealing with gender, diversity, aging, sexuality and providing medical care once the domain of hospitals. Typically, long-term care residents have been mostly women, currently about 80 per cent, but the number of men in care has increased. So has the number of younger people needing constant care and not served by a hospital. Most care workers are also women, many of whom are from racialized communities. Trying to find the most promising practices is not an easy task and one size will definitely not fit all, but at the same time there is much room for improvement, Armstrong says.
Armstrong, who holds a Canadian Health Services Research Foundation/Canadian Institutes of Health Research Chair in Health Services & Nursing Research, expects the project to create readily usable research.
“We hope the research will make a difference long before the project is done.”