I am also a professor at York University.
Thank you for inviting me here today, and for your attention to advancing inclusion and the quality of life for seniors. My presentation is based on my many years of research, which have made it clear that inclusion and quality of life are at least as important within health services as they are outside of them.
Today I want to focus on three main issues—namely, access to appropriate health services, the scope of home care, and the quality of long-term residential care.
I begin with health services. As I am sure you know, the 1964 Hall Royal Commission on Health Services concluded, on the basis of a thorough investigation of the evidence, that covering the full range of services was the only logical and money-saving way to coordinate care, ensure that people were receiving appropriate care, and eliminate both the expense and the delay of sorting the deserving from the undeserving. But the federal government decided it would start with hospitals, and then doctor care, before moving on to other services—an expansion that never happened.
The evidence gathered by the royal commission is still relevant today, and the need for universal, coordinated coverage of the full range of services is even more urgent with population aging. The growing numbers with chronic health issues need to be able to move smoothly among services and be treated within them by those who understand geriatric care.
We need a national initiative, similar to the Canada Health Act, to ensure universal, accessible, and comprehensive care, and to finally complete the project begun long ago. Our seniors, who struggled to bring us our most popular social program, deserve no less, and our search for equity requires it.
I now turn to my second issue. Care at home is claimed to be the first choice of everyone, and certainly this is what my friends say, but my friends are middle class and have pensions and a wide circle of family and other friends. The notion that everyone is best cared for at home ignores the fact that many people have no safe, healthy homes, and that many homes are not havens in a heartless world, as the feminists used to say.
Smaller families, more singles, and the need for children to move to find employment are among the factors that mean that many people have no family or friends near enough to provide care or companionship. The aging-in-place solution also ignores the fact that many people require skilled care that cannot easily be provided by partners and friends, who are themselves getting older, and it ignores the fact that many people live in places unsuitable for those very heavy care needs. I live in an old Victorian house that is full of stairs. You have to use three sets of stairs to get into it, and I can tell you that those lifts you see on TV won't fit on my stairwells.
Finally, care at home often means isolation at home, as we just heard, especially if the only accessible groceries are at Walmart, miles away, and the local bank has closed. Isolation is the opposite of inclusion.
The focus on care at home often ignores the conditions of work for those providing paid and unpaid care, at the same time as it fails to understand the skills as well as the risks involved for both patients and care providers. In other words, we cannot rely on care at home to provide for many of the current care needs. For those who can be cared for at home, we need to provide enough paid staff with appropriate skills, and create working conditions that ensure quality of life for those who provide, as well as for those who need, care.
Finally, I want to focus on long-term residential care. Very few people plan to go into long-term residential care, and most governments, as well as much of the population and many staff, see it as a last and worst resort. But no matter how much we focus on aging in place, we are all potential residents and have a vested interest in ensuring the quality of care there.
As a senior manager we interviewed in Ontario explained, “The average length of stay or living in the home is 18 months, and every day I say, ‘If you had only 18 months to 24 months of life left, what do you want it to be?’ And it's our job to make that the best it can be.” The job belongs not only to that manager and those staff, but to all of us. Our eight years of team research and studies of 27 care homes in six different countries have convinced us that the conditions of work are the conditions of care. You cannot have resident-focused care without creating the working conditions that allow for such care.
Right now in Canada, we too often fail to provide those conditions, which is one reason why those who provide direct care in these homes have the highest rates of absence due to illness and injury. Indeed, staff in care homes are more likely to get injured than police officers or firefighters.
If we are to focus on adding life to years rather than simply focusing on adding years to life, we need to understand the importance of not only having enough staff but also having enough staff with appropriate education and conditions that ensure continuity in staff. Higher turnover rates and reliance on casual, part-time, and agency staff increases the risk of injury while undermining the care relationships that prevent violence and provide quality of life for seniors, to name only some of the working conditions at issue. A significant body of research also indicates that ownership matters, and that the quality of care tends to be lower in for-profit homes.
In conclusion, I would add that the consequences of our current system are profoundly gendered. Women live longer than men, use the health system more, and have fewer economic resources, so the failure to provide care has a gendered impact. The impact is unequal among women as well. Women also provide the overwhelming majority of paid and unpaid care work, so poor conditions of work have the greatest impact on them. In home and residential care, a significant number of those women are from immigrant and racialized communities. We need a federal initiative to ensure universal access to the full range of health services delivered by non-profit organizations based on the same principles as the Canada Health Act. This also means a human resource strategy that ensures appropriate conditions of work. We need to do it now, before it's too late.
Thank you.
I'm sorry about my voice, I have a chronic issue in my throat.