I'm 68, and I'm thinking ahead. I too would like some better places around, and so that's what our big current project is looking at, what we call “promising practices”--not “best practices”, because that term is by definition decontextualized. You can't simply import something from one place and put it in another.
Certainly we've found some promising practices in Canada. We're looking for some more. The current study involves not only Sweden and Norway but also Germany, Scotland, England, Texas, and California, as well as five Canadian provinces. We're casting a pretty broad net. It's a seven-year study, so I can't report a lot on it yet, but I can certainly say that I've been at Abbotsford House here in Ottawa, for example, which I think is doing a lot of things right. We have had a meeting with the folks at Baycrest in Toronto, and I think they're doing a lot of things right.
Certainly, when you talk in terms of averages, or the sort of gross statistics I spoke of, you miss a lot of the variance between the good and the not-so-good.
Another thing I will say is that one of our research collaborators on the current project is Margaret McGregor. She wrote a paper for the IRPP a few months ago, and she looked at a whole range of studies and found that one big difference is that not-for-profit facilities tend to do better than for-profit. The reason is pretty straightforward. They tend to get the same kind of money. Sometimes the not-for-profits get a bit more because they get charitable donations, and the municipal homes for the aged, as they used to be called, sometimes get a bit extra because the municipality kicks in. But on the other side, the for-profits take money out for the obvious reason that they have to extract profit. The for-profits tend to have even lower staffing levels than the not-for-profits, and our argument is that the not-for-profit levels are too low.
There were some good studies in the States on hours of direct nursing care per resident per day, and the studies differ somewhat, but they usually come in at 3.75 hours per day. No Canadian jurisdiction meets that, so it's partly just a matter of resource availability. We treat the homes as embarrassing places we don't want to think about. We treat the workers as low-paid, low-skilled workers who we aren't going to think about much. That's one factor.
Another, which doesn't entail people having their hands out for more money, is how the work is organized. One of the things we found in the Nordic countries is that the workers have a lot more control over their work, so they can decide, well, today this person needs more help, or perhaps I will spend some extra time having a cup of coffee with that person, because then I will build up a relationship of trust and familiarity, and I'll be able to read the body language better; this person may be cognitively impaired, but there are degrees of impairment, and she will recognize me and I can help that person better in the bath and not get scratched because I'm not doing it the way she wants.
So the two main things are, I would say, staffing levels and also workers having more respect, more control, and more autonomy in what they do.