CCBI News – Euthanasia—No Substitute for Palliative Care; Francis—Care of the Elderly
June 17, 2022 Dear Friends of CCBI, Euthanasia is No Substitute for Palliative Care Two…
CCBI News – The Elderly: In Canada: Inquest; Wisdom; Catholic Social Teaching; Future LTC Homes
May 20, 2022
Dear Friends of CCBI,
The Elderly in Canada
The negligent ways in which senior citizens and the elderly were treated in the early days of the pandemic have been further revealed in a report by a Quebec coroner. According to The Globe and Mail, her inquest into deaths at the Herron home showed: “The local health authority for Montreal’s West Island, known by the initials CIUSSS, had told the home’s owners on March 29, 2020, that it was taking over the facility after Herron staffers deserted their posts. But for 10 days it wasn’t clear who was in control, and basic care remained spotty. The coroner found that, “No one took charge of it – neither the ministry, nor the owners, nor the CIUSSS. They wrote to each other, exchanged a lot of e-mails, but during that time people were dying, people were dehydrated, people were lying in their feces.” Incredible in a first world country – not that these actions could be sanctioned anywhere!
In a previous ‘Opinion’ article in The Globe, some well known figures in Canadian health care referred to the moral duty of fixing long-term care. Systemic problems are often stifled, but the statistics they quote should shock us into resolving, not hiding, the problems. The authors write, ” During the first few months of the pandemic, long-term care home residents accounted for 81 per cent of COVID deaths in Canada, a rate far higher than that of any other developed nation. By the spring of 2021, as the pandemic reached its one-year anniversary, 16,000 long-term care home residents across the country had died. Most upsetting is the fact that we could have avoided this national tragedy altogether if we had addressed structural problems in our nursing homes that health experts had been flagging for years.” The last part is correct: the structural problems are well known, but knowledge without the will to change is practically useless. Will the systemic problems remain? Do questions about them feature prominently in provincial and federal debates? Are the relevant ministers held to account? We say we care, but do we care enough to do something about this?
Dr Rory Fisher has long asked questions of this nature and has brought these injustices to public attention, seeking to remedy and improve the care of senior citizens and the frail elderly. In his contribution today he refers to the ‘warehousing ‘ of our elderly and makes strong recommendations about possible improvements. Social attitudes are changing about all sorts of circumstances in Canada, including euthanasia. It’s possible to see that people might choose such a course rather than put up with negligence and uncaring treatment in places we call ‘long-term care.’ If we truly care about human dignity, our actions will have to follow, and we need to become more active for the sake of the common good in trying to make society more aware that the elderly deserve a truly dignified, natural death, sustained by those who love them, in turn sustained by our health care systems.
If we were to realize more fully that such action ties in with our Catholic emphasis on the preferential option for the poor, perhaps our responsibilities would become clearer. We need to look beyond ourselves and our own circumstances to the common good, and that means some level of activity in the political realm. Catholic hospitals and facilities have a duty to establish and maintain this vision, but Catholics in general need to be looking to remedy areas destructive of dignity, especially when their parents and relatives are in care facilities. Regular exposure to Catholic Social Teaching is important to focus us and remind us of its core values. Care, long-term or otherwise is not about profits or worldly success in the first instance, but is care for people, vulnerable people who depend on that care in the later stages of life.
Pope Francis and Wisdom of the Elderly
In a short video, the Pope reminds us that the elderly are still very much alive and fruitful. They have a mission, like everyone else. They can still ‘bear fruit in due season.’ The Pope commends their wisdom and peace as fruits of their suffering and experience which help them recognize they have ‘met’ God. Pope Francis’ positive attitude of encouraging better treatment of our ‘anziani’ is also a reminder of how we can learn from them. This stands in stark contrast to the matters discussed in the other sections today, and there is no doubt which approach is the right one. A ‘Tweet’ by Bishop Crosby of the Diocese of Hamilton struck me as confirming this. On Mother’s Day he wrote: “Called my mother. Sent her flowers. Even in her senior years she appreciates both. Pope Francis asks us to remember all mothers living and dead. They deserve our affection eternally!” We can say the same for fathers and all those in their senior years – show them we care!
Pope Francis and the wisdom of the elderly in the face of suffering
Future Long-Term Care Home
Dr Rory Fisher
The major mortality in LTC homes throughout Canada during the first wave of the COVID pandemic highlighted the long-standing problem of the Canadian practice of warehousing the elderly in unsatisfactory, poorly-staffed facilities.
The wealthy have always had the means to buy the best care. Seniors of more modest means have historically been dependent on services made available by the authorities or charitable organizations. The Catholic religious orders played a prominent role in years gone by. In the UK, care by the religious orders ceased with the dissolution of the monasteries under Henry the VIII. In 1601 the Poor Law placed the responsibility for care on the local authorities which led to Alms Houses and later the workhouses which received such notoriety in Dickensian England. Later some of these workhouses became hospitals under the National Health Service. Another term for LTC facilities, particularly in the United States, is Nursing Homes though, as Dr Robert Kane has said, this may be a misnomer since there may not be much nursing and they may not be homelike.
At last, Provincial Governments are taking steps to rectify the situation. In looking to solutions, there must be a priority on expanding and enhancing home care so that the need for institutional care is minimized, as has been done in such countries as Denmark. New standards are being developed by the Health Standard Organization (HSO) and the Canadian Standards Association (CSA), funded by the Federal Government. Public input is being sought. These standards will be very helpful when completed but will require Provincial Governments to enforce them and ensure that there are appropriate penalties if they are neglected. For the Standards to be successful, the LTC homes will need to have sufficient appropriately paid full time staff, and resources.
A recent CBC program Marketplace “Crisis in Home Care” on the 18th of March 2022 identified the problems in Canada and showed the excellence of some facilities for the elderly in Denmark, with small facilities, well-appointed private rooms, and congregate space. Outdoor access is available, and technology used to provide maximum assistance to residents and staff. Examples of the advances in care of the elderly in Denmark have also been addressed in these Newsletters.
A long-standing Canadian example of excellent care for seniors is the Dorothy Macham Home for 10 eligible veterans with moderate to severe dementia. This one-story home is in the grounds of Sunnybrook Health Science Centre. It opened in 2001. It is based on a model developed by Dr John Tooth of Tasmania. It is designed like a home, with ten individual rooms, the floors of which have built-in sensors to alert staff if a resident has fallen or is out of bed at night. The floor was the work of the Finnish company EMFITECH. There are ceiling lifts to assist both residents and staff. The kitchen is open to the dining area. There is an interior wandering path and an enclosed therapeutic garden. The multidisciplinary team designs programs for each resident (Veterans Program, www.sunnybrook.ca)
Trent University in Peterborough, Ontario is planning a university integrated seniors’ campus of care, anchored by a 224 LTC home, where seniors can stay connected to lifelong learning.
Another North American model is the Green House Project(www.thegreenhouseproject.org). In the US there are now 359 homes in 32 States. The majority are licensed skilled nursing facilities. The buildings are small in scale, self-contained and self-sufficient. The elders are at the centre of the project. Each senior has a private room and bathroom. There is an indoor congregate space and an outdoor area that are easy to access and navigate.
The physical environment for future long-term care is extremely important but also important are appropriate programs to maintain the seniors as well as possible. The Butterfly Project has been developed by Dr Sheard of Dementia Care Matters in the UK, (www.dementiacarematters.com) based on the concept that people living with dementia can thrive in a nurturing environment where those living and working together know how to be person-centred. It has been adopted in an increasing number of locations in Canada.
The Montessori program has been adapted to assist with adults with dementia. This focusses on giving encouragement to and purpose for seniors with dementia in a respectful environment. There is a certificate program for caregivers (www.montessoridementiaprogram.com).
The LTC facilities can benefit from outside support by linking with external services and resources. The Regional Geriatric Program of Toronto provides some examples. In 2001 the Psychogeriatric Resource Consultation program was set up to provide training, education and support to LTC homes in managing residents with dementia. Consultants are now available throughout the Province of Ontario. A more recent program is that of Nurse Led Outreach Teams which provide emergency mobile nursing services to LTC homes. The RGP of Toronto also has many resources available on its website (www.rgptoronto.ca). Behavioural Supports Ontario also provide resources. (www.behaviouralsupportsontario.ca)
In summary, it is long overdue to find solutions to the problems with LTC facilities highlighted by the COVID pandemic. These solutions must be done with a major parallel increase in community care. Facilities need to be small, equipped with supportive technology to help seniors and staff, and with appropriate programs to maintain the elders as independent as possible. The increasing need for homes for seniors with dementia must be recognized. The payment of staff must be sufficient for it to be worthwhile full-time work. Other parts of the healthcare system need to provide as much support as possible. If not, the same old warehousing of the elderly will continue to the detriment of the increasingly aging population and their families.
Pope Francis’ Intention for May
For Faith-filled Young People
We pray for all young people, called to live life to the fullest; may they see in Mary’s life the way to listen, the depth of discernment, the courage that faith generates, and the dedication to service.
Moira, Rory and Bambi