CCBI News – Complex Issues—Bill 7 (More Beds, Better Care Act); Re-Imagining Long-Term Care; Nunavut—Perils of Climate Change

September 23, 2022

Dear Friends of CCBI,

This week we include ethicist Bob Parke’s response to Dr Bridget Campion’s article, “Considering Bill-7.” He addresses concerns about the Bill as well as the situation and options that both elderly residents and younger disabled people in longterm care facilities face. Dr Campion then offers “Re-Imagining Long-term Care” and “Nunavut and the Perils of Climate Change.”

More Beds, Better Care Act: Addressing Complex issues
Bob Parke

Thank you for the newsletter (CCBI News September 9, 2022) and Dr Bridget Campion’s article “Considering Bill-7” (More Beds, Better Care Act). There is much to be concerned about and I believe there will be legal and human rights challenges ahead.

Addressing the issue of Alternative Level Care (ALC) patients waiting in hospital for a Long Term Care (LTC) bed is a complex issue for which there is no one easy solution. However, finding ways to care and keep people at home and postpone admission to a hospital especially for “social admissions” should be supported. Having available, consistent and reliable home care can be helpful. Given the challenge to find staffing for home care, other options like a paid caregiver leave patterned on maternity leave could contribute to keeping people in the community for the longest possible time. Robust and available home care programs or a caregiver leave program could also have the benefit of supporting the informal caregivers who become burned out from the demands put on them. By providing robust care in the community, we will also significantly reduce the number of people admitted to acute care hospitals for social reasons.

On a more specific issue I have a concern about Bill-7 from the perspective of people with disabilities. I believe that people with disabilities who are in acute hospitals should be given an accommodation or exemption. At a recent meeting a person with a disability, who lives in a LTC facility, made a couple of points worthy of our consideration. The person pointed out the important distinction between the needs of people with disabilities going into LTCs and the needs of elderly people entering LTC. The elderly come into LTCs “to die,” while people with disabilities enter into LTCs “to live.” Most LTC residents are elders, often with dementia. Understandably, the environment, the recreational programming and staff knowledge are oriented towards that population, and they strive to provide good care so that the elderly resident can age and die in place.

By contrast, younger disabled people need a space or place oriented towards living which requires environments that are conducive to young people to allow them to thrive and “live.” Such environments for younger people include access to current social media, art that is displayed and relevant to them, food that is satisfying to their taste. It must be ensured that the social and recreational programs provided by LTC where disabled young people are transferred are oriented to their needs. Further, simple access to and from washrooms, hallways and meeting rooms makes a home that is adapted to a younger person’s needs. Fortunately, newer homes are constructed with better consideration for accessibility.

An additional issue in older homes is comfort during our hotter summers as some still are not air conditioned despite government direction. This is very concerning for younger persons with a disability. The homes that may have beds available are likely to be older homes which have the additional environmental challenges of accessibility and lack of air conditioning, yet this setting is where a disabled younger person may be compelled to transfer to from hospital.

For those of us concerned with the morality of MAiD and who want to uphold the dignity and worth of all people I recommend listening to the September 6, 2022 interview of Meagan Gillmore by Dave Brown on his AMI program, “NOW”. During this interview she spoke of how people with disabilities don’t want to live in LTCs and some of them are “terrified” to live there. In the context of the discussion about Bill – 7 she said that she would not be surprised if “there is an intersection with MAiD and this action.” To avoid the unintended consequence of a MAiD request, this is further reason to make accommodations for young disabled people being transferred from hospital to a LTC facility.

Some will argue that the legislation allows for people to be transferred from one LTC to a preferred LTC. Whether for the general population or for people with disabilities, this is a false hope as it rarely happens. 

I highlight these concerns about Bill – 7 from the perspective of disabled people who cannot reside in the community since appropriate housing is not readily available. They should be exempted or accommodated when hospitals seek to discharge them to LTC. If transfer to a LTC setting is the only option for people with a disability, then it should be made to an LTC that can accommodate their needs so that they may not only “live” but thrive. People should not ever be in the situation of thinking that MAiD is their best option.

Bob Parke

Sources:

AMI – NOW with Dave Brown – Ontario Passes Long-term care Bill: September 6, 2022
Interview with Meagan Gillmore https://podcasts.apple.com/ca/podcast/now-with-dave-brown/id1235751531?i=1000578583803

Re-Imagining Long-Term Care
Bridget Campion, PhD

I had planned to research alternatives to Bill 7 for this week’s CCBI News (creative ways of delivering acute care services, allotting more money to home-based care etc.) but I started thinking. Yes, the threat of having to pay $400/day may indeed move ALC patients out of acute care beds. But it occurred to me that there might be an even better way to free up those beds: make long-term care facilities safe, clean, and humane. Every one of them.

With COVID, the tragic shortcomings of Ontario’s long-term care system came under a klieg light, leaving people scandalized – and terrified. Governments insist that they are committed to the reform of long-term care; what I would like to suggest is that a re-imagining of long-term care will do a great deal to “solve” the beds crisis in the acute-care sector.

For instance, imagine if there were planning in place and money allotted to ensure that communities had enough long-term care beds for persons who needed them. In this way, residents would still be close to home and the support of their loved ones. Given the horrifying discoveries made by the Canadian military during the COVID crisis, imagine if long-term care facilities were clean, safe, and served nutritious food to their residents. Imagine if these facilities employed full-time (rather than contract) front-line staff, providing them with job security, good wages and benefits. Not only would this signal the facilities’ respect for hands-on care as skilled health care, but it would do a great deal to mitigate staffing shortages. Imagine if these facilities were resident- rather than task-centred in their care, encouraging and allowing staff to take time to engage in supportive interactions (e.g., conversations) with residents. Imagine if these facilities provided enhancement activities for residents, including those residents suffering from dementia, helping them to thrive exactly as they are. Imagine if these facilities regarded family members and loved ones as care partners who make valuable contributions to the wellbeing of residents. Even in times of lockdown, they would find ways for families and residents to connect. Imagine if these facilities were integrated into the community, providing space for community needs (e.g., after-school programs, allotment gardens) and activities open to both residents and community members. Living in a facility, residents would still be connected to their communities. At the same time, an otherwise hidden population would be visible, emerging from the margins. Imagine if residents and loved ones could be assured that the holistic wellbeing of residents and staff would never be sacrificed in the name of profits for investment firms now making their way into the long-term care “industry”. Imagine if residents and loved ones were assured that when death came, residents would be cared for with dignity, respect and love.

I think this “re-imagining” of long-term care would do a great deal to free up acute-care beds. And it would have the added benefit of enhancing the lives of a vulnerable and valuable patient population, as well as the lives of those who love them.

Nunavut and the Perils of Climate Change
Bridget Campion, PhD

Even as floods, droughts, heatwaves and wildfires engulf many parts of the world, in fact, it is the Arctic that is particularly susceptible to the effects of a warming climate. Relying on the experiences of Elders as well as scientists, the Government of Nunavut is preparing its population for the inevitable changes it will be facing.

According to the Nunavut Climate Change Secretariat (NCCS), warming temperatures are leading to profound changes in the environment: permafrost and sea ice are melting; the onset and duration of seasons are changing; precipitation and extreme weather are increasing; and without the weight of glaciers and ice sheets, the land itself is rising. These changes in turn have the potential to affect the health and wellbeing of the population.

For Nunavummiut, climate change carries with it the risk of food insecurity. According to the NCCS, “Climate change’s projected impacts include less access to wildlife and more safety risks from changes in sea ice thickness and distribution, permafrost conditions and extreme weather events. This means traditional food security may be significantly affected.” Traditionally, Elders had provided and passed on their ability to predict the weather – an essential skill in the provision of food obtained through fishing, hunting and gathering in the Arctic. However, climate change has led to “changing cloud and wind patterns” which have made it more difficult to predict weather, which can make travel more dangerous. As well, the NCCS notes that even if food is secured, “[f]ood storage is also affected by warmer temperatures and thawing permafrost. Interviews with elders suggest that outdoor meat caches, which used to remain fresh and preserved in the cold, now spoil.”

The shift to buying food from stores brings its own problems. Processed foods, with their excessive salt and sugar content, carry health risks. “Country food is still the healthiest food choice for Nunavummiut” according to the NCCS. More than that, food is often central to a culture’s identity. For Nunavummiut to switch to commercial foods is to chip away at culture and identity, which in turn is detrimental to the wellbeing of individuals and communities.

Housing, another pillar of the social determinants of health and already an area of great concern in Nunavut, will also be adversely affected by climate change. Melting permafrost will weaken the foundations of housing and other structures, making them unsound. It will also bring instability to infrastructure such as roads, airstrips, and pipelines.

While the Government of Nunavut is committed to adopting policies that reduce greenhouse gases, its overarching strategy is one of adaptation. As David Shewchuk, Nunavut’s Minister of the Environment writes in Upagiaqtavut – Setting the Course: Climate Change Impacts and Adaptation in Nunavut: “For generations, the people of Nunavut have demonstrated an ability to adapt to rapidly and drastically changing circumstances. It is this adaptability that has allowed Nunavummiut to survive in what most people in the world consider to be a cold and hostile environment.” But adaptation in the face of climate change is a monumental task. As the NCCS notes, “For centuries, Inuit have maintained a close relationship with ice (siku), land (nuna), sky (qilak), and wildlife (uumajut). Inuit rely on innovative survival skills adapted to the unique climate and weather of the Arctic. Rapid environmental changes will continue to affect Inuit culture and the well-being of all Nunavummiut.”

Sources:

Nunavut Climate Change Secretariat https://climatechangenunavut.ca/en
Upagiaqtavut – Setting the Course: Climate Change Impacts and Adaptation in Nunavut https://climatechangenunavut.ca/sites/default/files/3154-315_climate_english_reduced_size_1_0.pdf

Pope Francis’ Intention for September
Abolition of the Death Penalty

We pray that the death penalty, which attacks the dignity of the human person, may be legally abolished in every country.

Moira, Bridget, Bob and Bambi