Thread by @MoriartyLab

Every single #Canadian must read this report.

Desperation & exhaustion lead most ppl to place loved ones in LTC, due to completely inadequate support in communities. Isolation & lack of any supports leads others to be placed. Children who live far can't place parents near them.

https://twitter.com/IacovosMichael/status/1265358147608129536

In general, the level of care needed by most ppl by the time they finally get into LTC is high. Resident:staff ratios so high that it's not possible to take the time needed by many residents, and to prevent/deter rushing, abusive language by staff, reactive behaviour in residents

Staff burnout in these settings is high. Often enough, not always, but often, blame for failures rolls down hill. There is little inspection of homes, and "punishment" for failure to meet critical components of care is cursory.

Reputation matters to some homes--they have long waiting lists. But there's no real down side to having a bad reputation, except that it may be hard to get good staff, and perhaps more residents in crisis may be placed there, making the care burden higher.

There is such a shortage of LTC beds, that there's no incentive to do a great job. If the home is bad, they frequently aren't inspected anyway, and they typically aren't shut down, ever, because it's inconceivable to reduce the number of available LTC beds in the system.

There are basically no to few plans to expand LTC bed availability outside private partnerships--it's too expensive for many governments to consider funding, and it's considered fiscally prudent to do it as a private partnership.

The real cost of building & supporting LTC is the real cost. Private companies say they can do it for less. It's hard to know how they could, but we agree to turn a blind eye & believe in the unspecified money-saving magic of private enterprise w/out asking too many questions.

I estimated the real costs of caring for one person with moderate-advanced dementia, at minimum wage, based on my experience caring for both my parents. It's >$8,000/month, minimum wage, no holidays, no benefits.

That doesn't include "capital" costs like housing, social activities, food, diapers, specialized "services" i.e. nurses, physiotherapists etc. There are some excellent day programs that can help, but access is limited, and is in no way compatible w/ FT work by caregivers.

Unless families are exceptionally well off, the only way to care for someone w/ moderate/advanced dementia is for 1 person to stop working, or multiple family members to reduce hours. But even if workplaces help w/ childcare, there is nothing for caregivers w/ aging parents.

That's if you have a job that is stable & has some workplace protection. Forget minimum wage, less than FT jobs that many Canadian families rely on. Basically, the only way to do this is for 1 family member to stop working or greatly reduce hours, unless you're really well off.

And in many families, especially generations currently caring for aging parents, the person who quits the job or reduces hours or just can't work is the woman. If you don't have a partner, again, forget it--you can't care for an aging parent & pay rent if they need constant care.

I describe this, and how desperate it can be, even though I am very well off compared to most Canadians, I am extremely educated and articulate and know how to draw attention to a problem. But my partner had to stop working years ago so we could care for my parents.

We have been utterly desperate, and many days still are. We are exhausted, and have been doing this for 10 years. I have been told that I would have to die before my mom could be placed in LTC, and I had to nearly lose my job before my dad was placed on the LTC crisis list.

I cannot emphasize enough that we are the lucky ones, exceptionally lucky, and we have struggled profoundly. Every single PSW who cared for my mom & dad, in community & in LTC has been excellent. Every single PSW in community is vulnerable, most are recent, isolated immigrants.

What we turn a blind eye to, is the massive exploitation of unpaid and extraordinarily underpaid labour to care for our aging relatives, even though in many Canadian cities it's no longer possible for many people to house, feed & clothe their families w/out 2 income earners.

Most of us couldn't afford the real cost of care ourselves unless we truly are wealthy.

Never mind capital expenditures to build LTC homes. Universities have to mount massive fundraising campaigns to build buildings.

How many philanthropists would fund LTC buildings?

When we get down to it, ask any health professional student if they would work in LTC or geriatrics, even though the need is urgent for ppl to train & work in these areas. Many, not all, but most, will tell you they're not interested. Eldercare isn't sexy, it doesn't have cachet.

ok. I keep wanting to rant, but I have to stop and make myself just read and go to bed.

We've earned this crisis, every step of the way. All of us.