Watching a sampling of presentations to the province’s all-party standing committee looking at the upcoming spring budget, many organizations are couching their language in the context of ongoing fiscal restraint.
Not so for the Ontario Association of Non-Profit Homes and Services to Seniors (OANHSS). Good for them. Ontario’s frail seniors shouldn’t be tagged to pay for the 2008 global economic crash.
While the government likes to talk about the transfer of services to the community, Health Minister Deb Matthews should take into consideration that lower acuity settings cannot maintain the same cost structures when higher acuity patients start becoming the new normal.
Simply put, the OANHSS states in their recent budget submission: “the nature of the LTC population has changed and the LTC system needs to respond appropriately.”
The OANHSS has made a series of recommendations around improving resident care and safety and offered up a price tag of $135.4 million to do it. Not factored into that cost is a recommendation to expand the number of designated units for extremely aggressive residents. At present the province has six such units with 117 beds. Research presented by the OANHSS suggests about 11 per cent of the LTC population are “considered to show severe to very severe levels of aggressive behaviour.” 76,000 Ontarians live in a long-term care home – 11 per cent of that would be 8,360 residents for 117 beds. Further another 35 per cent of residents show moderate levels of aggressive behavior.
“Residents with moderate aggressive behaviours, while generally not posing a high level of risk to the physical safety of other residents and staff, do require more attention and that attention draws staff time away from the needs of the general resident population and lowers the overall quality of life in the home,” the OANHSS submission states.
The non-profit homes say that the present assessment system does not adequately take into consideration the resources they need to care for this evolving population.
“Not all seniors need LTC and all stakeholders are working hard to enable seniors to remain in their communities,” the OANHSS writes, “The result of this policy direction, coupled with the facts of demographic aging, is that those with the greatest need are the ones being admitted to LTC homes.”
The submission indicates a shift from primarily physical health issues to a growing prevalence of mental health issues. This is not surprising given parallel reductions in beds at the province’s psychiatric hospitals.
While many LTC homes have created secure behaviour units to deal with this shift in demand, the OANHSS notes there are limited or no additional resources made available to facilitate this.
The advocacy groups likes recent initiatives around providing what they call an “embedded model of care” where expertise and increased staff is made available to care for residents with manageable behaviours. They would like the model to include supports that would provide intensive therapy for residents with very difficult to manage behaviours.
How are resident needs changing?
According to the OANHSS overall acuity is increasing by 1.1 per cent per year. An average of 40.1 per cent of LTC residents have six or more formal diagnoses and that group is growing by 7.9 per cent every year. That includes chronic diseases such as emphysema/COPD (+3.1% annually), arteriosclerotic heart disease (+ 5.2% annually) and renal failure (+6.4% annually). The percentage of residents with some form of end-stage disease is increasing by 13.2 per cent per year. Antiobiotic resistant infections are going up by 20.3 per cent.
In terms of mental health, the percentage of residents with dementia is going up 2.9 per cent each year, presently representing nearly six in 10. Anxiety disorders are going up 9.8 per cent, psychological disorders by 4.8 per cent, schizophrenia by 1.9 per cent, and bi-polar by 3 per cent. Only cognitive impairment is actually going down (-2.1%).
The OANHSS estimates that additional resources required for residents with behavioural issues range from $9 to $14 per day. That would require an adjustment from $117.9 to $183.3 million per annum, although their final recommendation is only specifically looking for $92.4 million for increased staffing for moderately aggressive residents.
Last spring’s budget increased funding for long-term care by 2 per cent.
The seven recommendations by the OANHSS are:
1. A maintenance increase of 1.5 per cent (cost $27.772 million).
2. Increased funding for moderately aggressive residents (cost $92.43 million)
3. $15.3 million for ongoing training and education programs.
4. The ability to redirect or transfer residents to a designated behavioural unit.
5. Expansion of the number of designated behavioural units (cost TBA).
6. The Ministry directly fund all new designated units.
7. Research into characteristics of residents at high risk of aggressive behaviours ($250,000)