Cultivating joy: The solution to the LTC crisis

By Vivian Collings

Lurking in the shadows of crises in Canada are long-term care homes.

During the Aging Together as Community’s conference last month, Dr. Pat Armstrong, professor of sociology at the University of Toronto, spoke about her involvement in research of long-term care homes across the globe.

Canada, in comparison with other countries, is on the bottom rung of places with desireable care.

LTC homes can no longer be out of sight, out of mind, she says.

“Our purpose is to put life into years, not years into life,” Armstrong said. “Our goal is to understand that care is a relationship, a relationship that can bring joy to everyone involved in long-term care.”

This joy is dependent on the working and living conditions of a care home.

“We argue that joy is possible when people have a sense of belonging; when they have the opportunity for purpose and meaning,” Armstrong said.

And to get there, her team spent 10 years researching the successes and downfalls of long-term care homes in Norway, Sweden, the UK, the US, Germany, and Canada.

One of the main ways they conducted research was to send teams into government-regulated homes for a week at a time.

“Each team was multidisciplinary,” she said. “We would interview, observe, and then get together and talk about what we saw and what we heard.”

They talked to everyone: Those who did laundry, housekeeping, dietary work, those who provide direct care, residents, their families.

“We were looking for what we call ideas worth sharing, because we’re convinced there is no single right way,” Armstrong said.

Proper care depends on the residents, their health, the location of the home, and available social services.

The first idea she shared was a new way of seeing LTC.

“We know long-term care doesn’t have a good reputation in Canada. It is often seen as a last and worst resort. But, family members in Germany and Sweden did not feel guilty like they do here. A study showed that Swedish people over 65 would prefer to go into nursing homes if they needed help with more than two daily living activities,” Armstrong said. “That’s certainly not the case here.

She highlighted what’s worthwhile to keep in our current system.

The first is company.

“We know that isolation kills. The Ontario Science Table found that even if they had less complex care needs, those with less family and friends were more likely to die.”

The second is safety.

“One example was a woman who said she was insulin dependent, had a stroke, and couldn’t remember to take it on her own.”

The third are activities.

“They’re much less likely to sit and watch TV all day with activities.”

The fourth is lack of chores.

“Many residents were happy someone else takes care of meals, cleans the bathroom, and washes the sheets.”

Next came what needs to change.

“Of course staffing is the first thing that comes to everyone’s mind.”

Staffing levels in LTC in Sweden are twice as high as Canada.

With that many people, staff are able to take extra time to complete tasks.

“They can take time with the residents and their families to know what makes them laugh. They can take the time to help residents walk rather than putting them in wheelchairs,” Armstrong said. “When staff have the time, family members do not need to fill major gaps, which is what’s happening here.”

Of course, job security and continuity are needed for all staff members. Simply adding more wouldn’t be effective.

“In Ontario, over half of long-term care staff are part-time, and a growing number of staff are from temporary help agencies,” Armstrong said.

She said a sense of security and belonging is as important to staff and families as it is to residents.

“It takes more than numbers. To support continuity, staff need full-time employment opportunities and decent wages so that they are encouraged to stay. And it takes more than numbers and wages to create the conditions for joy. The staff need to have the training, which means recognizing the value of the skills required. Too often, the skills are dismissed as something anyone could do,” Armstrong said.

She said it takes skills to feed, dress, bathe and calm down residents depending on their needs. 

“Skill recognition and training are only one aspect of responding to residents as individuals. Staff need the right to act on their own knowledge based on individual needs and preferences.”

Which brought her to rules and regulations surrounding LTC homes in Canada.

“They can limit the staff’s ability to act on the basis of their skills. Staff are required to spend more and more time reporting on and counting what they do in ways that not only take time away from care, but also limit their ability to respond to individual preferences,” she explained.

Most scandals occur in for-profit long-term care facilities. The response was to introduce more regulations, like counting bowel movements and how many glasses of water that have been drunk.”

She highlighted a quote said by Albert Einstein himself, “Not everything we can count counts, and not everything that counts can be counted.”

“Try counting joy,” Armstrong said.

Adding on to better situations for staff in these homes, she said teamwork is a source of accountability.

“In a Norwegian home, staff coming off their shift had coffee with staff starting their shift to talk about specific residents and to share strategies about how to respond to those,” she said.

Another Norwegian home trained staff to integrate music into everyday life. When residents came into the home, staff made a copy of their favourite music. The list would be posted above their beds, and staff could play one of their favourite songs as they began bed care.

“This home also had a choir made up primarily of people who otherwise didn’t speak,” she said.

Her last point was the importance of the location and accessibility of facilities.

“Residents want to be part of the community where they can bring the outside in and the inside out,” she said.

She summed up her presentation with one final perspective.

“Life without risk is boring. The focus on years into life rather than life into years is a focus on risk avoidance.” Armstrong said. “We need to start saying, ‘How far can they go?’ Assume that they can rather than they can’t. We have to dare to dream.”