Recently, nursing homes seem to be receiving an increase in the acuity and demand of their clientele. Support workers and other first hand support staff can attest to this, stating that “only 10 years ago, we needed less staff and it wasn’t as busy!” There may be many reasons for this increase in acuity. Most notably, people are living longer lives and as a result, are succumbing to the ailments that plague the aged, mainly dementia and cancer. Since 1980, the life expectancy in Canada has increased by just over 6 years (StatsCanada, 2015). The rate of illness and morbidity is also increasing and as a result the demand on long term care facilities is increasing.
In order to get a better understanding of this issue, some research on the topic was reviewed. However, there is unfortunately a dearth of research available on this exact topic and thus required some investigation. Five first hand workers (personal support workers or nursing aids), with 10+ years of long term care working experience were asked about the evolution of their job and acuity of their residents. I summarize some of the results in this post.
A major issue being seen is the prevalent closure of psychiatric wards and group homes. Hospitals are pushing for shorter stays and budgets for outpatient care are are being cut. In the 1980s, people could expect to be admitted to the hospital for up to a month for as little as a broken arm. Now, you aren’t even admitted for a fractured bone, you are given a cast in the emergency room and sent on your way home. These patients that are either unfit to live in the community or have insufficient finances to live in the community are being moved into nursing homes and long term care facilities.
Times are undoubtedly changing, but the support is remaining relatively stagnate with little to no improvement in staffing. There is a dearth of literature, research and statistics available about the evolution of client to staff ratios over the years. Currently, according to HealthyDebate.ca, the current patient load of an RN and RPN in a hospital setting is 6-7 patients per one nurse. Within the context of long term care ,it is different. Registered nurses are assigned responsibility for the entire facility (can be up to 150 patients) and RPNs are given anywhere from 30 to 60 residents to deliver medications and treatments to residents. PSWs, who are involved in primary care (washing, bathing, dressing etc.) can expect patient loads of up to 10 patients per one support worker. This has not changed much over the years; however, the acuity has.
Some staff that were asked about the evolution of their residents stated that, “20 years ago, using mechanical lifts to get people out of bed was seldom heard of; but now, it seems every second resident I have I need to use a mechanical lift just to get them out of bed!”. Using a mechanical lift generally required the presence of 2 workers to operate it safely; however, it is reported that some nursing homes will allow the operation of a mechanical lift with one worker present, which is generally not considered safe practice.
Furthermore, with the increase in geriatric psychiatry residents, staff are needing more and more training in the area of psychiatric mental health management, especially in the marginalized geriatric population. However, primary care staff are not getting this training they require and are expected to adapt to these changing environments with little to no support. The curriculum for PSWs is insufficient in its attempts to adequately train and accommodate students in the area of mental health support and care in dementia.
In addition to the insufficient staffing and training, wages are another issue that are plaguing the staff of long term care facilities. According to ONA (the union that represents nurses in Ontario), the pay scale for the average registered nurse is anywhere from $30.35 – $46 in a unionized environment (not icluding in lieu pay). However, this can be more or less in non-unionized environments and thus a dichotomy exists between pay grades for nurses. Pay for licensed nurses has increased since the 1980s dramatically, which is expected as a result of inflation. However, the pay for support workers remains quite marginal despite their expanding roles and responsibilities. HelathyDebate.ca outlines that, for the most part, PSWs are making $16 hourly for their services currently. In the past, PSWs usually made minimum wage; however, they did not require formal training. Currently, formal education has become standard practice for any entry level PSW position in Ontario. One PSW comments that they started off making $7.50 (in the 1988) and currently they are making $19.45 (in 2015), which is only a marginal $11.95 pay increase over a 27 year period. That’s roughly .14 cents a year!
It would seem as though, with the increasing acuity of the ageing population of today, there is very little support being offered to the front line workers. In fact, most of the population is ignorant to the lack of support of long term care facilities, even those who have family members residing in such a facility. Budget cuts are being made in all areas of healthcare in Canada and more of an expectation is being placed on long term care facilities to deal with these cuts and still be able to accommodate all of these demographics that are being sent to these facilities. It is unbelievable the little attention and neglect that long term care facilities have in society today, when these same facilities are going to become a fact of life for a large portion of the population in 50-60 years, when we ourselves are resident’s in these facilities. Hopefully by that time, we all realize that we should have offered more support and attention to this oppressed and marginalized area of healthcare.
Geriatrics and Long Term Care 