Changing long-term Care

Healthy Boomer
By Peggy Edwards

Moving forward in a positive direction

A few months ago, I had the privilege of hearing Pat Armstrong speak at a seniors’ advocacy conference on how to change long-term care (LTC) in a positive direction. Pat is a Distinguished Research Professor Emeritus at York University, and an expert on LTC, both in Canada and on the world stage.

She prefaced her remarks by saying, “We will need, and should want, congregate care places that allow all those who live-in, work in and visit in long-term care to not just survive but also to experience joy. To do so requires that we understand care as a relationship.” Then, she set out the top 10 things that matter in moving forward to change LTC in a positive direction. She and her research team developed these guidelines after studying homes in six countries in search of promising practices that we can adapt in our own different contexts.

What is needed to move forward change in a positive direction

1. Working conditions matter. This includes having enough staff; providing the time they need to care; access to full-time, stable employment, decent wages, benefits, and opportunities for advancement; support through teams; places to grieve and places to eat. Unless we address these conditions, there will be few, if any, to provide care.

2. Training matters. The work in LTC is done primarily by women, many of them racialized and/or newcomers. Training for those who do this paid work should be based on the recognition that specialized skills are required to appropriately deal with this population. The need for skill training includes housekeeping, laundry, dietary, nursing and medical staff. The skills need constant upgrading to address changing needs. Training needs to be provided inhouse on paid time and include anti-racist strategies and cultural competency.

3. Location matters. We need to locate care homes as near as we can to where residents, families and staff can connect to their communities. Attending to location also means ensuring access to good public transit as well as to parking so that staff can easily get there and so can friends and relatives.

4. Size matters. We want to avoid places that look like old-style hospitals, but this does not necessarily mean small overall. Larger places are in a position to have doctors, nurse practitioners therapists, hairdressers and recreation folks full-time, and to have more flexibility in their labour force. But we need to create small communities within these larger buildings. Denmark has been successful with smaller LTC homes built in the middle of community neighborhoods.

5. Standards matter. We need clearly defined principles for access, quality of care and quality of life. These would provide for standards, rather than for standardization. Standards can be broad enough to allow different ways to address specific contexts and populations while ensuring a common ground, as the Canada Health Act has done for hospital and doctor care.

6. Accountability matters. We need to ensure that the standards are enforced and that problems are addressed quickly and effectively, with major penalties for failure to comply. Accountability also involves democratic decision-making structures that promote the health of staff, residents and families, and ensuring that governments at all levels provide accessible reports to the population on a regular basis.

7. Food, housekeeping, clothes, and laundry matter. Mealtimes are not just to get nutrition but also to get social contact and support. Clothes are about identity and a sense of self. Clean rooms and clean linens are not only about safety but also about how the place feels and looks. All these aspects of care are about respect.

8. Integration matters. We need to desegregate at multiple levels, including all paid and unpaid workers in the care team. We need to ensure all services are provided in-house, avoiding the
contracting-out that fragments teams and the provision of care. We need to bring various communities together — to mix ages and integrate the health care system by effectively linking long-term
care homes with home care and other services.

9. Profit matters. We need to ensure that the focus is on care, not on making a profit.

10. Risk matters. We need to tolerate some risk. Being able to walk with a walker (and not be automatically confined to a wheelchair), to have a glass of wine, or to make your own tea brings a sense of still controlling your own life. The risk of allowing families in, during an infectious disease pandemic, may outweigh the risk of residents dying from loneliness.

Pat concluded by saying “This top ten list is not exhaustive, but it does provide some critical starting guidelines.”

Many of you have faced the suffering and loss of loved ones in long-term care during the last two years. Let’s pressure our governments to enact policies and programs that put these guidelines into action!

Thank you, Pat, for sharing these guidelines and what you have learned from your extraordinary work in LTC. Dear readers, how do these guidelines resonate with your experience and feelings? Are some particularly important? We would love to hear your thoughts and comments. Write to Peggy Edwards at wanderingpeggy@me.com.


At the time of writing this, the Ontario government tabled the Fixing Long-Term Care Act, 2021, which is intended to improve and replace the old act and regulations on LTC. The Council on Aging of Ottawa (which is a major voice for older people in the Ottawa area) responded with a Statement of Concerns and suggested revisions to the existing Act. In summary, the Council concluded that:

1. While the proposed Act has very aspirational language and proposes some key needed improvements, it does not differ substantially from the current provisions in the Long-Term Care Homes Act (2007).

2. The government has missed an opportunity to present a new vision for long-term care in Ontario. It has missed the opportunity to strongly support transformation and innovation in LTC and to move away from the current institutional models of care and underlying structural deficiencies of the existing Act.

3. The proposed Act does not address the important issues of ownership and improving the conditions of work in LTC homes. It does not tackle many issues of funding to nurture the development of good care in all LTC homes, such as changes in capital funding and in accommodation fees. It does little to ensure that LTC will meet the needs of a changing and growing older Ontario population and encourage more municipal development of LTC homes.

4. The bottom line for families who rely on LTC is to ensure adequate care, increased funding and stronger accountability that makes better care available for LTC residents right now. n

Peggy Edwards is a recognized speaker who has written extensively on aging and health, and is a coauthor of The Healthy Boomer: A No Nonsense Midlife Health Guide for Women and Men, The Juggling Act: The Healthy Boomer’s Guide to Achieving Balance in Midlife, and Intentional Grandparenting: A Boomer’s Guide, all available at amazon.ca.