Blog by Dan Levitt, MSc, CHE

On the next #hcldr tweetchat we welcome special guest host Dan Levitt, CEO of Kin Village in BC. He will be leading us in a discussion on a very important topic – the state of long-term care. Levitt believes that we need to transform not only the facilities themselves, bur our approach to running them as well.

Please join the community on Tuesday January 25th at 8:30pm ET (for your local time click here).

Special thank you to the Canadian College of Health Leaders @CCHL_CCLS for helping to make this

Enjoy Levitt’s wonderful blog below.

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On the eve of 2022, as we were getting ready to celebrate the New Year, we learned of the death of 99-year-old Betty White who was weeks away from her 100^th birthday.  Adored by millions for entertaining audiences of all ages, her recent rise to superstardom started from a Facebook campaign in early 2010 to have then octogenarian play host to an episode of Saturday Night Live. The online movement was ignited by the former Golden Girl’s appearance in a Snickers commercial broadcast during Super Bowl XLIV. This episode was nominated for seven Emmy Awards, including one awarded White, for guest actress in a comedy. TV ratings skyrocketed for this episode of SNL, with nearly 15 million viewers.

While society embraced Betty White for defying ageing and demonstrating old age is not a reason to stop living, society is not as enamoured by the sight of older people impacted by deteriorating health, a reminder of what might be in one’s future.

Popular culture’s view of old people can be coined by a single word: Ageism. The discriminatory aspects of ageism have been strongly linked to gerontophobia: the irrational fear of older persons that someday all young people including oneself will eventually be old and experience chronic disease and health decline often associated with old age.  These feelings toward ageing and older persons impacts on how health care systems are designed and social services are organized to support the ballooning older demographic cohort.  Before the pandemic ageism seemed to be accepted as a tolerable “ism”.

Did COVID-19 expose ageism? When the public health emergency was declared in 2020, were the rights of older persons given the same priority as children and adults? How do we ensure the rights of older adults?

These questions must be confronted in response to the crisis in care as Canadians looked inside long-term-care homes as they battled COVID-19.  The topic has been spotlighted on the evening news, newspapers, radio talk shows, online, in best selling books and documentaries.

The past two years has been an emotional roller coaster for front-line care staff, older persons living in care, families, gerontologists, researchers, seniors advocates and leaders of the care homes especially for some of the largest COVID-19 outbreaks.  We have seen heroism and sacrifice, honouring the staff who worked through extraordinarily difficult situations while paying needed attention to the key challenges of long-term care.

Seemingly, the seeds of this crisis were sown decades before the pandemic with policy decisions not putting senior’s rights at the fore.

COVID-19 was devastating to long-term care. People in nursing homes are typically 85 or older and immune compromised. They often have several health problems and live in close quarters, often in outdated buildings without modern air circulation systems. They are cared for by different people who come in and out of their rooms all day. It seems to be a petri dish for viral spread.

Long before the pandemic, viruses would spread in nursing homes with annual influenza outbreaks often leading to deaths.

The pandemic is a wake-up call. We must do everything to create a better future. A permanent long-term fix is needed to improve the seniors care system in Canada and globally.

We can honour the people who lost their lives in nursing homes from COVID-19 by improving how we care for them when they cannot care for themselves. We need new models of care, we need more resources to allow for the best care, we need the right regulations and accountability.

While you may not know anyone who lives in a nursing home, if you live long enough, someday the frail person who requires long term care maybe you or someone you love.

Destigmatizing aging and humanizing care for all people would ensure the right to age with dignity. Creating non-institutional living environments would empower the lives of people who live and work in them. Reinventing the nursing home means older adults are seen as unique individuals, in control of their own lives, each with a unique history, preferences and ability to exercise choice.

This would be accomplished by rebuilding outdated nursing homes with small scale homes for just 10 to 12 people, self-contained and self-sufficient. Enabling residents to function as autonomously as possible, built around a common living room and dining room with a say in the daily menu, a private bedroom with ensuites, a front door for each home, and outdoor spaces that are easy to access and navigate.

We as Canadians need to strengthen aged care to ensure high quality programs and safe services. With complex care and social needs, older adults who can no longer live independently are a vulnerable population with diminished ability to advocate for themselves. We must be their voice.

We as Canadians value our rights and freedoms. We must find ways to ensure these human rights are extended to all Canadians — that no matter what your age or abilities, living in your community as long as you are able is a choice.

If the COVID-19 crisis has not been a rallying cry that reaches every ear, what would it take to transform societal attitudes on the care of older adults? Elderhood is the anthem. The pandemic is the sign. Do you hear the people sing?

When you are an elder, you deserve nothing less.

Topics

On Tuesday January 25th at 8:30pm ET (for your local time click here), we will be discussing the following topics on the weekly HCLDR tweetchat:

1. The pandemic brought to light many of the challenges faced by long-term care homes: lack of infrastructure, understaffing, lack of training, and mistreatment. Was there something that surprised you or was the state of long-term care homes what you expected?
2. The cost to transform outdated facilities is often the biggest impediment to eldercare renewal. Other countries have come up with creative ways to help raise money for change (such as the bond program in Australia). How should we rethink and incentivize capital investment?
3. In a recent survey, 96% of older adults said that they would do anything to avoid going into a long-term care home after seeing what happened to the residents during COVID. Do you think the reputation of long-term care settings will ever recover?
4. How can health leaders better plan for the Baby Boomer demographic who will expect better care than their parents experienced?

Article and Abstract

“Transforming the hospital-style nursing home to a centre for living” (open access through January) — Dan Levitt, MSc, CHE

COVID-19 has put a spotlight on the senior living sector. Transformational change is needed to address the challenges of an institutional model of long-term care. This article makes recommendations applying the Systems Transformation domain of the LEADS leadership capabilities framework to change the way older persons experience the ageing journey by creating a small home model of living. A literature review reinforces the spotlight on the capital investment needed to reinvent the nursing home into a centre for living.

About the Author

In Dan Levitt’s Ted Talk “Rethink Aging” he lists examples of how people are changing age care.

Additional Reading

Healthcare Management Forum, January 2022 with Guest Editor Dan Levitt, MSc, CHE

CCHL event listing (with participation instructions): Forum Tweetchat -Transforming long-term care facilities into “Centres for living”

CCHL news release: Join us for a discussion on transforming long-term care facilities into “Centres for living”