Licensed practical nurse Anita Dickson speaks with authority and knowledge about public and private seniors care in British Columbia and she works hard to make change.
The high COVID-19 infection rate, heavy death toll and traumatic stories coming out of long-term care (LTC) facilities across the country, especially in Quebec and Ontario during the first wave, have made seniors care a focus of attention. In Ontario, most deaths in LTC homes happened in privately owned for-profit facilities, which triggered a nationwide conversation comparing for-profit, not-for-profit and public LTC homes.
Anita Dickson, a licensed practical nurse (LPN) with an accounting background, has worked in both types of facilities. At first, she had aspired to be a registered nurse, but the reality of being a single mom of three meant she had to take things one step at a time. She now works as an emergency room nurse. Prior to that, she worked as an LPN in palliative care as well as an instructor, consultant and manager in two assisted-living homes, one in a private setting and the other in the public realm.
Given her experience, Dickson knows a lot about the health-care system and delivery in British Columbia. She knows the field and its politics, and she knows about the research and advocacy surrounding seniors care.
One key lesson for her is the importance of having front-line workers at the decision-making table. Often, when politicians and health officials organize roundtables and consultations, they go to academics for advice. And while university professors should, and do, influence decision-makers with their research findings, too often the thoughts, needs and voices of the people working on the front lines of this system are not heard. Even when frontline workers, who know best how the current system works, are at the table, they don’t always get their points across.
“You have these people [who] have never had a chance to sit at these tables, so they don’t know how to express themselves,” Dickson says. “They get overwhelmed, so they usually don’t say anything. We have to give them some leadership skills before we throw them into these forums.”
Dickson also has some thoughts about the differences between the two models of long-term care homes.
Staffing issues, for example, exist in both models. Though this issue is more acute in the private sector, both kinds of facilities face staffing challenges because, by nature, long-term care is labour-intensive.
“The staffing model has not caught up to being able to provide good quality care” for people at end-of-life with significant needs, she said. “And still today, even though they talk about this gentle care approach, they still run [these facilities as institutions.]”
Another issue facing the public LTC sector, at least in B.C., is accessibility. Many people want to go to public LTC homes in part because they’re less expensive, but because of the limited number of publicly funded rooms, wait times can be very long. Moreover, the caseworkers who assess patients on the long list are registered nurses and heavy caseloads can mean the systems become paralyzed. Additionally, people previously did not have any say in where they were going, but recent legislation means patients can list three choices that must be respected, which is a great improvement, according to Dickson.
In the private sector, Dickson says, you can easily access a room without significant wait times, provided you can afford it. But high costs can deplete seniors’ retirement savings and impact their capacity to leave an inheritance to their loved ones. She said the rooms are nicer in the private sector and so is the food. But there is no quotient for the amount of care a patient receives each day, or regulation of wages. This means lower wages for staff and lower staff-to-resident ratios, she says.
Asked whether for-profit LTC homes can run profitable businesses while offering quality care and good working conditions, she feels they can, but currently that often means passing on costs to the residents, as there is no legislative limit on cost increases. She witnessed such increases during her time as a manager in assisted-living homes.
“They raised their cost every year, to the point that people were saying, ‘I can’t live here anymore,’ and they were crying,” she recalls. “I would [ask] the same thing for long-term care — could they provide at that level? They could, but it would be at a huge cost to the person wanting the services.” In the end, she does not believe one should make a profit out of health services.
At the moment, Dickson sees the most immediate issues facing seniors care in homes as staffing ratios and changes to the way PPE is supplied and distributed. In the short term, staffing ratios should be the priority, she said. She suggests each province create a working group focused on developing a better model to increase staffing ratios across the board, which would enable the sector to provide better care. Her second priority, related at least in part to the COVID-19 pandemic, is for PPE supply and distribution to be managed by the health authorities and then billed to the for-profit sector.
Over the long term, given the forecasted ballooning of the senior population in the coming years, she recommends major restructuring of the LTC business model. That could involve limiting private investment to buildings and fixed assets and leaving the management of human resources and health care to working groups, not-for-profits or public organizations. That work needs to start now, she says, because seniors deserve it.
“Let’s keep making noise; this is my mantra,” she says. Dickson, the recipient of various nursing awards, including a “best bedside-nurse award” from the Vancouver Community College, a “health-care hero award” from the Health Employers Association of B.C. and recognition as one of B.C.’s 150 outstanding nurses by the provincial government, will likely do exactly that.
Jean-Sébastien Côté is an advocacy and policy officer at the National Association of Federal Retirees. Côté first heard Anita Dickson speak at a December webinar organized by the B.C. Health Coalition, titled Committing to Seniors Care: Addressing the Gaps.