Brian Martin has never been shy about asking Saskatchewan’s political leaders to commit to improving the planning and delivery of long-term care in the province.
Martin is the executive director of Mont St. Joseph Home (MSJ), a not-for-profit private special care home in Prince Albert. He’s been known to question political leaders on their plans for the sector whenever he can — often at Chamber of Commerce events when government and opposition MLAs speak to the local business community.
COVID-19 has created its own challenges for the province’s long-term care homes, but it has also created opportunities, as more and more people are talking about what’s going on in long-term care and what needs to change.
Special care homes are defined as homes that offer a range of personal and health services to people who are elderly, disabled or chronically ill and need 24-hour care. Most of the time, when people in Saskatchewan talk about long-term care, they’re talking about special care homes.
“Because of COVID, special care homes are in the news. The attention in itself is good,” Martin wrote in a recent MSJ newsletter.
“But, folks, this attention is too damn late! For years, various organizations have advocated for improvements in the planning and delivery of long term care. Challenges before special care homes today haven’t just happened. They’ve been here for years for a variety of reasons, most of them complex and evolving. The reality is that advocates like the MSJ Home’s Board of Directors have made little progress convincing society and various Governments through the years that substantive improvements are required.”
Long-term care has been in the news throughout the pandemic. In other provinces, such as Ontario, COVID-19 took hold in long-term care, sweeping through facilities and leaving dozens of deceased residents in its wake.
In late May, the military was called in. A report documenting the horrors of what they saw in some of that province’s care home opened up the conversation even wider. How did this happen? How did we let the living conditions of our most vulnerable fall to the wayside? Could this happen here?
In Saskatchewan, for the most part, care homes have stayed clear of major COVID-19 outbreaks.
The government has attributed this to standards in place and the hard work of staff.
The opposition NDP has said it’s due to the work of staff, the province’s geography, and luck.
They began asking questions about long-term care and, from their perspective, the lack of minimum standards of care.
The government maintains the care guidelines are minimum standards of care. The NDP disagrees.
The opposition has brought family members forward who have spoken about what they’ve seen in provincial care homes.
The union representing hundreds of care home workers has also spoken to a lack of resources in long-term care.
During this conversation, the annual CEO’s report was released.
That report sees senior health authority leadership tour care homes and document what they see. They talk to staff, residents and families. Some facilities documented staffing struggles, slipping care and crumbling infrastructure. Other facilities came off with praise, looking fine.
The opposition and unions said the report was a rosy look at the situation in care, and an independent look was needed.
One voice that seemed to be missing, though, was that of special care home operators.
Mont St. Joseph did well in the CEO’s report. There were no major complaints. Residents wanted better food choices and more activities to keep them occupied.
Residents expressed gratefulness for the way they’re treated, for their freedom and for the quality of care.
Martin, though, knows there is always room for improvement.
“There are so many things that we need to be better at in terms of meeting the holistic needs of the people who live here,” he said.
There are many things to think about when improving long-term care, he added, but first and foremost is establishing standards of care for long[term care.
“We’ve argued forever that the province’s program guidelines for special care homes are just that — they’re guidelines,” Martin said.
“The program guidelines that the Ministry of Health is using, they’ve been there forever. They were around when the NDP was here, they were around when the Sask. Party got into power. There have been some minor revisions to them, but in the grand scheme of things, they’re not that much different than they were 20 years ago.”
Martin said his organization has been advocating for standards of care that are tied to measurable outcomes with specific, dedicated resources.
“We’ve been preaching that message for a long, long time,” he said.
He said he understands the government’s position that the program guidelines are the minimum standards.
He questions, though, if that’s good enough.
“My question to society, to your readers, is do the people who are living in the homes today, do they deserve minimum standards, or do they deserve something else? Our position is very clear.”
Improving long-term care, Martin said, will require a strategic approach. It’s not just a matter of throwing money at the situation.
“We need to understand, in a better way, the type of care needs people being admitted into our care homes today have,” he said.
“People don’t age in place here. They come here with very complex care needs. I believe that the system hasn’t fully comprehended the implications of that.”
Part of that is managing expectations and establishing what long-term care homes should be.
“There would be a lot of work to creating standards of care, and there would be some tough questions to ask,” Martin said.
“The reality is most people are very, very reasonable and supportive of the work that our special care homes provide to people today, but there is not a person that I’ve ever talked to that wouldn’t like to see more services. More opportunities for therapy. More opportunities for recreation. More opportunities for the soft things that are usually so important for people’s lives.
“The bottom line is, implementing standards of care that evaluate the services we provide is going to cost somebody money. The question is, who?”
Operational issues such as staffing levels, care expected and the resources required to do that aren’t the only issues facing the province’s special and long-term care homes.
Critics have called Saskatchewan’s long-term care facilities “crumbling.”
The CEO’s report details leaks, asbestos, mould, broken sidewalks and ramps and pone and call systems that don’t work.
In the 2020-21 budget, the provincial government earmarked $80 million for infrastructure costs relating to long-term care facilities in the province. Of that, $73 million is for new facilities in Grenfell and La Ronge. The remaining $7.2 million is for 82 priority renewal projects. Those include improvements to flooring and window replacements, heating and air conditioning upgrades and water and sewer line replacement.
Those significant investments in capital infrastructure and equipment is “really good news,” Martin said. But he believes the provincial government had a solution, way back in the early 1990s, before health care reform was undertaken by the NDP and then-premier Roy Romanow.
In those times, a formula was used to calculate annual funding for major repairs and the replacement of equipment and furnishings.
That was kyboshed. It hasn’t returned.
From then on, care homes haven’t had predictable, reliable capital funding. They’ve not known whether they would get any funding or not.
“It’s not very supportive of a good business model,” Martin said.
“We’ve been encouraging governments, both the NDP and Sask. Party, to create that consistent funding formula so people can plan, so organizations like us can plan.”
He’s said as much to politicians who have come through Prince Albert. No one has committed to it.
That, Martin said, would make things better on both the operating and infrastructure sides, as then care homes would know what to expect, be able to invest in what they need.
None of these issues are new.
Martin has been advocating for better standards and more predictable funding for care homes for years.
Family members have been advocating, too. But up until recently, Martin wasn’t seeing much uptake in terms of decision-makers and the general public care what happens behind those care home doors.
“Our collective silence has contributed to this long-standing oversight,” he wrote in the MSJ newsletter.
“Once society’s sense of accountability kicks in, we’ll roll up our sleeves, get to work in a collaborative way and address this challenge. When that happens, all of us will emulate the heroes currently working in our special care homes. For this, I pray.”
Martin was even blunter over the phone.
“The reality is most people in society think about special care home as places where old people go to die,” he said.
“We don’t believe that at all. We believe when people with needs come into a special care home like Mont. St. Joseph, they come in with an expectation that they’re going to do the best they can until they die.
“But if society thinks the way they do, the reality is, all of a sudden, what happens in special care homes doesn’t become a priority. I think that needs to change.”
Martin is hopeful this newfound attention on special care homes that has come from COVID-19 can lead to meaningful change.
“Oftentimes, it’s when things are tough that we take a good look at what we’re doing,” he said.
“I’m hoping that’s what’s going to happen here. I pray that’s what’s going to happen here. It has to happen. It has to.”
Read Martin’s article below:
In the March 2020 edition of MSJ Peak Preview, I observed that with a provincial election looming, it
was appropriate for all of us to ask political leaders if their Party has plans to improve the planning and
delivery of long term care in our Province and, if so, what those plans are.
Since then we – and the world – have been pre-occupied with COVID. Every person who cares for their
families and neighbours are making conscious efforts to follow the protocols and recommendations of
our health-care experts, the Chief Medical Health Officer and Premier Scott Moe. I see firsthand the
efforts Mont St. Joseph (MSJ) Home staff who are following the protocols to safe guarding our Elders.
To say it is humbling to watch these efforts is a huge understatement.
It only takes one COVID incident to jeopardize the safety of our Elders, staff and community at large.
Although the uncertainty is difficult, I quietly remind myself our staff are trained, committed and
dedicated to those they serve. Our SHA and Ministry of Health partners are providing expertise, PPE
supplies and support in a collaborative effort to minimize the impact of COVID. Families and friends are
respectful of the visitor restrictions, as hard as this is for everyone.
Because of COVID, special care homes are in the news. The attention in itself is good. But, folks, this
attention is too damn late! For years, various organizations have advocated to improve the planning
and delivery of long term care. Challenges before special care homes today haven’t just happened.
They’ve been here for years for a variety of reasons, most of them complex and evolving. The reality is
that advocates like the MSJ Home’s Board of Directors have made little progress convincing society and
various Governments through the years that substantive improvements are required.
There’s already arguments about whether the provision of long term care should be removed from the
private domain. That’s too bad because it diverts attention from the root cause of the challenges before
long term care providers – public or private. The root cause of these challenges? It’s simple! There are
no standards of care tied to measurable outcomes and dedicated resources to meet those outcomes.
Sounds simple to address, but it’s not. Standards of care will also increase costs of care. The real
obstacle to adopting standards of care relates to who should pay. Always has been, always will!
Determining the answer requires open and honest dialogue; there are implications for the users of long
term care, unions and Government. These discussions will be complicated. Likely emotional and
potentially divisive. But, nothing will change if there is not a collaborative commitment to change!
So, in the midst of COVID, I urge every citizen to ask political leaders “what their plans are to improve
the planning and delivery of long term care in this Province.” Ask when those plans will be initiated. If
COVID teaches us anything, I hope it’s a renewed commitment and focus on our families and neighbours
and their health and safety. And, for the record, standards of care are about safety. Standards are
about the provision of quality, holistic care in a compassionate environment for the people living in
special care homes today and tomorrow. For this, there can be no disagreement, can there?
Frankly, I believe that all of us must ‘look in the mirror’ and acknowledge that our collective silence has
contributed to this long standing oversight. Once society’s sense of accountability kicks in, we’ll roll up
our sleeves, get to work in a collaborative way and address this challenge. When that happens, all of us
will emulate the heroes currently working in our special care homes. For this, I pray.