‘Culturally’ responsive care is needed for seniors across Ontario but openings are rare and wait times can stretch for years
Many people grow up in a community where culture is king – the smell of familiar foods, people speaking the same language. It’s easy to take care of these absently comforting touchstones in one’s own home, where family doesn’t even have to think about it.
When these familiar comforts are suddenly removed, decision-making gets more difficult. For example, when the time comes to put an elderly loved one into a space where dedicated care is provided, finding a home that checks all the cultural boxes is tricky and stressful.
Adding to this, there aren’t many ethno-culturally specific long-term care (LTC) homes in the province. According to numerous media reports, the figure ranges between 50 and 60 catering to a specific culture in the province. Only two facilities in Brampton fit this description: Grace Manor and Faith Manor, both serving the Dutch-Canadian community, which is owned and run by Holland Christian Homes. Yee Hong Centre for Geriatric Care in Mississauga serves the Chinese-Canadian community. The Pointer was unable to determine if there are other facilities in Peel that have specific ethno-cultural features.
Getting into these homes can be difficult. According to a 2016 report from the Wellesley Institute, those who apply for ethno-culturally specific homes generally wait longer than those who apply for conventional homes. In 2016, the difference was six months.
At the beginning of October, 198 people at Faith Manor were waiting to access basic accommodation. A majority of applicants spend 1,026 days on the list, according to wait times reported by the Central West Local Health Integration Network (LHIN). At Grace Manor, 217 applicants are on the list, waiting on average 1,245 days to get basic accommodations.
Baldev Mutta, the CEO of Punjabi Community Health Services, speaks with Brampton NDP MPPs Sara Singh, Kevin Yarde and Gurratan Singh, as well as Leader Andrea Horwath
Before COVID hit, the waiting list at Yee Hong had 456 people and stretched out to 1,064 days, a spokesperson told The Pointer. In January 2016, the average wait time was 2,033 days.
‘The Cost of Waiting for Care’ report, authored by Seong-gee Um, highlights the importance of cultural accommodation for health, well-being and quality of life in LTC homes. For example, when it comes to the intake of Chinese residents, they would prefer congee (a rice porridge) over cereal for breakfast, and rice over pasta for dinner.
When residents have access to culturally appropriate food, they’re more likely to eat it, the report states. In turn, this reduces the risk of preventable concerns common in LTC homes, such as malnutrition. The same thinking can be extended to language and cultural specific care, as they can also have a positive impact on a resident’s health, and assist in reducing isolation and depression, Um wrote.
But the need for culturally appropriate care extends from LTC homes to the home as well. A second 2016 report from the institute, ‘Ensuring Healthy Aging for All,’ states clearly that immigrants were twice as likely to report their needs not being met for home care services over non-immigrants. This was most common for those residents whose mother tongue was not English.
In Peel, with its large South Asian-Canadian population, there are currently no homes catering to this specific demographic. While it’s common for many in this cultural group to live as a complete family unit and not in external care, the need for senior support still exists.
When Baldev Mutta, the CEO of Punjabi Community Health Services, speaks to seniors in the community, cultural competence and cultural appropriateness in home care are topics that consistently come up.
“Every time we talked to seniors…the whole issue of food, cultural appropriate care, the ability for caregivers to get in touch with the professional staff... those are the ones that are near and dear to the senior’s heart,” Mutta said this week.
He joined NDP Leader Andrea Horwath and all three of her party's Brampton MPPs over Zoom to discuss the cultural gap, which is part of the NDP’s plan to overhaul the senior care sector.
To address the specific cultural need, they plan on partnering with community organizations and other experts to create spaces that reflect a familiar community for residents, including food, activities, and religious accommodations. Appropriate training programs for staff will also be developed, the plan states. It will be enacted in 2022, if Horwath becomes premier in the next provincial election.
“We are committed to partnering with communities here in Peel to help you build with us culturally responsive long term care homes,” she said.
Partnerships with Indigenous Nations will also take place to build culturally-specific homes for them. The plan ensures residents who speak a First language will continue to do so while they’re in their new home, and will come through the hiring and training of specific staff members.
While the concept is great on paper, it’s lacking details that explain how these solutions will work. For example, the plan emphasizes the use of staff speaking with residents in their preferred language, but it does not mention any impact staff might experience.
A review examining cultural diversity in Ontario LTC facilities illustrated that some homes surveyed enlisted staff members who speak a specific language to assist members in the home. But the 2017 report noted some workers reported burnout if they had many requests to interpret, while also completing their existing workload. The report notes culturally appropriate practices must be incorporated in all aspects of a program, from policy making, to strategic planning, and outreach.
The NDP’s plan comes as the second wave continues to make its way through LTC homes across the province. In Peel, there are currently two outbreaks at LTC homes and two at retirement homes. Since the onset of the pandemic, 639 LTC residents in Peel have been infected with the novel coronavirus, and 199 residents have died. There have been 316 staff cases in the region and one death.
The NDP’s plan also includes clearing the wait-list of residents needing a bed, and establishing staff that works full-time and is paid and trained appropriately.
The plan blames “decades of underfunding” by previous Liberal and PC governments that have led to staffing shortages in LTC homes. While staffing issues seem to be more prevalent now, it has existed long before the pandemic.
In February, the Ontario Health Coalition shared a report that illustrated some homes can be short five to 10 personal support workers (PSW) in a 24-hour shift, while others need 20 to 50 more PSW’s. This leads to staff completing double shifts, facing burnout, and residents not receiving adequate care – all without staff being properly compensated.
“They have to rush the basics, like help with eating or bathing. And, tragically, they have to choose which call bells they can get to, while others ring and ring, unanswered. Personal support workers are badly overworked and underpaid,” the NDP report states.
During recent months, staffing in some homes such as Grace Manor was so greatly impacted, the military had to be called in for assistance. The Canadian Armed Forces deployed a medical unit to the home April 28, with 25 soldiers filling shifts onsite.
The need for more PSWs’ and other staff members will only increase, as there are 38,000 residents currently on the wait-list for a bed in an Ontario LTC home. In its plan, the NDP says it will create 50,00 spaces within eight years, fast-tracking projects and utilizing planned capital funding.
Concluded Howarth: “This is not one of those things that we can accomplish just over a couple of years. It's a very broken system, and it's a system that’s going to take some time to fix.”
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