Proposal for South Asian long-term care home stalls after Brampton staff pulled offer ahead of deadline

Time is running out for Indus Community Services. The local organization’s innovative plan to bring a long-term care facility dedicated solely to the city’s South Asian population was allocated 192 long-term care beds by the government of Ontario in 2021, but without a spot to locate the facility, the not-for-profit may soon lose its eligibility for provincial funding.

Without land committed by March 23, Gurpreet Malhotra, the chief executive officer of Indus, says the organization stands to lose the unique opportunity being offered by the Ontario government.

“Once we have land, we can start arranging financing, we can start doing architectural drawings and then start working with our communities to build this here,” he told councillors during a presentation in January.

“As our one-year deadline expires in March of 2022, we’re hoping that this amazing opportunity is not lost to our many members of the community, but also to the City of Brampton,” Malhotra said. 

He told councillors that in December, Indus was presented with a pair of opportunities by City staff for either a two-acre parcel of land in north-central Brampton or a one-acre parcel in the east end of the city, but those offers were withdrawn not long after.

“We immediately asked why, but have not received any reasoning around that,” he told City council.

"I did want to clarify that staff can't offer any piece of land without Council's approval," Regional Councillor Michael Palleschi said during the meeting.

The discussion was moved into closed session following a motion from Councillor Rowena Santos. It’s unclear why she pulled a public issue behind closed doors, preventing Malhotra or any other member of the public from participating in the conversation. 

According to staff, Brampton is currently exploring options to assist Indus Community Services with its proposed Campus of Care facility it wants to build for seniors. 

The Pointer has repeatedly reached out to the City of Brampton for an update as the provincial deadline approaches, but has not received a response.

As a non-profit, Indus could receive a one-time planning grant of $250,000 from the Province, as well as support for eligible construction costs, land costs, development charges, signage and $23.78 per day per bed as operational funding for 25 years (which may amount to approximately $1.6 million annually, provided all 192 beds are occupied and operational).

Indus will only receive the funding after it files the application, which is delayed without land to build on.

“At this point, every penny that the agency has spent to explore the idea, write the contracts, to hire consultants, to explore working with the City—all that time and effort has been through donations to the agency,” Malhotra told The Pointer.

He said the City has stated it is willing to write a letter of support, if needed, to the provincial government for Indus to get an extension. 

The City of Brampton has also previously committed to helping projects similar to the one proposed by Indus. 

In March of last year, councillors approved a resolution leasing 5-acres of land to the Golden Age Village of the Elderly (GAVE), which caters specifically to the Vietnamese-Canadian community. The same motion committed to assisting similar projects in the future, noting “staff be requested to support any additional long-term care (LTC) applicants in 2021, with charitable status and interest in Brampton, and which have received licencing for additional LTC funded beds, with similar and comparable assistance and resources, with all final decisions subject to Council approval.”

“The Council resolution clearly states that they would provide similar help to anyone who's similarly asking and they have not,” Malhotra said. “There is demand in South Asian communities for a safe respectful place for elders to be respected and live with dignity on the one hand, and be understood and feel that they're at home.”

Brampton is also considering further support for the GAVE project, following a request from the organization Secretary General Tanya Nguyen, and Vice Chair Dr. Quynh Huynh, to waive development charges for the project. The matter has been referred back to staff for further study. 

Malhotra told The Pointer it’s a good thing that Brampton is supporting long-standing charities that are trying to build much-needed, culturally appropriate long-term care homes in the city.  

“Indus Community Services once again asserts its desire for an equal partnership with the City and asks that this is done fairly,” he said. “My dream is that as we grow in size of long-term care homes, not just in this, but all our communities, that they increase their diversity and specificity so that they'll be able to be more specific and more helpful.”

For two years, the novel coronavirus has plagued Ontario’s long-term care homes. It has left 4,122 residents and ten health care workers dead across the province and exposed the tragic gaps in the way our healthcare system cares for the elderly. Since March of 2020, 444 residents and 5 staff members have died in Peel’s long-term care and retirement homes. 

A lack of qualified staff, understaffed and overworked personal support workers (PSWs), inadequate nutrition and cramped living spaces that allow sickness to flourish, were problems that existed well before COVID-19 started invading these homes in 2020. These issues have only gotten worse. 

Members of the Canadian military were called in to assist with handling the crisis in long-term care homes across Ontario early in the COVID-19 pandemic. 

(Canadian Armed Forces)

For Peel’s largely immigrant population, the list of issues within the healthcare system is much longer. The immigrants that choose to settle down in Canada face a number of additional struggles, including navigating a healthcare system that is different from what they may be used to, models of care that may not align with religious or cultural beliefs and language barriers that can prevent individuals from receiving critical care.

A report published in September 2020 revealed shocking disparities in the amount of time spent waiting to receive care in Ontario’s long-term care facilities among people with different backgrounds. 

The ‘Waiting for Long-Term Care in the GTA’ report by the Toronto-based Wellesley Institute, which works in research and policy to improve health and health equity in the Greater Toronto Area, shows serious inequities in people waiting for care. Individuals who may not speak Canada’s native languages of French and English, are unfairly penalized by the system. 

“People who reported neither English nor French as their first language waited longer than those whose first language was English or French, and this has been consistent from 2012 to 2017,” the report reads.

The report states that from 2012/13 to 2017/18, the median wait time for long-term care in the GTA increased by 35 days to 223 days, compared to an average of 146 days in the rest of Ontario, which saw an increase of 13 days.

A comparison of the change in median wait times for admission to a long-term care home in GTA vs Ontario from 2012/13 to 2017/2018.

(Waiting for Long-Term Care in the GTA)

The current median wait times for long-term care in Ontario averages 188 days according to Health Quality Ontario, the provincial lead on the quality of healthcare.

Even for those with English as a second language, many often revert to their mother tongue and lose English in old age, this is particularly true for residents suffering from dementia, Ontario’s LTC COVID-19 Commission report says. Long-term care homes dedicated to particular demographics, like the Indus proposal and the GAVE project could go a long way toward closing these harmful gaps. 

"This means that the only way to communicate is through family members. Being cut off from families during the pandemic left these residents isolated,” Malhotra said.

It is only natural for immigrants that do not speak the same language and do not share the same cultural ethos to seek care in a setting more familiar to them, where someone who understands them and their needs can take care of them. Along with the Indus project, the 160-bed Guru Nanak Long-Term Care Centre, dedicated to serving Punjabi-Canadian communities in Brampton, is looking to do just that. 

According to the Wellesley Institute report, there is a significant demand for these types of services. Twelve out of the 20 long-term care homes with the longest median wait times were ethno-specific or religiously specific long-term care homes. 

In 2017/18, the median wait time for a religious, ethnic, or culturally-specific long-term care home was 246 days longer than those waiting for space in a mainstream facility. 

Another study by the Wellesley Institute found that linguistic and ethno-specific care services have positive impacts on residents’ physical and mental health such as reduced social isolation, lower rates of depression and fewer falls and hospitalizations.

For the South Asian-Canadian population, there is not a single dedicated long-term care facility in all of Ontario, despite South Asians being the single largest visible minority group in the province, accounting for 29.6 percent of visible minorities as per the 2016 Census data. According to the same Census, South Asian-Canadians made up almost 45 percent of Brampton’s population. 

The absence of culturally appropriate long-term care homes leaves many seniors dependent on visits by family members to address cultural needs, including communicating in their mother language and providing food that is familiar. This became a significant issue when long-term care homes closed their doors to visitors at the start of the pandemic.

Before COVID, Sunita Sharma would drive every week from Cambridge to Mississauga to see her 88-year-old father at the Silverthorn Care Community. When the pandemic struck, she was forced to only see him virtually for an entire year. 

“COVID hit and then I couldn't come see him and he just didn't want to stay anywhere. He just wanted to come home,” Sharma told The Pointer.

“When our families have not been allowed to go in, when food has not been able to get delivered, it bothers me,” Malhotra said. “For someone used to eating dal roti their entire life now finds themselves with mashed potatoes and peas and chicken on a plate, that is not to their liking, not to their spicing, not to their style, not to their comfort.”

The needs of this demographic can be complex as the South Asian community is far from homogeneous, with different languages, foods, and cultural nuances among different groups that make up a rainbow of diaspora communities.

“South Asian is an artificial construct as terms go… you're looking at a diaspora close to 1.9 billion people (including in the subcontinent) who would be considered South Asian,” Malhotra said.

A Long-Term Care Homefinder that the Ontario government launched in early February could potentially help families find appropriate long-term care for their relatives, but it lacks basic features to do this. The website works similar to Google Maps, helping people find nearby LTCs. The tool provides the number of beds in the facility, vaccination status of the staff, inspection reports and wait times. There are no options to check LTCs by linguistic, ethnic, dietary or cultural focus.

Amy Friesen, founder and CEO of Ottawa-based Tea & Toast, a for-profit organization that has been helping families and seniors with the daunting and stressful task of finding retirement and long-term care homes for the last eight years, says there are a lot of unnecessary extra steps one must take to find answers, which make the site less user-friendly.

“It would be simple enough to list the languages spoken in the home,” she says. 

The current tools for looking at long-term care homes and retirement homes in Ontario lack a specialized understanding of what the public needs, Friesen says, noting family members already dealing with the incredibly emotional decision of placing a loved one in long-term care must navigate complex websites and multiple pages to find basic information. 

Amy Friesen, founder and CEO of Tea & Toast, which helps its clients find senior living and care facilities in Ottawa.

(Image from Amy Friesen)

“And for families who don't understand industry lingo, it causes a lot of problems. The fewer steps for a family in crisis the better,” Friesen says.

Aslan Hart, a spokesperson for the Ministry of Long-Term Care, says the government consulted seniors, caregivers, residents, long-term care home employees and the placement coordinators from Home and Community Care Support Services, who help seniors find and apply for long-term care, when devising the new online tool. 

It is being rolled out in phases and future ones will add more functionality and features on individual profile pages for long-term care homes, Hart says.

“The next phase of research is currently underway and will guide future iterative improvements, with the ultimate goal of creating a more user-friendly, useful tool for future residents and their families,” she says.

Friesen says it would benefit the government to consult with the private sector, especially when they are providing information about private businesses. 

“I would love to have a conversation to develop resources for seniors. I think that it would show some forward-thinking in an industry that can think archaically,” she says.

Until the government can enable more culturally appropriate care in the province, the onus to make sure elders have some sort of cultural familiarity continues to fall on family members. When she could not bring in home-cooked food, Sharma had to get involved with a dietician.

“My father does not mind the Indian or even the Canadian food, but there are certain meats that he doesn't eat. That’s why you have to talk to the dietician,” she says. “I tried to make sure that wherever I found a place for him, that there are nurses that are mixed [representing South Asian communities] because those are the two things that he needs.”

In Brampton, where a large number of families live in extended, intergenerational households, this dynamic can be problematic when it comes to trying to avoid COVID-19, which thrives in crowded, enclosed spaces. The lack of culturally-specific long-term care can potentially leave these seniors and their families with few places to turn during a health crisis.

Hart says the Ministry of Long-Term Care realizes the importance of culturally appropriate care. 

“We have recently approved a number of homes that have indicated that they would provide culturally appropriate care and services to the South Asian Community; including Indus Community Services and Guru Nanak Long-Term Care Centre in Brampton and Schlegel Villages [will open in 2025] in Oakville,” she stated.

The Ontario government announced $933 million for 80 new long-term care projects in March 2021 to address the growing needs of diverse groups. This funding is reported to be going toward additional spaces in high-need areas,  upgrading older homes to eliminate three and four-bedrooms units, and promoting campuses of care to better address the specialized care needs of residents.

Providing adult day programs for over 20 years at three locations, Indus has been able to address some of the much-needed demands of South Asian-Canadian seniors.

“While they are there, they have people who talk the same language, the food is something that they are used to receiving at home, as well as the programs and services that tie into their culture, for example, carrom boards or musical instruments they recognize,” Malhotra told The Pointer.

Indus Community Services has long been serving Peel’s South Asian community and the organization has experience jumpstarting LTC projects in Peel.

Indus has been working alongside Trillium Health Partners and Yee Hong Centre for Geriatric Care since 2018 to construct a 320-bed long-term care home—including 128 beds that will cater to the South Asian-Canadian community—in neighbouring Mississauga.

The Mississauga LTC home was expected to be completed this year, but has not moved ahead as Indus and its partners have not been able to secure land for that joint project either Malhotra explained.

For the Brampton project, Indus has partnered with the Hamilton-based Thrive group, which operates two long-term care homes in Hamilton—the St. Peter’s Residence at Chedoke and Idlewyld Manor. 

Malhotra said he wants the region with one of the largest South Asian diaspora communities in the world to recognize the need to reflect its own residents, and take care of them just like any other group that relies on governments to understand the needs of their own citizens. 

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