It’s gotta be tough to be a senior, or more honourably, an elder, these days.
I am not of the “even if it saves one life” crowd, nor “every effort must be made to save every life.” We all die at some point. If we get to live past 75, we should count ourselves lucky. Life can be miserable even when we are healthy and young, but when our bodies fail, very few of us want to be hanging around longer than either our Maker decrees (or our modern MAID provides.)
Around 90 per cent of COVID-19 deaths are those over 60 years old and most of those occurring in long-term care (LTC.) We should be grateful for the heroic efforts made by LTC staff to make the lives of their residents brighter but I don’t think we should be proud of the system we have developed.
With roughly one per cent of our population in LTC, improving the quality of their care presents a major challenge. The “good” statistic is the 2016 census found that 6.8% of Canadians aged 65 years and older were living in a nursing home or residence for senior citizens. This proportion jumps to 30 per cent among Canadians aged 85 years and older. So, most elders do still manage to stay at home in their final years.
For those that need 24/7 care, we need to rethink our solution to the problem of providing good care. I will toss out just a few ideas and hopefully it starts a needed conversation.
Too many times I have heard families decide to send their loved one into care because “what will the neighbours think if we leave mom on her own during the day?” Perhaps we need to reconsider our role as neighbours and turn from judge to helper. Perhaps we need to readjust the balance between physical safety and quality of life? We need to adjust our neighbourliness and push to direct more of our healthcare dollars to cover the cost of installing safety measures and providing homecare for families. This would make aging-in-place or staying with family a viable option for more elders.
Maybe we need to treat frail elders in a way that honours their long life by not giving them drugs simply to keep them alive when they would much rather leave? In my experience, I have seen both excessive treatment, negligent treatment, and “just right.” The excessive example was dealt with by a quick rip to remove the heart medication patch from an Alzheimer’s patient. The negligent was a frail elder with a broken hip dying after three or four days in the emergency room. His family should have been told there was no forthcoming surgery and he should have been allowed to be brought home to die there.
The “just right” was still not easy but it didn’t extend life, it simply made life a bit easier and death was painless. The last year of care was in an LTC facility, but the staff was kind, the atmosphere was homelike, and there was no dinner bell. It took the main caregiver two years to recover from the burden of the previous years of care but the only regret is not doing enough.
Perhaps neighbourhood-based eldercare/daycare/night-care would meet the needs of some families? Or move some facility-based care to home care. More mixed student and elder housing? Increase tax credits for those caring for a frail elder, provide more government-funded care equipment, planning mixed generation neighbourhoods, and tax credits for building wheelchair-accessible homes?
The disruption caused by COVID-19 is a good time to reconsider the way we care for our frail elders, especially those in our LTC system. The improvements need to be diverse and flexible to meet the needs of families, while within our reasonable ability to pay for them. They need to honour the life and contribution of our elders and those that care for them and those that love them.