“No problem can be resolved, or detected, if care is taken, from the start, to eliminate all possibility of seeing the problem exists.” (our translation)
— Bertrand Russell, Philosopher and Logician, 1872-1970
With the numerous cuts in nursing positions, that have recently occurred in several residential and long-term care centres (CHSLD), it is incredible to learn that the Minister of Health and Social Services has stated that “it’s not cuts, but modifications in the supply of services”. Even more incredible to hear about a reduction in the needs for care in a CHSLD to an assistance in accomplishing the tasks of daily life.
We must stop maintaining this myth that makes a CHSLD a simple living environment. A CHSLD is first and foremost a care setting where mainly elderly people who no longer have the necessary autonomy to move back to their home are found and their health condition, at the time of admission, required a minimum of three hours of care a day.
Among the people living in CHSLDs, nearly half are over age 85, two-thirds have at least three chronic problems, 60% have cognitive disorders and at least 20% suffer from mental disorders and exhibit major behavioural problems. So, whether it is hygiene care, distributing medications, assistance with walking and mobilization, assessment of the physical or psychic condition or intervening in emergency situations, the care delivered to these patients requires time and a professional expertise.
The beneficiary attendants in a CHSLD, even if they do essential work and are an integral part of the care team, cannot however, provide medical care. Nurses, licensed practical nurses and respiratory therapists are the only healthcare professionals who need to be present 24 hours a day, 7 days a week.
In the area of care for people with loss of autonomy, the CHSLD represents the equivalent of a critical care unit. Therefore, it is not normal that an elderly person is moved to an emergency department because there are insufficient healthcare professionals to give him the required care. Considering that it takes a few days for the condition of an elderly person to seriously deteriorate, the risks and the costs associated with a prolonged stay on a stretcher in the emergency department are not justified.
It is no longer normal that a licensed practical nurse is responsible for such a large number of patients that it takes her four hours to distribute medications. It is still even more unacceptable that the only solution that the employer has to propose is to make her wear a bib with a message saying not to disturb her during her work.
I do not want to question here the ministerial willingness to allow our elderly with loss of autonomy to age with dignity. That willingness however, must translate into action, by guaranteeing immediate access to a complete and adequate care team for those who have worked all their lives to build our society.