The New Normal at Au Chateau and LTC Homes in Canada

The devastating reality of drug use, a burnt out workforce and obvious solutions to a generational crisis.

Out of bed for breakfast (if they wake up on time), back in bed, out for lunch, back in bed.. It's sad and depressing. Staff are giving their all just to meet basic needs. There is no care beyond basic care happening... Physio, exercise, and even baths are so sporadic and definitely don't seem routinely planned. We need more staff, family, friends and volunteers in there desperately. I try to help out others when I am around but I am constantly reminded that as someone lacking the appropriate number of COVID shots my help is forbidden.

- An Anonymous Caregiver at Au Chateau LTC Home in Sturgeon Falls, ON

A middle-aged friend of mine recently told me “ I told my kids don't ever put me in there...” when referring to nursing homes. Her sentiment is one felt by so many these days. Nursing homes in Ontario are perpetually understaffed. Anyone with a family member in a home today can attest to this. Homes are not meeting the basic needs of residents. Imagine no longer receiving regular exercise or a regular bath beyond once per week. Imagine not getting any personal attention other than being wheeled back and forth between your bed and the dining room. That’s the reality of most long-term care (LTC) homes today. And as much as we want to insist that we will never end up there, the unfortunate truth is that most will eventually need to be placed in a LTC home one day.

I reported on the hard facts related to one LTC home back in January. Au Chateau in Sturgeon Falls is currently short 77 shifts per week. That means that the home has funding to have 11 extra staff every single day but cannot do so because of the lack of availability. In short, these seniors are missing out on a much needed 88 hours of care per day. To put this into context, this home has 160 residents. So each resident is missing out on 3.85 hours of direct care every single week (88 hours x 7 days / 160 residents).

Although the ministry mandates that LTC homes offer residents an average of 4 hours of care per day, most homes are falling well short of this requirement. Au Chateau is only at 3.4. Which would explain why residents frequently report feeling neglected.

“They are all drugged up” - Anonymous Caregiver

An under discussed topic in the realm of LTC care is drugs. We’ve become desensitized to speaking of the opioid epidemic affecting our communities. But the general population doesn’t realize how “drugged up” our seniors are.

One caregiver who has had a family member at Au Chateau since before the COVID pandemic started, has seen a huge increase in the amount of drugs being used to quiet the residents. In order to make them less aware of their negligence.

Luckily the Ontario government does monitor this issue to a certain extent. The Ministry of Health requires homes to report the percentage of residents that are not living with psychosis but who are still given antipsychotic medication.

This is a problem that has gotten worse because of Canada’s pandemic response.

For Au Chateau this number has gone up 28%.

Prior to the COVID pandemic in 2018/2019 Au Chateau only gave antipsychotic medication to 14.8% of residents who were not psychotic. In their latest report in 2021 this number has gone up to 18.9%. They are now in line with the provincial average (of 19%) despite outperforming this metric just a few years ago. Although Au Chateau has seen a steep increase, they are not as bad as many others. In 2021, 48 Ontario LTC homes reported a percentage higher than 30%.

*You can find this statistics for any LTC home in Ontario here.

“It's often an indicator that people in the home are being managed chemically.” - Tamara Daly, the director of York University's Centre for Aging Research and Education

CBC investigated this topic last year when they reported that Canada-wide LTC homes have seen a huge uptake in psychotic drugs being given to residents in light of the pandemic response.

According to the Canadian Institute for Health Information (CIHI), these types of medications are intended to sedate, and is used off-label to combat a variety of behaviours, from wandering to insomnia.

Tamara Daly, the director of York University's Centre for Aging Research and Education said that "Antipsychotics have been referred to as chemical restraints. When we see an excessive amount of prescribing for antipsychotics, where there's no clinical reason or disease state to be prescribing it, that would be a flag. It's often an indicator that people in the home are being managed chemically."

1 in 5 resident who are not considered psychotic are regularly receiving antipsychotic medication in Ontario. That is on top of the residents who are considered psychotic receiving such medication. Those numbers are hard to determine but the Canadian non-profit Age Well reported last year that up to 76% residents in LTC homes are diagnosed with a mental disorder. We can only assume that most homes have over half their residents on some form of antipsychotic medication. Substantiating the claim from a local caregiver whom I’ve spoken to. She has told me “they are all drugged up” when describing the atmosphere inside her loved-ones home.

Some attribute the overall anxiety surrounding COVID as the cause for the overuse of drugs and an increasingly depressing environment. But it’s not just that.

With excessive lockdowns measures imposed throughout the pandemic and extremely restrictive visitor policies, there are a lot less family and caregivers around to help out. But this means there are a lot less of them around to ask questions and to object to excessive drug use. Multiple caregivers have told me that they have witnessed these types of drugs be administered without consent. This was particularly more prevalent and troubling when some primary caregivers were forbidden from entering Au Chateau for over 13 months.

I believe they have repeatedly given my mother antipsychotic drugs without my consent (as power of attorney). When I reported these problems and asked that I be informed prior to such changes in medication, I was told that notifying family was not necessary. - Anonymous Caregiver

Another obvious problem is the staff shortages and overall burnt out workforce. As widely reported, health care workers in LTC have been stretched to extreme levels throughout this pandemic. But I have spoken to many of these staff and most of their biggest concerns are not their own personal well being. It’s feeling of helplessness at the end of a shift when they know they didn’t have time to give every resident the care they deserved. As I have reported on frequently, in Sturgeon Falls, the LTC home still forbids critically needed employees from coming back simply because they don’t have at least 3 COVID therapeutic shots.

Drugs have certainly been overused but in many cases there is likely legitimate depression taking hold. When a poor resident is lonely, deprived from their closest family for over a year, deprived from seeing the uncovered face of any caretakers for two and lacking a normal social life for three, we can understand the increased desire for antidepressant drugs.

Dr. Samir Sinha, an experts in the field of geriatrics and advocate stemming the overuse of antipsychotic drugs has stressed that LTC homes are too often taking the easy route.

“We should expect that they should be providing that level of care first, rather than taking the easy route that might actually potentially cause more harm than good."

Dr. Samir Sinha, director of geriatrics at Sinai Health in Toronto

I agree with Dr. Sinha. Providing the appropriate level of care should be the number one priority. And all solutions, debates, discussions should be welcomed. ALL QUALIFIED HEALTH CARE WORKERS should be welcomed back immediately regardless of their personal health choices. ALL VOLUNTEERS willing to help should be welcomed.

We also need to change the culture around these institutions. Many are overworked but also afraid to speak up. This was highlighted recently when a city councillor brought up the fact that healthcare workers have personally told her that they risked reprimand from administration if they did not lie on patient charts (falsely showing that all services had been delivered).

There is a definitive culture of silence and potential bullying on behalf of management. This type of culture will never solve the monumental crisis we are facing in Canada. A crisis of a collapsing LTC industry coinciding with a growing segment of the population that will desperately need this industry very shortly.

Note to Readers: Last week the administrator of our local LTC Home took out 2 full page ads in a local newspaper (at an undisclosed cost of public funds likely exceeding $1,000). In these ads he attempted to shrug off anyone advocating for positive change in LTC as a “minority”. He falsely accused anyone of wanting to fix the problems “of tarnishing his organization’s reputation” and falsely accused us of harassment. Simply for asking questions…

I will not let this intimidation tactic prevent us from asking questions. I will not let these taxpayer-subsidized lies deter us from seeking fairness and dignity for LTC residents and their families. I am NOT against Au Chateau. I am NOT out to tarnish it’s reputation. I am here to save this crucial institution and industry because I know we will all need it in the future.