This blog will address some of the first hand experiences that my clients and I have had when interfacing with the Long Term Care sector.

1.  Younger adults. I worked with a 42 year old gentleman who lived with a degenerative motor disease. He could no longer live on his own and spent several years under Alternate Level of Care  (ALC) status in a hospital. This is not a new issue and the Toronto Star wrote an article highlighting some of the challenges.

At that time, there were only 2 LTC’s that identified themselves on the placement selection list as catering to younger adults. I am aware of only one setting that actually had its own distinct unit for younger people rather than integrating them with the general population. It goes without saying that one’s interest in their 30’s is quite different than those of someone in their 80’s.  Individuals who are developmentally delayed also face tremendous challenges.

2.  Residents with behavioral difficulties. As highlighted in last week’s blog, over 40%  of residents exhibit aggressive behaviours stemming from their cognitive condition. There is not enough staff and/or they are not equipped/able to actively problem solve and explore the reason for the outbursts and intervene in a helpful way.  Simply put, there is not the time  to understand the A,B,C’ of someone’s behaviour (A=  antecedent, B= behaviour itself and the C=consequence).  There are a handful of settings that are specifically designated to accommodate those with significant behaviourial challenges but again, there simply are not enough spaces to accommodate.  There were previous concerns regarding the high number of residents who were on anti-psychotic medications.  Health Quality Ontario[1]reported in Ontario in 2017 that almost 23% of  LTC residents are on this medication without a diagnosis of psychosis. This is an improvement from the 2015 data that documented 27% of residents were being given this medication.

3.  Couples who want to continue to live together also face challenges as bed offerings are rarely two at a time. This was highlighted in a few different newspaper articles 

4.  LGBT community has also had to provide specialized training to staff however other residents may not all be so welcoming.

5.   Securing a linguistic and culturally appropriate setting can also be very difficult. For many in the later stages of dementia, they revert back to their mother tongue. While we are an ethnically/linguistically diverse community, it seems that many of those working within these facilities do not share these language skills.

This blog has highlighted several challenges that families experience daily.   I know there are others but these are my starting point.  My next blog will highlight some of the steps the Ontario government is taking to hopefully address them.

[1] https://qualitycompass.hqontario.ca/portal/long-term-care/Antipsychotics?extra=pdf (October 2017)