Q and A with the experts: Long-term care after a year of COVID-19

Monday, March 22, 2021

Nurse with iPad speaking to older adult.

What has changed a year after COVID-19 first wreaked havoc on long-term care homes last spring? Paul Stolee, director of the Network for Aging Research and a professor in the School of Public Health and Health Systems, examines some of the issues associated with long-term care during the pandemic.

The impact of COVID and technology on aging will also be discussed at the University of Waterloo’s Conference on Aging, COVID-19 and the Adoption of Health Technology on March 24-25. If interested, please register by March 23 at noon.

What role can health technology play in supporting older adults at home and in long-term care?

There are many ways that technology could support the care and quality of life of older people. Some examples are digital technologies to support social interaction, social robots, wearable technologies and other monitoring systems, artificial intelligence models to support clinical decision-making and many others.

For these technologies to have an impact, though, they need to be adopted and used, and this is where many obstacles and barriers arise. In the context of the pandemic, a digital device – such as an iPad – could connect socially isolated long-term care residents with their families or facilitate virtual care provision between providers and older adults.

However, in an underfunded system, who will pay for the device and the internet service? With staffing shortages, who will help the older person learn to use the device and set up the connection with the family member or provider? For these and more complex technologies to have an impact, other challenges facing the long-term care system – like funding, staffing, facilities – also need to be addressed.

What lessons have we learned when it comes to protecting aged populations during a health crisis?

The first is that we should not wait for a crisis, like the COVID-19 pandemic, to address persisting deficiencies of the health and social supports available to older adults.

Secondly, the pandemic has exposed the weaknesses of the long-term care sector caused by chronic underfunding, understaffing and outdated facilities. If we don’t now respond to the tragedy in long-term care, then it is unclear what would prompt our public officials to take significant action. It is very discouraging that despite promises to defend long-term care residents after the first wave, the second wave resulted in a greater number of deaths.

Another lesson is that we need to recognize and support the essential role of family caregivers. Restricting family members from visiting their loved ones in long-term care homes may have been a short-term necessity for public health reasons, but caused heartbreaking social isolation of residents, some of whom died without their families with them.

A less obvious consequence was the loss of the direct care that family members provide in understaffed homes, as well as the oversight they provide on the quality of care. This exposed a major system shortcoming and an over-reliance on family caregivers to supplement lacking supports and services, contributing to caregiver burnout.     

A fourth lesson is that we cannot look at one part of the care system in isolation. Although the narrative surrounding the care of older persons has focused on long-term care, it is important to acknowledge that most older Canadians are in fact community-dwelling. For older Canadians who are aging in place, an integrated system of community care (including primary care, home care, and community support services) is necessary.

There are many other lessons, but the last lesson I will offer here is that the devastating consequences of COVID-19 were not inevitable. Aggressive early responses in some long-term care homes and communities were successful in avoiding or mitigating outbreaks. We need to learn from these success stories.

What has to happen before some semblance of normalcy can be restored for people living in long-term care homes?

Let’s hope that we don’t see a return to “normal.”  The normal state of things in long-term care – chronic underfunding and understaffing, outdated facilities – is unacceptable and this has been widely recognized for years. I hope that the pandemic is finally a catalyst to improve our care of older people.

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