Institutional inertia, neoliberalism, and a failure to view long-term care as a public good have all led to a gap between knowledge and action.
The concentration of COVID-19 outbreaks in long-term care facilities across Canada, responsible for an estimated 82 percent of total deaths, has exposed and magnified lingering, systemic issues in senior care. But why doesn’t knowledge translate into action, and what can we do about the knowledge-action gap?
There is no shortage of academic research and public inquiries into issues in long-term care health systems. We have long known that underfunding in senior healthcare has caused deterioration in seniors’ health outcomes. Contrary to widely held beliefs, healthcare expenditures have decreased in the seniors’ age group, with a more than 60 percent decline in all 65+ age groups from 2002 to 2012.
We also knew that for-profit, private care facilities provide an inferior quality of care compared to non-profit and public facilities. The higher the profit for private pockets, the poorer the public health outcomes.
For example, the Ontario Provincial Government ignored for two years the findings from the Public Inquiry into the Safety and Security of Residents in Long-Term Care Homes System in 2017, spurred by the case of a nurse-turned-serial killer in Woodstock.
Had the provincial government and other agencies acted collaboratively on the inquiry’s recommendations, the long-term care homes sector would have been more prepared to deal with the pandemic. The Ontario government asked for military help in late April to stop the spread of COVID-19. Subsequently, the military released damning reports on the sad state of seniors’ care, particularly in for-profit privately owned facilities in Ontario and Quebec.
The military report’s findings on high staff turnover and poorer health outcomes in for-profit care homes are well known. Neglected and ignored, these findings are familiar to those working within the care sector. The Canadian Centre for Policy Alternatives has produced at least five major research studies, circulated in Policy Note. There are several books and academic articles on the subject, notably by York University professor Pat Armstrong and research teams across Canada.
So, how do we explain this failure to connect good knowledge and effective action? Did researchers fail in knowledge mobilization, or connecting their findings to policy-makers? Or, did policy-makers fail to act on these findings? Or both? Why didn’t research findings on how to address systemic vulnerabilities not translate into transformative changes?
First, inertia can seep into institutions at all levels of the long-term care system. They can become unresponsive and not dynamic and agile enough to engage in meaningful learning and ultimately take action. This inertia can occur because there are so many interests to juggle in the system, and so many stakeholders to consult. It’s also worth underlining that long-term care recipients themselves are not a homogenous group – they have a range of needs.
Eventually, health care systems as bureaucracies lose sight of the end user. They suffer from rigidities, outmoded designs, and inflexible rules. Families face a fragmented system to navigate, with complicated application processes, conflicting information and an overall lack of transparency.
What’s required is overall “systems thinking” to help break through the inertia. Ontario’s long-term care public inquiry report noted, “An effective systemic response requires all those in the system – both individuals and organizations – to work together to address the systemic failings that have been identified. Collaboration, co-operation, and communication must become the watchwords for the system.”
Second, neoliberal values and the for-profit interests of various players in the system can hinder transformative action towards publicly beneficial goals and objectives. Researchers and advocates for long-term care residents can find it challenging to convince governments to take bold steps when the underlying ideology centres around small government and supporting business.
Privatization has led to increased financialization in for-profit care homes in Canada. In British Columbia, for example, senior care homes such as assisted living units, have attracted investments from large corporate investors, domestic pension funds and international capital because of attractive profit margins, steady income streams, and stable real estate components.
Policy-makers and the public as a whole must realize that public interest is not an outdated concept or ideal. A sense of the public good must remain the main evaluative criterion and axis around which debates over long-term care must revolve.
Federal and provincial governments can collaborate to make public investments in long-term care facilities and buy out for-profit care homes with poor health outcomes. Doing this will also bring staff salaries to unionized, living wage levels, and avoid high labour turnover and staff having to patch together work in various seniors’ home to get adequate incomes.
Third, one of the key factors impeding policy action is the underlying public attitudes towards aging and the elderly in society. Our culture glorifies youth and productivity, and those who no longer participate in the workforce can be seen as a drain – and not as a priority. An Ipsos poll conducted during the 2019 federal election suggested that only 14 percent of Canadians would list “seniors’ issues/aging population” in their top three concerns.
We need champions within the federal and provincial political class to speak up for seniors, and to generate public support for a humane, high-quality long-term care system that everybody will eventually need in some shape or form.
COVID-19 has stimulated our collective imagination of alternatives to current systems. It has invigorated civic conversations on national standards, the role of public institutions, and resurgence of the idea of the public interest.
This pandemic-driven crisis can hopefully help us get past institutional inertia and traps. Let us find common meaning and purpose for why we care about seniors and their quality of care, especially during the pandemic.
This article is part of the Facing up to Canada’s long-term care policy crisis special feature.
For related content, check out the IRPP’s Faces of Aging research program.