Government as Usual

OK, here’s the problem. I’ll use Ontario’s numbers because I live here; I acknowledge that the situation varies by province. I’ve rounded-off decimals and such where I could, to keep it simple, because that’s how I grok this sort of information.

1,280 – Number of new LTC beds just announced by Premier Ford. Hurray! It sounds good, right?

It is good. But here’s the rest of it.

2021 – Year of completion for the new facilities.

12 – Month of completion. They hope.

What? They won’t be done until December? It takes 17 months to build a nursing home? Well, to contract it out responsibly (And we want that from government, yes? Even if WE might not?), even using an accelerated procurement process, and then to build it, even using an accelerated build program, yes, it takes long. That long.

But it’s going to solve the LTC-bed problem, right? Well, you be the judge.

34,000 – Number of frail seniors who were on a waiting list for an LTC bed at the end of 2019.

40 – The percentage of beds we’re short by, given that we have 78,000 filled beds and 34,000 people needing one.

1.6 – The percentage we’re increasing beds by between now and the end of 2021.

I’d need more data and some modelling skills to figure out how fast this accelerated-build program would clear that backlog and catch up with demand. If the program were continued. If there were no change in demand. I’d need a nifty program to allow for average stays (I see figures ranging from 5 months as the median to ~13 months as the average) and, well, death rates, since death is the event that empties most LTC beds.

But even without sophisticated analysis, it seems to me that a 40% gap in capacity isn’t going to be filled anytime soon by a capacity-building program that delivers just 1.6% more capacity every year and a half. Look at it this way: If we went 10 times as hard and added 12,800 beds in the next 17 months, at the end of next year we’d still have more than 20,000 frail seniors on the waiting list. And we’re not planning to go 10 times as hard.

But surely some of these folks could live in their own homes? Or with their families?

2/3 – Proportion of those frail seniors who have a dementia diagnosis.

3/5 – Proportion who take 10 meds or more every day.

9/10 – Proportion who have some cognitive impairment.

We’re not talking about people who can be safely supported in-place with a home-care visit twice/day, and it’s a rare one who could live with family. That why, right now, they’re waiting in hospital beds.

But surely the wait isn’t that long?

5 – Average months spent in hospital after being deemed suitable for an LTC bed.

But it gets worse. What? Yes.

30,000 – Number of LTC beds (of the total 78,000) that must be redeveloped by 2025 to meet new standards. Think “no more rooms with 4 beds” in case of, oh, I don’t know, a pandemic. Think “must now have air-conditioning” in case of, oh, I don’t know, a hard lockdown in response to a pandemic and windows that don’t open, for safety reasons. Not that it would help to open the window anyway. Ontario summer: ’nuff said.

Now, I don’t care who or what’s to blame:

  • 8 years of Mike Harris’s Common-Sense Revolution and its focus on balanced budgets?
  • 15 years of subsequent Liberal government spending on wind farms et al, and hang the deficit?

I. Don’t. Care.

What I do care about is this: We can’t fix this problem with government as usual. And I don’t see anything else on offer. Do you?

We can’t solve problems
by using the same kind of thinking
we used when we created them.
Attributed, more or less reasonably, to Albert Einstein

I begin to wonder whether we can fix it with government at all.

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10 Responses to Government as Usual

  1. Tom Watson says:

    Isabel
    I need a prediction, so shine up your crystal ball. Will I live long enough to see it as a reality?
    Tom

    • Isabel Gibson says:

      Tom – I hope we will see change for the better. That’s as far as I’d care to commit myself. And as the US General noted, “Hope is not a method.”

  2. Dave Jobson says:

    Hi Isabel
    Have wrestled with these issues since retirement in 2008. Useful to look at Scandanavian countries; not perfect but much better. I will spare you the economics and policy stuff.
    PS: In Alberta I like to divide people into the two categories : the flat taxers and the progressive taxers. If they are in the first category then there is really nothing one can say regarding positive change.

    Dave

    • Isabel Gibson says:

      Dave – I believe Australia also handles this aspect better – there was some coverage of that sort of mid-cycle of our (i.e. ON & QC) COVID-19 meltdown in LTC homes. Not perfect, of course, but I’d happily take “better.” Indeed, am close to demanding it, dagnab it.

  3. Dave Jobson says:

    We need social democracy as in Scandanavia. Just sayin…

  4. Jim Taylor says:

    You have dug (duggen? digged?) much deeper into the statistics than I have. Thank you for doing that. When confronted with the figures, things look pretty bleak, don’t they?
    Jim T

    • Isabel Gibson says:

      Jim – Dugged, I think. 🙂 Not that it took much dugging: The Ontario LTC Assocation has most of this; the rest was from press releases. What took some thinking was how to lay it out so it could be seen. And I guess it’s a reasonable question: How long is too long for a frail old person to wait in hospital? Maybe 5 months *is* tolerable. Less tolerable is the business of having so little choice as to where you go. Much less tolerable is the 4 people to a room. But what’s a bit frustrating is that it’s not a technical problem: We don’t need to develop and deploy any untested technologies. We just need to spend money.

  5. Barry Jewell says:

    “We just need to spend money”
    I think that should read more as “invest some money”. I am suspicious that the cost of five months in a hospital bed is a sum that would pay for a large number of months in a long-term-care home.
    We are so afraid of spending, investing, a buck because that would cause a deficit that we end up costing five bucks. Those with the money are certainly OK themselves, but not OK with someone else receiving something for nothing. They are willing to spend large sums of money to prevent the “unearned largess”

    Soylent Green is very tasty!

    • Isabel Gibson says:

      Barry – Yeah, I agree that hospital beds are likely pricier than LTC ones, based on staff levels alone, not to mention the facility cost. A quick Google search didn’t turn up any straightforward answer/comparison to validate that hunch. This is a bit like failing to invest in home-care supports which is a crazy “economy” because it helps keep people out of LTC before they really need regular medical care.

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