 My name is John Molloy, I'm the Associate Dean of Research and Graduate Studies at the Faculty of Public Affairs at Carleton University. I do a lot of things in that job, but I always say the best thing is I get to host author meets readers every month like this, which is great. Wonderful. Before I go further, I do want to acknowledge that Carleton University and the land where we are here is the traditional and unceded territories of the Algonquin peoples. Land acknowledgments are very common these days. I always like to think that they are a regular thing we do, it's never a routine thing. Each time we acknowledge the land in which the university is on in particular, to me that's always reminded of the particular role of post-secondary institutions in further reconciliation between Cad indigenous peoples. And so when we get a land acknowledgment, I think it's always a chance for each of us to reflect on our own relationships to land, our own status as indigenous peoples, and just a chance to least briefly to reflect on those responsibilities. And so we always try to acknowledge the land where the university is and where this probably is where we gathered here tonight. And we are gathered here indeed for author meets readers. So as many people know, this is a series we've been running for many years, which features a book by a faculty member in the Faculty of Public Affairs every year. Every year we have lots of books, lots of different topics, lots of areas. So we always bring readers in to give the responsive book to people from the community that have their own expertise and lived experience and it's always a rich discussion. Each one I have to say is a little different. I've hosted many of these, I've attended even more. Each one is unique and that's what I really like about author meets readers. There's always something a little different. So I get to briefly introduce people and then I'm going to let them take it away. Of course our featured author tonight is Susan Bradley from the School of Social Work. So also Moonlighting is director of the Institute of Political Economy. It's among her many, many activities and duties. So it's really great to have Susan here and to feature her book on care homes in a turbulent era. Do they have a future? So we're glad to feature the book. We're glad to talk about the book. And so Susan, thanks very much for being part of author meets readers. And speaking of readers, I do want to briefly introduce the three readers that we have with us here. And I'll just go in the order of the RFI first on the far right. There is David Rock, the Executive Member of the Champlain Region's Family Counsel Network and a long-time advocate for quality nursing home care in Eastern Ontario and across Ontario. So thanks very much for being here. Next is Dr. Amy Hsu. Dr. Hsu has a, it's with the Brewery Research Institute. She holds a U Ottawa Brain and Mind Brewery Research Institute chair in primary healthcare in dementia. Long title sounds very prestigious. She's also senior lecturer in the Department of Family Medicine and is an expert on long-term care on the topics. We'll be discussing here tonight. And finally we have Don Cooper. Don is a member of the Long-Term Care Advocacy Committee for the Clean Association of Retired Persons Ottawa Charter. Thank you for being here as well. My pleasure. I will now stop talking. I'm going to turn it over to Susan to speak a bit about her book and then have the readers also respond to the book. And of course we'll have a chance for questions to audience participation later. But Susan, I'll now turn it over to you. Thanks so much, Jonathan. And thanks to the Faculty of Public Affairs for sponsoring this evening. I really appreciate it. So I'm here to talk about a book that I can write so much as co-edit. And I guess I wrote lots of it. But it's a book about long-term care homes. Sometimes called nursing homes or special care homes. In Ontario, these are the residences that are provincially funded for medical and social care and where residents pay for a room and board. So I want to be really clear about this. I'm not talking about private pay retirement residences. And I'm not talking about supportive housing that is also available in Ontario. And those distinctions are important to the work that I'm going to talk about. Some people argue that it's time to abolish long-term care homes. They argue that care homes are irretrievably bad. It's a system. These are warehouses for those with complex frailties, dementia, and disabilities. They speak often of the growing numbers of people under 65 who live in these homes. It is about 10% in Ontario and growing. And they say that these folks and others have no alternative except to go to a care home even when they don't want to go. They argue that care should be in people's homes, that home care should be improved, and that care should be in the... I agree that care homes should not be a dumping ground for everyone who needs 24-7 care regardless of age or reason. I agree that home care needs to be improved and more accessible. But for many reasons, including that not all of us have a home that's safe and suitable for care, that not all of us have sufficient community that's going to be in and out of our homes, and that family members' health and well-being are often deteriorated and compromised and brought to the brink of care at home, I disagree that we can do without care homes. But I don't think they should remain as they are in Ontario. I have seen care homes that offer safety, care, community, and even joy for older people who require 24-7 care. I've seen places that all of us would enjoy visiting, working in, and count on when we need them to help care for families and ourselves. But to develop this kind of care here, we need a revolution. This book offers research from an international team that I've been privileged to work with since 2010 that we've had. Some people leave and lots of wonderful new people join us, but we have continued. It has branched into many projects related to long-term care, but it was put together by the amazing Pat Armstrong who wishes she could be with us tonight. She is a distinguished research emerita and a tireless research and advocate. Frankly, she deserves the order of Canada in my estimations for her many contributions. She is a national leader on healthcare, women's work, and long-term care. She is co-editor of this book and remains a major instigator, and I use that word very specifically. She is an instigator of much of what this team does together. We wrote this book as a team, and I think this is not always usual. While there are different authors on each chapter, we all discussed and commented on each other's work, shoved drafts around. It is a tremendously collaborative process. Our authors are from Norway, from Sweden, from Canada and the U.S., bringing different perspectives in, and we've done research that is actually in long-term care in all of those jurisdictions and more over many years together. So what did we conclude? What revolution do we need? Well, we noted nine major changes. First, we need coordinated, committed leadership from government. While communities have a role beyond voting, long-term care is an essential public service in our view. Second, we need to remove profit from care. Making a profit from state-funded services assumes that for profits we'll make efficiencies that nonprofits and publicly operated services won't make. Well, it hasn't worked out that way. Long-term care homes have become big business. International private equity funds have become involved, often with investments from, for example, big Canadian pension funds, including the Canada Pension Fund that we all contribute to. Since most of the costs for long-term care are labor and relatively skilled labor, efficiencies need to be found by cutting care labor, and people don't get the care they need and deserve as a result. Due to the problems that have come to light in for profits, Norway currently has a commission exploring whether they should get rid of for profits. Ontario is heading in the opposite direction. Number three, we need to improve working conditions as a major path to improving living conditions. In our team, we often talk about these aspects as the rights to care, the right to get care we need as older people, and care workers' right to properly meet the needs of those for whom they care. So many workers have told us that they are ready to leave their jobs, not because they don't love them, but because they are so rushed that they can't do their job properly. Fourth, we need training, not only for staff, but for families, residents, and volunteers, and for the members of governing bodies, so-called decision makers. All these groups need training to understand frailty, dementia, and infection control. Further, the train needs to be continuous to keep all of us abreast with changing long-term care needs. And since 2010, when I started with this, they've changed a lot. Fifth, we need care homes that are embedded in communities and communities that truly embrace, support, and get involved in the long-term care homes. Sixth, we need residences with physical environments that reflect and respond to residents' needs, staffing, and the communities involved. Seventh, we need more democratic decision-making about long-term care matters to support all of this, involving those both inside and outside care homes. Eighth, we need nursing homes that can attend to people's needs, including residents, staff, and all who visit in ways that attend to their diversity, their safety, and their welcome. Ninth, we need an understanding of quality that goes beyond the numbers and the absences of bad things to account for quality of life, right to death, and the quality of work. In a book about policy and practice, you may be surprised to learn that the concluding chapter is a chapter about joy. Joy as a sense of belonging, joy as a sense of meaning or fulfillment, joy as sharing, joy as pleasure. We argue that care homes have the possibility for joyful collective living and caring, and the conditions that give rise to joy are potential quality indicators. And our book by saying this. In planning for the future of care homes in the shadow of the devastating effects of the pandemic, welfare state shifts, labor force shortages in health and social care, and rapidly aging populations, it's easy to succumb to pessimism and throw out the promise of collective living and caring in later life. We encourage all those concerned with care for older people to take a critical angle, to consider the future of care homes and the promise of quality by starting with joy. Thank you. Bravo. And so I'm going to turn to my friend from the Canadian Association of Retired Persons. There we go. And what did you make of this kind of crazy book? On the opinions and tremendous amount of research that filled in a whole lot of gaps that I did not know that I have somewhat perhaps biased opinions on because just because. Yeah. Okay. So I came into this position out of a peer ignorance, but that's where I fall into a lot of my adventures. Delighted to be here. Delighted to be a member of part of Ontario Ottawa chapter. Because there's such a need to take this revolution and bring it forward. And you and your colleagues are writing this book, which I have to say was in my view, very well, very well researched. You've got all of the, there's almost as many pages of references. There are a documentation or whatever I have to say, I skipped those. You'll have to forgive me my speaking. Anyway, so how I came into this was during COVID. Well, I guess I should start with a lifelong volunteer. That's what I love to do. My professional opinion, my professional profession was in fundraising. So I spent a lot of time at hospitals and foundations and actually raised a bit of money to build two hospitals. Kind of the fun thing in the hospitals take care of the people now, but who takes care of us later. And that's something that is very significant to me because I'm coming up there fast. So there's a little bit of self interest in this. And so I very much appreciated the way you sorted the, the items in your book and the flow of the characterization. I will say it was a tough read. The print was small. You had a lot to say and a short amount of time to say it in. But which all, all that meant was that I went through my book with my highlighter and my little stickies and my pencils and my, because I didn't want to miss. So a couple of comments that I have around the, and I kind of have a little bit of a comment and all of your items there. The staffing concerns is something that really concerns me. Mainly because 90, what percentage of the staff are women. The report that came out to, I think this week from Statistics Canada said that it was 90% of the respondents that were women. And we have a, you agree with that Amy? And then, and then another huge percentage are the people who are in residence. Do you know what that is as well? So it's about 80%. So 80% women are staff and 90% are staff women and 80% are residents. So where are the men I asked this afternoon? And she said, well, they're, they're wives and daughters and sisters and whatever. I'm looking after them. So, and that's the truth. So, so we do, we do bear a huge burden and, and we all accept it. We, whether we struggle with it or whether we just pick it up and run with it. That's who we are. And I say God bless us all. As far as a nursing home ownership, I've been quite impressed with the information that I've been getting as everybody is about residential homes, which are not care homes. But they are these beautiful things, buildings with saltwater pools and pool tables and many golf putts and whatever. And, and it's a wonderful place to downsize from your big five bedroom home or whatever. And until such time as you need more care. I don't know enough and hope somebody else will talk about how, what kind of care is given. I believe in some of the residential homes. There's some care that is given. I'll let somebody else deal with that. But I, the only thing I can say about long term care homes or residential homes is that every, every one of them must be held accountable to the same standards for quality of care. You can't have anybody skipping out on attending to this regulation or that mandate. My opinion. The most vulnerable people in our country are the people who are in residential care. And because of the complexity of the homes, the retirement homes and the long term care homes and the extended cares and whatever. It's exceedingly complex and really hard to understand. And that is an issue that our car organization is actually going to be dealing with shortly just to look at in March, I believe. Is that correct? We're doing a webinar on, on the difference, what's the difference between long term care, care, whatever, whatever. So we'll give you some information about how you can look into those webinars. They're, they're really very informative. I don't have a lot to say about the labor issue, which is item number four, other than the fact that they are very special people who will take on the care of older people. They're skilled. They want to be there. They, they get exhausted. They have been leaving in droves. I have a daughter who is immersed in, in care at the Ottawa hospital and she's exhausted beyond belief over that whole period of time. And during COVID, that was what hit me in the, between the eyes when we saw people being carried out of long term care homes, residences in body banks. It was inconceivable. And so the reaction to our canate from our Canadian government, I was personally quite impressed with that things were happening. The PPEs became available. The people were, were isolated so as not to spread. We all learned how to hand wash because we never knew how to hand wash before, right? Anyway, it was, it was what really engendered my desire to join the PARP organization and to help promote and advocate for improvement in quality care. And it includes with all that I've read from what you guys have talked about. It includes personal space. It includes, it includes understanding the residents. Not just how many bowel movements they had or did they have corn flakes for breakfast, but who they are, what they did. And we don't get to be my age without having had some kind of significance in your life. And we don't know enough about these people who don't get to tell their stories. So I say God bless anybody that tries to make that better. In terms of family members, the one thing I have to say about that, I, I did spend six years working as a volunteer at Hospice Care Ottawa. And I had, I remember one lady who, who came in after having cared for her husband by herself at home, bathing, dressing, everything, everything. And when she finally came into Hospice Care with her husband, she said, it's just such a relief that now I can just be his wife. I don't have to be his caregiver. And that still stands, she was up my spine. So I think that's, that's kind of significant. In terms of diversity, well, we seem to have a problem with diversity and I grew up as an Air Force brat on a military compound. So I didn't know anybody that was a different color, a different race, a different religion. Well, you could either be Protestant or Catholic, but there was nothing in between. That's why I didn't grow up understanding what the huge difference was, which meant that my view of humanity was we're all good people. We all do the best we can. Sometimes we make mistakes and sometimes we do things really well. Sometimes we mock things up, but we can learn from each other. And I think we need to put more attention on diversity. I'm probably out of time here. And so the only a couple of things that I'd like to say, I do feel like I have to speak to your 10th item, which is the condition of joy. Because from infancy, what do we live for? We live for moments of joy. We live for feeling proud because now we know how to tie our shoes. We live for pride because we have a boyfriend or a girlfriend. We live to celebrate birthday parties and our life is about finding joy. Nobody has it all the time, but we all deserve a little bit of it and some attention paid to it. Sometimes we need to do that, create that attention ourselves. So if I could talk just a second about the carp chapter, is there anybody here that are in fact carp chapter members? I can't see here. So oh, very good Doreen. And I know Barbara is and I am as well. We have about 10,000 carp members in the Ottawa area. And we are a board of about eight people with a few extras in a working group that Barb is part of working on our focus right now is on changing long term care and changing it now from institutions to homes. So we really promote the smaller spaces, the colorful ones we promote, including the residents in meaningful activities. We need to peel the carrots or whatever for dinner or just living life the way they possibly remembered if they can. So that's about carp chapter. If you have an opportunity to see a flyer or a zoomer magazine coming around. I think there's really interesting information there and some very good people are working to help Susan run this revolution. Thank you. Oh, thank you. Just a little bit background story. I started my, I guess I actually as a volunteer in high school. So in Ontario, there's a mandatory 100 hours that you have to do to graduate to satisfy those requirements. You have to volunteer for a week and hours. There was a long term care home to spend some time. And then so I started as a volunteer when I was in Toronto. And I think for a lot of people, the first experience or their experience with long term care. To your point about chapter 10, I saw a lot of joy, you know, in a lot of these homes, I saw a community. I felt a sense of that support. He spoke Spanish and I don't speak Spanish. So there was a lot of gesturing for about a year and a half. But I was through that I built a relationship with, I just saw so much meaning. And when I started to kind of study long term care in graduate studies, I was working with to help the combination and that market forces and some of the things like this structure. And whether or not we can find any within the sector in order to improve all the quality. And after four years of research as a doctoral student, we found out there were no interstitial seeds within our long term care market, which is a great conclusion to come to after spending four years looking into this. And for a long time and where they started to use. And so a lot of the research that I follow for a long time. And so it's such an honor, such a privilege to be part of this channel and to read your book and just to really see it all kind of coming in my career and research. Maybe when I write a book, you know, in 10, 20 years that maybe the landscape would have been different. That's my hope. And I was just almost highlighting single sentence. You started that chapter talking about the south support our aging population know a lot about long term care. But even as a long term researchers, you know, they don't, they don't necessarily want to go into the long term care home. But the challenge is that, you know, if you're caring for someone with dementia, your work general, but especially older adults, societal appropriation policy was actually something that. So I have lots of questions actually. I want to make sure that this is interactive as well. So I'll probably just get here and then hopefully we'll have the opportunity. How much time do I have? 10 minutes. 10 minutes, okay. Somebody give me a thumbs up when it's time to stop talking. My name is Doreen Rock. I'm a caregiver. I'm a member of the family councils and three different homes in the Champlain region. I'm a member of the Champlain region family council network, which means that we're a group, a small group of volunteers getting smaller as we age, but anybody interested in speaking to me afterwards about more. Please, I'll be around. And I'm really pleased and happy to say that the founding individual of the Champlain region family council network, who has worked so hard for many, many years to keep the network going is here tonight and that's nice to see you. So what the network does is we, we, most of us have or have had at some point in our lives along love planning long term care. And we advocate for the improvement of quality of care and life. The residents of long term care. We support family councils which are led in the legislation for the fixing long term care act and the act before that homes all homes long term care homes may have a family council. It must have a residents council, but they may have a family council. And so we assist families who have loved ones in long term care in starting and maintaining a family council in the home. And this is a really important group of people to keep an eye on what goes on in long term care. And I have to say, Susan, thank you. Your book, your book is, to me, your book is mandatory reading for every MP, MPP, anyone who cares about long term care. You cover so much and I could go on for hours about the many things that you and I have highlighted in your book. So I better skip to my script or I'll go. Yeah. So some of the things that I found new, surprising or interesting in the book were many of the things that Sweden is doing. Did you know that in Sweden a majority of the people would actually like to go into a nursing home if they required more than two aspects of care? How many here would like to go into long term care? Nobody. And I'm one of the reasons I advocate is because I know someday it could be me. In Sweden, each resident has a contact person who spends one hour a week focusing on the individual, the resident's wellbeing and keeping in touch with the family. That is unheard of in Ontario. And the other surprising thing for me is because we excuse me, we are advocating for smaller homes such with the person centered care that's focused on the residents such as the butterfly model or many others that they don't have to be small homes to do person centered care. So that's encouraging because the government will keep on building larger, larger long term care homes. And that in spite of the fact that Norway and Sweden do not have legislated staffing levels, they have more staff. What's wrong with us and families in homes in Sweden, they can go in and just visit. They see themselves as visitors and not in Ontario where we, because there's such a shortage and staff that are, we have to go in and we have to help the staff and support our residents with their basic needs, feeding them, making sure they're clean, making sure the rooms are clean, et cetera, et cetera. And it'll be nice. I mean, I didn't tell you, but I had my mother who lived to be 97, spent her latter years in long term care. My brother, my husband, who was diagnosed with Parkinson's at about the age of 50, who I cared for at home for 13 years, eventually I had to move him to long term care and where he lived for seven years. And he hated when I went in to visit him and I busied myself with tidying the room and advocating with the staff for better care, et cetera. And then the third person in my life was one of my older brothers who at the young age of 70, my age, ended up in long term care. And yeah, the same thing he would say, oh, let's go out. Take me out. I want to go for a drive. Let's do this. But at the same time, I'm going, oh my gosh, his clothes have been just dumped on a chair and I need to hang them all up. As a caregiver, I would love to be able to just go in and visit, but that's not possible in the current situation. The other thing I learned was that there is no best way to organize the physical environment of a long term care home. There's many ways you can go about it and there's so many things to consider. Chapter 6 covers some very well. And one of the things, because the primary residents, the majority of residents are women, because I had a husband and a brother in long term care, there's very little activities that devoted or dedicated or oriented for men. My husband ended up enjoying bingo and my brother, well, he liked the tea and toast or the trivia, but other than that... We played a lot of bingo in long term care. You get a lot of bingo jokes. Yes, and if you get a full card, you win $5. So what was confirming for me in the book was all the background and discussion about how COVID-19 impacted long term care. I lived it. Many of you might have lived it as well. I was grateful that my mother was not alive during COVID. She would have never understood why we couldn't go and see her. My husband was also spared COVID-19, but my brother lived it and he was a character. And he wanted to know why he couldn't go out and why I couldn't come in. And the one thing in grace he had was that he was a smoker, so they let him go out to smoke. So I would have my visits with him outside, and that kept the two of us going. So I talked about the importance of family councils. We talked about joy and the importance of belonging and having opportunities to have a purpose or meaning. We didn't talk about exactly what were pleasures, so this is kind of an uncomfortable topic, I think. Because pleasures, as the book defines, is intimacy and sexuality and treats such as ice cream days and stuff like that. But intimacy and sexuality in long term care is nonexistence. And I can remember a couple who were at the home where my husband was. He was quite a character and he stopped me in the hall one day and I said, oh, you were away for the weekend. And he said, yeah, he said my wife and I, when we want to have sex, we go to a hotel. You know, they still have feelings and they still need pleasures. What else shall I say? The need for more staffing is critical, absolutely critical. And the need to properly train and support and treat the staff is, these are the two key areas. If we want to improve long term care, we must do that. Because, I mean, it's so, so difficult to recruit these days. And more and more homes are using agency staff who were paying twice and three times the amount we would be paying full-time employees. So what's promising? The need to attend to the social, physical, mental and emotional needs of everyone who work, live and manage nursing homes. It's critical. The need to remove, you may not all agree with me, but the need to remove for-profit homes from our system. They, thank you, thank you. It's critical. I mean, in reading your book, I not only, you know, for my own experience know that for-profit pay their staff less, because what are they? They're not there to provide, maybe they are in their hearts, but it seems like the focus is profit making and stakeholders and making sure you have money. But what I didn't realize, of course, is that these long term care companies, corporations, well, they know that there's subsidiary businesses. They have subsidiary businesses out there that they own too. And maybe you'll talk a little bit more about that, Susan, because that is like, oh my goodness. Not only are they making money off the backs of the vulnerable, but then they're making money on the services that those people need. I'll let you finish up. Okay, okay. And the other thing that sort of surprised me and I think is really important is the, you know, in long term care home, we have a very, in Ontario, we have an extremely low tolerance for risk. And so there's, you know, they're taking away the bedrails because that's seen as a risk for people who could get entrapped in the bedrail. But what about the, I have a real case, sad, this gentleman who had had a stroke among other reasons for being in long term care. They took away his bedrails and he used his bedrails to reposition himself in bed and to sit up and things like that. And his wife fought adamantly with the home to put the bedrail back on. They took it off without even notifying her. They wouldn't put it back. They may have tried other things like putting a bed, a mat beside the bed so that if you did fall out, you'd have a soft landing or lowering the bed as close to the floors. They could, if they can, if they have beds, so do that because anyway, don't get me going on that. He eventually fell out of bed. Of course he did. He fell out of bed and he hurt himself. And they took him to the hospital and at the hospital they discovered that he had many, many, many more health issues than just being a risk for falls. And he passed away. Was she bitter? Absolutely. But she's coming around and she's said to me one day not too long ago. Well, you know, if he hadn't fallen out of bed, he would have never been sent to the hospital. And we would have never known of all the other health issues that he had. I can get really emotional. So that's, yeah, I could, as I said, how many hours could I say? So thank you. Thank you, Susan and Pat and all your team for all the work you do to advocate for better long-term care. And thank you for endorsing Family Councils in your book for the support that you have provided to the Champlain Region Family Council Network and our friendships that we've developed. And thank you to all of you who work in long-term care and truly care. And thank you for being caregivers. Well, you mentioned a few things and I really appreciate that everybody's been so nice. But, you know, we kind of put it out there in this book and assert a kind of vision for the future care moms. And one of the groups that we don't have up here tonight and not because I didn't try were the unions that represent long-term care work. And they are an important voice as well in the struggle for long-term care and they are hurting. They're hurting that the work is incredibly difficult and becoming more difficult. Managers, I was in a long-term care home last Friday along with some of my students and you could feel the fatigue. It's not that people aren't still keen. It isn't that they're still caring. Some of these people I've known for a long time, but there's a weirdness and there's a sense of, I won't say hopelessness. I just say of a more restricted horizon that you feel in conversations about improvements. I kind of refuse that out of a sense of possibility because I get to go to places that offer something else. And I get to see policy developments that take us in other directions. And Amy, you've seen a lot because of the COVID pandemic and your view of the statistics coming out of that. Can you speak a little bit to that and how the book looks from that perspective? Because you had a really very particular view of long-term care during the pandemic. Specifically, Ontario and California are the two examples. Exactly. But we're still seeing so much variability. So the challenge for me and Susan, this would be a tough question. You know, how do you balance it? I appreciate Pat's perspective here, which says, if we're going to allow for a for-profit home, basically it exists within the sector to provide care. And that regulation must be strongly enforced because for-profit homes will then give room, allow room for the restricted in everything that they do. And also the flexibility for innovation because I feel there's so much fear that's instilled in the workers when, especially now with the... Now the workers are afraid to share the perspectives. So how do we... Yeah, well, I'm still going to say we need to kick out the profit in long-term care. I don't think any amount of regulation is going to take care of it. I'm going to stick with that point adamantly. And, you know, all the research that I have seen, you know, the vast majority of it supports that viewpoint. When we look at for-profits in terms of hospitalizations, we see more hospitalizations per resident in the long-term care sector. I mean, we have somebody here in Ottawa who's done a lot of that research. We also have it in BC and the findings are exactly the same in both jurisdictions. We also see a higher rate of death in for-profit homes despite the fact that actually the condition of people at admission is healthier. So, you know, we see admissions healthier in for-profits and higher rates of death. Help me understand. Then we see in terms of staffing, there is the staffing and the numbers of staff that are hired and who's supposed to be on the floor. But that's different than who actually shows up at work and how they're organized. And repeatedly, we see in the for-profits lower rates of pay, more workers being absent, fewer workers on the floor, fewer replacement workers being called in. And so we see more qualities of care on all kinds of measures. So to me, we just have to remove it. No amount of regulation is going to address that. I think there are some public services where absolutely there's just a room and the evidence is quite clear. That being said, I actually, in when we've seen jurisdictions where workers have more discretion and are able to use their judgment, we find higher levels of personalized care and more satisfaction. So it's not about regulating everything that people do. It's actually allowing people to do their work. So giving workers more autonomy, allowing them more opportunities, not having time to get to know the residents. Do you realize how many people in the sector actually have permanent full-time jobs? Maybe you have that at the tip of your fingers. No, but I also know that so when we look at data about a third of them are working multiple jobs, which is their hours are split. And I remember during the pandemic, early on, we were speaking with and so her day consisted of, you know, working a lot of care in the morning. And then she has to take the bus for an hour and a half to get downtown to where she does that six days a week. So when you see your family in paper, it seems like it is a single employer because it's a changed facility. They also open and operate the retirement home. But she doesn't get enjoyed. It's interesting because when you look at the private sector as a whole, this is coming from the perspective of, you know, it's not that you can't strive to have these goals. So when you look at a large hotel chain like Marriott, their model is that we care for our workers because they care for our clients. And they know as a treat their work as well that they'll produce better work and then they'll treat the clients, the customers well. But for some reason within the healthcare sector, that is not recognized either by the providers or our government. So I think. Well, and because because it's public service and because the resident rates are fixed, you've got a certain budget. Marriott can charge more for the room. It's a different, you know, that's basic, you know, economy. Why is it in the health sector? Because it's we can't jack up the fees and nor should we. Now, on the other hand, we have to look at the amount of GDP. So people go, oh, you know, and we certainly hear our politicians say this, I mean, we've been hearing that forever and ever. But in comparing in working internationally, we see that actually Canada and particularly spends less of their GDP on long term care than almost any other jurisdiction. It's no wonder that. Better care is so bad. It's that we're not. Frankly, and when we compare it with better care and other jurisdictions, we'd see the difference in that. I also don't want to romanticize the Nordic countries. Sweden cut their long term care beds severely a number of years ago. They did ramp up home care. That was a good thing. But they've still got some some issues and they are struggling with the same kind of politics that we are in Canada. So I want, I just want to be very clear about that. Norway has a different model. But some of the things that are happening there, there's different kinds of pressures that are technologies that can help. Our team is investigating those and we're monitoring and understanding those. And so there are technologies that can support workers to do their jobs more smoothly and more easily. We've had a big project actually here in Ottawa on continents care. We can talk about all the things that we don't talk about with long term care, but there's two things, sex and bathrooms. And you just don't talk, oh and booze, that's the other thing. But as we sit in the pub, we have seen in this project on continents care involving one of my colleagues, Shantel Trudell, who's an industrial design at Carlton. We have seen the ways in which workers have to move in order to do comments care. And it's crazy the way that the supplies for continents care are so rare that workers hide them so that they can make sure that they can care for the residents properly and that the products don't go astray. We can see the real inefficiencies in terms of how they're disposed of, so that there's unfortunate odors that come up in long term care that don't need to happen. So we can improve with technology. We can improve by design. We can do things, make it easier for workers and make it easier for residents to have respectful things about care. I'm sure that Doreen, that all of this rings a bell with you in terms of what you've seen. Absolutely. And I know that even within the not-for-profit sector continents supplies are like gold and you have to go hunting for them, etc. So I resorted to buying my brother, whatever he needed. And I said, you know, long-term care for-profit homes limit the number of continents care products per resident. So can you imagine, okay, you can have four a day. And then, you know, they'll get into the details. You can all do the math and figure out how long that's gonna last. And then they collect them and they put them in the hall where everybody can enjoy the order. But I have a question and something that always irks me when we talk about long-term care is that they, you know, they, they say that one in five, I believe it is, maybe it's different, residents in long-term care don't need to be there. That in my experience, 20 years of walking the halls of long-term care homes, I would love to know who doesn't need to be there. They're, you know, and the acuity of care is just increasing continuously, continuously. I get it that maybe in the 60s, people throw them in and parked the cars and they lived in long-term care. I get that. But today, and even when I first started looking, getting involved in long-term care with my mom, you know, maybe one or two had a car, but I don't think they ever left the parking lot. You know, where does this stat come from? No response to that. It's a response from some of that research. So the caveat is that actually, the argument is that what if I do not need to be within the community if there's sufficient funding, you know, I could personnel all that. Who would have supported them? If there was sufficient, if. It's a big if. It's a big if. It's ended that way. It's always like, oh, there's all these people in long-term care who really don't need to be there. And that just, as you can see. It was actually meant to be an argument for more supports in the community. I get it. Individuals in the community, if we had to support it. Yeah, I get it. And I, you know, the answer to the question, do they have a long-term care home self-affuture? Absolutely. Yes. We need both. We need. There's lots of people. I would like to stay in my home forever. I don't want to go into long-term care the way it is today. If I do, you know where I'm going? The pearly. It's the best one in the city. And they don't have a pool. If they have a great recreation room. They have great recreation. And they have a putting green. We're talking about long-term care homes with pools and a pub. Yay. Ice cream on Wednesday. Ice cream on Wednesday. I got my retirement plan down. You do. But if there's a, when you see a home that has a pool and a park and a golf course, it's retirement and you pay five, 7,000 plus a month to live there. That's not long-term care. Sorry. I mean, what about the issue when those statistics are made? What about the issue being long-term? To me, I don't want to live in my home when I'm frail if I'm by myself. I don't want to be waiting at the window watching the people go by and waiting for a caregiver because that's the only person that I get to talk to. I would much rather be in a collective living situation where there are always care workers and other people there and where I have private space to retreat to for rest, but where I also have opportunities for some simulation and some meaning-making with others. What about how that gets taken up in not needing to be there? When it's about those basic human needs of connecting. Failure to thrive? Yeah. And going in to check out, it is really difficult, I think, and especially if you're thinking about as in Canada, of Ontario, and the closest neighbor might be an Albert Drive. Do other people have questions? I'm sorry. It's very bright up here, so I'm going to have to put my, yeah, I've just been writing about the situation between long-term care and retirement homes in Ontario and the way that it's developed. So as long-term care has become more restricted, it's not surprising that the retirement industry has seen a huge market opportunity. And so we have seen the rapid development of retirement homes. I mean, any of us living here in Ottawa can see one up and down our blocks. And there's been this huge market opportunity. It's really expensive to live there. Most, you know, majority of people can't afford it. And it also is, you know, what they call the silver economy, the opportunity to profit society. And I can remember seeing the first conference, a retirement residence, a senior living conference in the Scotia about more than 20 years ago about this is what's going to happen and here's the market opportunity and there's going to be lots of money in it and let's jump on. So that is what's been happening. During the pandemic, actually alternative level of care beds were established in some retirement homes and people were transferred there. It left those people in a real gray zone where they were not covered by the long-term care act and they really didn't fall. The retirement home act is the regulation there is not terribly stringent. So they were kind of in this gray area of care where the government actually put them there but they actually didn't have the protections that someone should have either in a hospital or in a long-term care home. There are many tragedies there and we'll all end up bawling if we start talking about that stuff. Can I add one thing? My experience has been that many friends of mine who had parents who needed care but not long-term care move into and who are wealthy enough to have the rent money for the retirement residence and they serve a purpose. As soon as their care needs become too much, they're asked to leave. They have to get out because they're just not equipped to make their needs. Right now, I was looking at the data, not long ago, and I'm going to get it wrong. Is it 26% of the people that are, might be higher of the people that I'm waiting list for long-term care living in retirement residences in Ontario? I'm sorry, I can't remember the exact time. I'll be surprised by that. I think it might be higher than that. I'm being careful because of where we are. But anyway, there's a considerable number and that number is growing. And so there's a really clear trend there. The other thing is, I don't know whether you saw it in the paper this week, but people who are living in retirement homes who moved in around the pandemic when retirement residences were experiencing a lot of vacancies, they were given a discount. That discount, that discount didn't have a timing on it. And just recently, they've been evicted from their retirement residents because they weren't able to handle a rental increase. So I think there were a CBC report just this week on that. So there's lots of these movements in retirement homes, and clearly the answers are public care, public care, and more long-term care. We need it, we deserve it, and more community support. We all have to, our attitude, our attitude toward long-term care has to change. We have to care about it rather than saying, that's for other people, and I'm never going there. Some of us will go there, and we want it to be good. Exactly. We have a lineup of questions. Oh, great. I can't see. Please ask. There's a second model, but I had a conversation with someone today, this week. They said that the lint is lying to the families because they want them to stay in home care. They tell them what they're eligible for, but you're not going to get anywhere near where you're eligible for because they want you to stay and it's burning care for us out. And I know I was burned out before mom and dad got into the Greek Center. So this is unsustainable, and we need to change. And I also think for long-term care, we need national standards for long-term care. I was part of CSA group, national standard for long-term care. And as I said in the community health coalition thing last two weeks ago, that there's a backwards way to get that in with CMHC ensuring long-term care mortgages. I got a meeting today scheduled for Yasser Nafi, who's voluntary secretary for health, and I'm going to push the hell out of that one. And I also talked to Terry Sheehan during the event. So I'm trying my best. I was at CSA group one for building a nightpack, tossed my hat on the edge here so I didn't get in, but I think we need it. Even the good home-like Greek Center, I see issues except the ring. We need it. Thank you, Tom. Thank you very much. Good evening. Thank you so much for the book. It sounds tremendous. I can't wait to read it. My question is on this issue of joy, which I was so happy to hear about is in the book. Have you found, and it's to everyone, a tension between joy and infection prevention and control? And I bring this up because in my research, I've been interviewing long-term care homes, administrators, IPAC leads, directors of care, and they bring up this tension. And I don't know those in the field bring it up. And so it's not on me to argue against it. And I don't know how real it is or what a response might be. And the classic example is always given, the joy is being around people if my loved one or friend has COVID, they are isolated and that decreases joy. Therefore, there is a dichotomy. Is that a true dichotomy? So the question of joy and IPAC. Thank you. I will thank you for this event. It's very interesting. My question, yes, my question is about waiting lists. I've heard that long-term care had a lot of waiting lists and that the retirement forms are not so much trying to take the market than just trying to help out. Sorry, it don't mean to be a pain, but can I add another question? Aside from long-term care and retirement home, I will love some discussion on alternative housing model such as the co-housing in Denmark, the Swedish multi-generational housing, etc. Because we need alternatives. I'm sorry, it's like, I don't want to go in long-term care myself. So I helped mom and dad before he passed, but I want an alternative for me. Well, let me start by saying that I think what we're talking about here is making care homes so different that you wouldn't recognize them. For example, in Sweden quite some time ago, they changed long-term care homes so that everyone has basically their own apartment. In the long-term care home, it has to have a cooking possibility. That cooking possibility for people with dementia is often unplugged, but it is there. There is always laundry in the apartment, and the workers would do each person's laundry individually, and that actually has helped deal with some of the infection control issues. And you can understand anybody who does the laundry can understand how that operates. And that creates a different atmosphere in the home. These apartments are not huge. They're quite small, which means that coming out and having a dining experience or going out into the living room, the living areas is pleasant. And there's also a kitchen on the floor where every afternoon something's being baked. People are sitting around the table because they have a little bit more time. Family members come to the table and share in the food and have a cup of coffee. And the workers have enough time that they can sit down and chat to the family member and bring them into the loops while their family member is there saying, you're wrong, you're wrong, you're getting it wrong. I'll tell you how it really is. So it's those kinds of conversations that go on, and care homes become something quite different from what we see in our communities, places that are the kinds of places that Swedish older adults want to go to when they need care. So that is what I think I'm proposing. About the infection control and joy, I think it's a post-academy, and I think you were alluding to that actually in your remarks. I was in a Danish long-term care home not that long ago, and they were talking to me about how they handled separation. When you have more staff, when you have workers that have more control, the ways in which IPAC and distance were handled very, very differently. And with huge success, they did not have the kind of death rates that we had in Ontario. It doesn't have to be the way in. That's a long conversation. We could get into lots of details, but I think it's a post-academy. But I think here in Canada, in Ontario, in Ottawa, when we were at the beginning of COVID, where nobody knew how it spread, we didn't know very much at all about it. And even as they learned, people were confined to the bedrooms. They don't have a place, they don't have a house or a living room. If there's a bed, there's a dresser. If you're lucky, you could put a TV on the dresser. There's a closet, a small closet. And if you're lucky, you have a private bathroom, but that's rare. Purly has private bathrooms. Purly know they're getting a plan. I spent 13 years there with my husband. But there was. It was all about protecting them, keeping them in their room, keeping them, my God, they couldn't go to the dining room if they thought they had COVID. If they couldn't leave the floor, they couldn't do anything. So definitely, I think that COVID and joy were not something that... Yeah, at that moment. At that moment, I mean, I visit my brother. And finally, in the latter parts of his life, which was October 22, I was able to visit him in his room and take my mask off. But prior to that, you were masked. You were new advisors. If you were a loved one that had COVID, you had a gown. We were masked, right? Yeah. Anyway, Amy? Yeah, just thinking of, you know, one of your books, Susan, is that, and you mentioned this specific ending in chapter 10. There's no one size. There's one size, this whole model of care, right? And I think really, it's about really shifting a paradigm of how we think about caring for elders, how we can approach this long-term care. Because right now, it's so fragmented. The example of retirement homes. As soon as you meet this threshold, beyond this threshold, you go somewhere else. So we're not thinking about that continuum. I think you're, like, the book really iterates out, really, what is long-term care within the context of it. It doesn't have to be. And isn't that just what your group is working toward? I'm here now. Thanks. That is one of the things that we are working on. And one of the things that we are starting to be very interested in accumulating are statistics around how many faults have been prevented by different modalities, grab bars or whatever, or been railed or whatever. And what about, what are they, how do we can measure how much fewer trips to the hospital are, you know, lessened by having smaller, more carefully designed homes, by having social activity that I enjoy and meaningful activities. So all these things that we think are absolutely wonderful. And if I can have a few seconds to talk about one of our recent webinars. No, I can't. Okay, I'm going to get the horn. One of our recent webinars, and I think it was October, was highlighting a woman who is the CEO of three municipal long-term care homes in Gray County. And she won an award for the program that within the community, and this is very rural communities. It's a lot of small towns and farming areas and whatever. And she pulled together a whole program with complete consensus and consultation and questions and whatever. And they designed their own program that is called Color at Your Way. Color at Your Way. And so the C stood for something and the O stood for something and whatever. And every time they came up with an issue, there was an increase in whatever, whatever, isolation or something, they would say, do we have to color this in order to come to a solution? So with every problem they had, they took it back to their process. I thought that was brilliant and it worked for them. Would it work anywhere else? Maybe. But the idea is that you don't have to have a butterfly or a hodjaway or whatever. Find your way. And I think that's not a bad thing. Thanks very much. So I said earlier, this is a great part of my job. The unpleasant part is I always have to bring the conversation to an end far too early and cut people off, so I do apologize for that. But I'm afraid we really don't have time. We only have the space for them to get out of time. Open access and I have a code, but I do not have a box of books. However, I have lots to talk to me after and I'll make sure you get one. That is an important question. Thank you for that. So I have a couple of quick closing remarks. Of course, I want to thank Susan and our panelist here, Green and Amy and Dawn, for being great readers and great contributors and doing some good, excellent dynamics back and forth. Thank you so much for that. I do want to thank the people that put this together. I want to highlight Jeff particularly, the videographer who's been filming everything here. And this and all of our previous recent Awkmate readers are on our YouTube channel. So check out Carlton University Faculty Public Affairs YouTube channel. And of course, this one will be up soon. So if you want anyone else that might want to watch this or hear this again or you want to watch it yourself again, check our YouTube channel for that. So Jeff, thank you very much for that. I also want to thank Moro McGrath, who is our events coordinator who puts everything together in so many details. Moro, thank you so much. And of course, I want to thank our host, Irene's publicly, Mike, that always puts up with our many audio issues every time with a very professional manner. So we really appreciate his work as well. And everybody's here. And finally, I just want to thank our author. And I just skip over, of course. This is a collated effort, along with Pat Armstrong and so on. But Susan, thanks very much for being our author tonight. We're really, really good at this together. And just to thank you for all of you. Yes, thank you. Thanks to all of you. And again, check out our YouTube channel.