A Cry for Critical Thinking

As our local population ages, frustration with long wait lists, staff shortages and strained social services has highlighted the need to provide more innovative solutions for elder care.

The trees grow thick and tall around the old hospital on Ward Street in Port Hope. Dense and impenetrable, they hide the buildings inside. No heroic prince will be cutting through on his way to a magic castle. This will take heavy equipment and a lot of men in hard hats, and the vitriol in the air suggests there is no happy ending in sight.

Will it be a well-restored red brick heritage building, in the tradition of Port Hope, or a rather severe, seven-storey, grey structure, purpose-built for long-term care? That has been the question playing out for six years now. An old building versus old age.

Port Hope’s reputation rests in large part on the community’s dedication to its heritage. The town rents itself out as the perfect Victorian movie set, and most telling: its aura of well-kept yesterday has pushed up property values and attracted scores of real estate newcomers from Toronto. The competing reality is that more than a quarter of the town’s population of 17,000 is over 65; three-and-a-half percent – among the highest ratios in the province – is over 85. These are the very people who are lining up for long-term care. But is this the kind of long-term care they and their families want?

The competing reality is that more than a quarter of the town’s population of 17,000 is over 65; three-and-a-half percent is over 85.

THE NEIGHBOURHOOD

The building behind all those trees on Ward Street is the original town hospital. Established in 1913 to take care of First World War soldiers, it has sat ignored and abandoned for the last twenty years. Right next door is Hope Street Terrace, an unprepossessing cinder block structure long marked for the wrecking ball, and one of 35 Ontario facilities owned by Southbridge Care Homes. Southbridge, seeing an opportunity – long-term care is a galloping growth industry – bought the old hospital in 2015. Three years later they brought a proposition to town council for a three-storey, 160-bed facility. Almost immediately Council got the ball rolling on a heritage designation that would preserve the exterior of the original building. Ultimately the old provincial Conservation Review Board said yes and declared the hospital a “Landmark” and its grounds “Heritage Landscape.” Covid descended with all its long-term-care implications, and in the fall of 2021, Southbridge came back with a new proposal, this time for a seven-storey building. Letters and submissions from the public came pouring in – the majority were opposed to Southbridge’s proposal, and the necessary rezoning was refused.

But the need for new, safe long-term care was undeniable. The Port Hope Architectural Conservancy of Ontario, the largest chapter in the province, put forward alternative design possibilities that they maintained would let the town have its cake and eat it too. One design from architect Phil Carter would have turned the old hospital into 20 sorely needed seniors apartments, built a new more harmonious long-term care facility and put Southbridge’s proposed shopping-centre style parking lot underground. A land swap with the municipality was suggested. There were meetings and more meetings.

Southbridge dug in its heels and let it be known that if the seven-storey building was not approved, they would not only abandon the new building but close the Hope Street Terrace long-term care home. Its days were clearly numbered. Under post-Covid legislation, Hope Street’s four-bed wards – petri dishes for infection – were disallowed, making it less profitable. Pro-Southbridge protesters began to appear at council meetings, often in tears, pleading for current residents and for their own jobs. Feelings ran high. Flyers were slipped through mailboxes calling anyone against the new Southbridge development “elitist,” “selfish” and “anti-change.” These were followed by flyers labelling Southbridge “Ontario’s worst LTC landlord.”

The two sides growled and circled each other. No one was playing nice.

WHAT’S AT STAKE

What started as a dispute about a building took on a new dimension. Nearly two years ago local MPP David Piccini announced the creation of 168 new and 376 upgraded beds in 3 different privately owned long-term care homes within his riding – more beds to reduce the ever-increasing wait list, more upgrades to reduce infection rates. The province is putting $3.4 billion into long-term care and wants change fast. The government construction subsidy was raised to $35 per bed per day. The proposed new Southbridge building would add 192 long-term care beds – based on the arithmetic, that’s more than $61 million over a term of 25 years. Long-term care is big business: in Ontario, 57 percent of LTC homes are for-profit (nationally it’s 25 percent). And most of this business is consolidated among a few companies.

Fees that residents pay for basic, semi-private or private rooms are set by the Ministry of Health and are the same for every long-term care home. But it’s widely agreed that the quality of care is not consistent. Publicly owned facilities and not-for-profits have higher staffing levels, fewer hospital admissions and more direct care. There is one publicly owned long-term care home per municipality. Not-for-profit homes are usually run by charitable organizations. Ontario’s Covid Advisory Table reported that when an outbreak hit a for-profit home there were 78 percent more deaths than at a not-for-profit. Pickering’s Orchard Villa, also owned by Southbridge, was one of five long-term care homes where the military was called in. More than seventy people died. More recently, a new Southbridge-owned LTC home in Owen Sound was barred from accepting new patients due to serious problems found during inspections.

Inspection reports for every home – and there are more than 125 in the region – are posted online. Not many of these say “no violations,” and most list complaints that make for frightening reading.

“A hundred years ago we stopped warehousing orphans,” says an exasperated Dr. Anne Teklus, “but we are still doing it to older people.” For thirty years she was the resident doctor at Hope Street Terrace but retired in 2019. “The building is old, but it used to be better managed. After it changed hands, staffing was a big issue. People were always rushed off their feet.” Teklus was horrified when she heard about the proposal for a seven-storey, even bigger facility. How would staff cope when personal support workers as young as 18 are deemed qualified after five months’ training, part of it on the job?

Consider the fact that the average age of residents is 83. Seventy-five percent of residents suffer from dementia. Half of people over 80 are incontinent, and 20 percent are fecally incontinent. The average stay in long-term care is between 12 and 24 months. In Ontario a quarter of men and women over 85 live in long-term care. The rest are holding on to whatever alternative they have found.

85 IS THE NEW 65

On a Sunday afternoon in September, Stephanie MacKenzie bounded up the stairs of her back porch and thanked everyone gathered on her lawn for coming to her 75th birthday party. She’s fit, walks for miles, and is up to her neck in projects. MacKenzie shakes her head and says, “No, I’m not ready for long-term care. It’s that step in-between that I want to figure out.” Scaling down, being prepared for whatever strikes.

There are nearly 58,000 seniors (over 65) in Northumberland, Belleville, Quinte and Prince Edward County. That’s up 24,000 since 2010. In Ontario, the conventional middle ground – when the house gets too big and everyday aches become debilitating – is a commercially owned retirement residence that delivers as much or as little luxury as you can afford. The price ranges from $2,400 to $7,000 or $8,000 a month in this region.

There are other ways to deal with the situation. Take co-housing: random individuals who band together, act as their own developers and build community-oriented condominium complexes, some with spectacular common facilities. One such development on the waterfront in Sidney BC has its own private dock. All decisions are made by consensus. Most importantly there is an ethos of community care, an undertaking to support your neighbours as much as you choose: Would you pick up your neighbour’s prescriptions if they were sick? Put casseroles in the common freezer? Would you change your neighbour’s diapers? That last one is the question that stops nearly everyone in their tracks. But surprisingly the longer co-housing people live together, the more intimate tasks they undertake. It’s mutual support that guards against loneliness and delays the move to long-term care. There are now 49 co-housing communities in the country, most in Western Canada.

For most people however, the alternative is aging in place.

In Denmark, everyone gets a call from their public health nurse on their 65th birthday: “Happy birthday. What can we do to help you?” Or perhaps it’s someone to administer medication, to help with a bath – all provided by the government.

AT HOME

Ontario has – at least on paper – committed to providing more at-home help to keep people out of long-term care.

At the end of the summer, local providers – private and not-for-profit – showed their wares at a forum on aging in Cobourg. One seventy-something woman came home with 23 different brochures – a lot of well-intentioned information that, the consensus is, adds up to not enough services. Other countries do it differently. In Denmark, for instance, everyone gets a call from their public health nurse on their 65th birthday: “Happy birthday. What can we do to help you? Someone to help with your shopping?” And since it’s Denmark, “Is your bicycle in good working order?” Or perhaps it’s someone to administer medication, to help with a bath – all provided by the government. It seems to work. In 2021 institutional care in Denmark – never high – was down 30 percent.

There are nearly 58,000 seniors (over 65) in Northumberland, Belleville, Quinte and Prince Edward County. That’s up 24,000 since 2010.

Here, aging in place is more catch-as-catch-can. In Cobourg, Wendy de Vries looks after a husband who has dementia. Too often the extra work at home is piled on the backs of the healthier half of the couple – usually the spouse, or the daughter or son who lives closest. One of de Vries’s children lives out of the country, the other out of the province. She’s organized and realistic but she’s on her own and she has a heart condition. According to Health Quality Ontario nearly half of home caregivers in this region – higher than the provincial average – are angry, depressed or frustrated, and the numbers have been steadily rising. DeVries has found that everything from an Accessible Parking Permit to a Disability Tax Credit is a fight. It’s wearing but fortunately she’s not intimidated by bureaucracy. “I’m lucky,” she recognizes, “he got into his program (a dementia day program) in time. Now there’s a big waiting list.” For any practical help at home she’s reliant on whatever the Home and Community Care coordinator allocates as respite care. In her case, one hour a week. Any more and it’s $40 to $45 an hour. They can afford it – others can’t – and so far it’s been working; but increasingly she’s hearing stories of contracted Home Care Workers who just haven’t shown up. Her husband is on the list for long-term care in Cobourg. There’s a convenient website that shows the median number of days he could wait is 469 – 15 months. Double the provincial wait time.

A few years ago Jenny Munro and her sister realized that even with the PSWs they’d hired, they could not properly look after their mother, another dementia patient, at home. Their mother is Alice Munro, Canada’s Nobel Prize-winning author. “Not that my mother deserves special treatment,” Jenny is quick to add. Well no, there really isn’t any special treatment to be had. It took two years to get long-term care that would work for her. Alice Munro’s LTC home has a waiting list of nearly 800.

Looking after her mother is one reason Jenny Munro became part of an ad hoc Port Hope group calling itself Safe Harbor that has come together to look for alternatives. The other reason: at 22 she was a Personal Support Worker in a long-term care home in Victoria BC. Every morning she washed, dressed and herded 29 people down for breakfast. “Sometimes they gathered at the elevator looking for a way to escape,” she remembers.

Safe Harbor is still defining itself – will they try to set up a non-profit LTC home, or simply be an advocacy group? It’s too soon to tell. Jenny Munro wants to see compassion, dignity and relative autonomy in long-term care. She is in touch with AdvantAge Ontario, a well-established champion of not-for-profit homes; she’s talking to the Dutch De Hogeweyk, where caregivers and residents with dementia live together; and to the American Green House project, a group of more than a hundred small, not-for-profit homes. Yes, there are other ways to do things but it takes work and time. Jenny Munro knows that she too has the genetic marker for Alzheimer’s. Every day when she walks to her artist’s studio she passes what might be the new Southbridge long-term care home and is reminded of what she does not want.

END GAME

The back-and-forth between Southbridge and the Council goes on and on. In the spring of 2022, Council firmly refused the company’s re-zoning request, turned down the demolition permit and finalized the heritage designation. Port Hope had blocked the proposal, or so they thought. It wasn’t over. Long-term care waitlists were growing, and the province was pushing. In the spring of 2023, provincial cabinet ministers and Bay Street executives came calling on Port Hope Council. Council was not persuaded. Two weeks later the province overrode the town’s zoning decision with a Minister’s Zoning Order (MZO). That left only the heritage designation standing in the way of the bulldozers. The provincial government’s More Homes Built Faster Act is amending the Heritage Act to “reduce red tape.” Thousands of properties across the province are expected to lose heritage protection. In July, Southbridge appealed the heritage designation to the new Ontario Land Tribunal.

Many expected Port Hope Council to cave, not to answer the appeal, but Mayor Olena Hankivsky declared that they would not settle the case. Port Hope would defend its decision. The first appearance before the Ontario Land Tribunal took place in October. The dispute is expected to go to a full hearing in March.

It’s a tough call – pitting long-term care against heritage. It’s too close to home. Finding help for an elderly mother-in-law now in hospital, or a 102-year-old grandmother who is starting to get a little lost on her daily walk, is urgent. The 102-year-old is fiercely independent and doesn’t want to live in a seven-storey hermetically sealed building. It’s unlikely that she’ll have a choice. Any alternative will take years to launch. There are thousands of people on waiting lists. How long will they have to wait and how good will the help be? A daughter-in-law looks aghast when she realizes that adult diapers are frequently “rationed” in long-term care homes. Will there be enough staff – will they be paid enough to stay – to deliver the soon-to-be-mandated four hours of daily care?

This time the privatization of domestic needs – a place to grow old and die – might well beat bricks and mortar heritage.