Peeling Back the Layers: The Overregulation of Long-Term Care
By Joanna Carroll, Chief Administrative Officer, Think Research
There are countless problems plaguing long-term care in Canada, but near the top is regulation. Not a lack of regulation, rather an overabundance.
For decades, our response to any crisis, complication or elementary inconvenience in long-term care has been to add more regulation in a misguided attempt to minimize risk, justify funding and protect against perceived threats to resident and staff safety. The result? Layers upon layers of, at times unnecessary, and at others contradictory, rules, reporting requirements and prohibitions which are not only devoid of good public and health policy, but which have seemingly paralyzed a workforce whose sole function is to care for our seniors near and at the end of their lives.
Consider that in order for any long-term care home to be compliant with applicable regulation, its staff must ensure that all residents are present for breakfast in a prescribed eating area during a mandated, determined and limited period of time. The regulation fails to account for numerous resident complexities, including those arising from dementia let alone individual resident preference and choice.
It has been argued that the current long-term care regulatory scheme has deprioritized resident individuality and choice. That is to suggest of course that it was ever in its purview. Avoidance of risk (regulation) and freedom of choice are most often always at odds. If we are to truly make strides in improving resident quality of life in long-term care we must, in part, trade rules for risk. Allow residents the freedom to choose the risk of a fall for the freedom to walk unassisted into the arms of a spouse or loved one; to forgo breakfast in favour of fatigue or the time to reflect on a photograph.
Among the many observations and conclusions which can and should be drawn from any overregulation, are the overwhelmingly inescapable ones which are that the regulators long ago lost sight of that which they were seeking to regulate. And the risk they were seeking to mitigate against. In long-term care, the result of this potentially crushing effect is, as referenced above, the crippling of workers who are required to spend more time on compliance than they are on care.
I am hopeful, as we all must be, that the work the federal government is undertaking in establishing nationally recognized standards in long-term care will not only be resident-centred and based on compassion, respect, dignity and quality of life, but will necessarily entail the peeling back of years and layers of regulations that no longer are – or ever were – necessary or relevant. Moreover, they must be focused on the people and system they ostensibly seek to protect.
In defining and implementing national standards in long-term care, let us truly seize the opportunity to put our seniors and the people who are devoted to caring for them at the centre of those standards. As we move upward beyond the recent pandemic, may we also grow comfortable with the acceptance of certain risks in favour of quality of life. And in so doing, avoid regulation for regulation’s sake.
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This OpEd originally appeared in The Hill Times.
