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Stuck in bed 23 hours a day: What's wrong with home care in Canada and how another country changed course – CBC News

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Seven days a week, Margot Algie can’t get out of bed before noon. Not from choice. She has amyotrophic lateral sclerosis (ALS), a debilitating neurodegenerative disease, and needs a home care worker to help start her day. 

But once someone arrives to shift her into a wheelchair, dress her and help with toileting, Algie often only has one hour — sometimes two — before another home care worker arrives to put her back to bed at 4 p.m.

“Being stuck in bed … isn’t great for my body, my skin or my psyche,” said the Toronto woman, who is gradually losing the ability to do all basic living activities. 

But the home care company says “that’s all that’s available,” she said.

At least once a week, she gets a call to say no home care worker is available at all. 

“I’m terrified when they say I can’t have help,” said Algie, 63, who says she’s fully dependent on the care she receives. 

A home care worker helps Algie transfer to her wheelchair. (Norm Arnold/CBC)

Algie is not alone when it comes to complaints about substandard home care. A recent CBC Marketplace investigation sparked hundreds of stories from home care clients and their families across the country, complaining of missed visits, shortened visits and the inability to get visits at all.

Compounding problems, the number of people who rely on home care is expected to increase by more than 50 per cent in less than a decade, according to the Canadian Medical Association (CMA).

It estimated in a recent report that more than 1.1 million Canadians receive home care and that by 2031, that number will likely increase to 1.7 million. On top of that, the report estimates the annual cost for long-term care and home care in Canada will almost double during that period, from $29.7 billion to $58.5 billion.

“This problem is getting worse,” said CMA president Katharine Smart. “There is a real risk we will see our systems start collapsing over the next months and years.” 

It’s a grim prediction that doesn’t have to materialize, said Dr. Samir Sinha, director of health policy research for the National Institute on Ageing and director of geriatrics at Sinai Health and the University Health Network in Toronto.

Geriatrician Dr. Samir Sinha says more investment in home care is needed to avert a financial long-term care crisis a decade from now. (Tiffany Foxcroft/CBC)

“The problem that we’ve had in Canada is this notion that if you can’t care for someone at home, they need to go live somewhere else,” said Sinha. “And so we have this real culture of institutionalizing people.”

Sinha said what’s needed isn’t rocket science. Provinces need to invest more in home care to help people age in place.

“Right now there are about 200,000 Canadians living in long-term care homes,” he said. “About a third of them — 60,000 or 70,000 people — could’ve actually stayed in their own homes, with proper home care support.”

Meantime, he said, at least 50,000 Canadians are waiting to get into a long-term care bed but there’s no room. Many have no option but to wait in hospitals for a spot to open up.

WATCH | The system this clinician says he’s up against:

‘That breaks my heart,’ says Canadian geriatrician

23 hours ago

Duration 0:30

Dr. Samir Sinha says Canada’s home care system often robs the dignity of his patients. 0:30 

But Sinha said making a fundamental change to invest more in home care is a hard pitch to sell.

“Our politicians are living on four-year political life cycles and just trying to focus on getting re-elected — rather than figuring out how to create a sustainable health-care system for the future,” he said. 

Smart says time to act is running out.

“I think there has never been a more urgent moment to shift our health-care system.

“This is a real example of where the government needs to get beyond politics and understand that Canadians need this system. It has to be functional. And right now it is not.”

Look to Denmark, geriatrician urges

The way forward is to take a page from Denmark, said Sinha, who has travelled to the Scandinavian country to study its long-term care strategy and returned last month with a CBC Marketplace crew.

In the late 1980s, Denmark — which, like Canada, has an aging population and publicly funded home care — slowed the growth of new nursing homes and instead used that money to heavily invest in home care. 

In Ringsted, Denmark, elder dwellings with no stairs are available to rent. Here seniors receive home care and live independently. (Katie Pederson/CBC)

Now, according to the Organisation for Economic Co-operation and Development, roughly half of all long-term care spending in Denmark is based on providing care in people’s homes, whereas in Canada only about one-third of spending goes to home care.

The funding means people in Denmark can get anywhere from 20 minutes to 10 hours of home care a day, depending on their needs.   

When Danish people turn 80, they are automatically offered a home visit by a nurse to assess how things are going and whether they need any support to help keep them aging at home.

“We talk about if they have lost their husbands or wives, and how it is to be alone,” said Camilla Hove Lund, who manages the home care program in the municipality of Ringsted, 70 kilometres southwest of Copenhagen.

“We talk about their network — do you have some friends? Some family? Do you have activities you go to?” said Hove Lund. “And if we hear they need a little bit of help, we give that to them.”

Camilla Hove Lund runs the home care program in Denmark’s Ringsted municipality. She says focusing on prevention keeps aging people out of long-term care beds. (Katie Pederson/CBC)

It may sound like a warm and fuzzy approach, but don’t be fooled, said Sinha. “It’s actually a deliberate strategy to keep the overall health-care system sustainable.”

When Danes find themselves struggling physically — perhaps no longer able to bathe themselves — they’re registered in what’s called a “reablement” program. 

“We offer them the bath,” said Hove Lund. “But we also offer training with our workers … to do the bath by themselves again.”

WATCH | Come inside a home in Denmark:

‘The goal is to strengthen his legs,’ says Danish PSW

23 hours ago

Duration 1:07

Johnny Olsen does rehab exercises with a trained personal support worker as part of Denmark’s ‘reablement’ program in home care. 1:07 

It’s a much different approach than the home care most often provided in Canada, said Sinha.

“The little home care that we make available to Canadians is often what we call ‘reactive’ home care,” he said. “Someone falls, they need a bath, we send in people to help. Whereas [in Denmark] there is this idea of preventative home care.”

In Ringsted’s rural outskirts, 72-year-old Johnny Olsen, a former farmer, is struggling with Alzheimer’s disease. 

He gets six home care visits a day, including physical therapy twice a week to strengthen his arms and back and try to prevent him from falling.

Johnny Olsen, who has from Alzheimer’s, pictured here with a regular home care worker, gets six home care visits every day in Ringsted, Denmark. (Katie Pederson/CBC)

“It’s working,” he said, as he diligently followed the prompts of his home care worker to raise and lower his legs.

In Denmark, all home care workers are trained to do preventative physio to try to keep people aging in place, whereas in Canada, it’s not standard practice for home care workers to get rehab training and physiotherapists are in high demand.

“We have a big group of elderly who need a lot less help if we give them rehabilitation,” said Hove Lund.

Those who do get rehab also have their progress tracked.

“The results are very important to us,” said Hove Lund. “We have to show our politicians that this works. You have to give money to this.”

Lonni Bensadon stands next to one of many electric vehicles provided to personal support workers in the Danish municipality of Ringsted so they can conduct home care visits. (Submitted by Samir Sinha)

It’s all a deliberate effort to help people age at home — and all a far cry from what’s being delivered back at home, said Sinha.

“We need to say that we don’t have a system that’s currently working as well as it could,” he said. “These aren’t pie in the sky ideas — we’re physically seeing them here in Denmark.”

Promises to invest more in home care

In 2018, Ontario’s Conservative government hired Sinha to develop a Senior Strategy — a long-term care plan for the province’s aging population.

He presented a report that called on the government to build fewer long-term care beds and invest more in home care. 

But he said the Ford government basically shelved his report and instead committed to spending $6.4 billion to build 30,000 new long-term care beds by 2028. That’s on top of its annual $6-billion budget for long-term care and $3 billion for home care.

Ontario Premier Doug Ford talks on Feb. 1, 2022, about committing $6.4 billion to build 30,000 new long-term care beds by 2028. (CBC)

“They chose the solution that frankly is a lot more costly to taxpayers, but works really well for developers,” said Sinha.

“It really troubles me because we’re not getting the fundamentals right here. Nobody actually aspires to end up in a nursing home. But for the public, it’s being presented as, ‘We’re doing this big thing to take care of this big problem.'”

But earlier this week, in a surprise announcement, the Ontario government said it plans to invest an additional $1 billion over three years in home care if re-elected in June.

“This significant investment will ensure Ontarians can receive the care they need in the comfort of their own homes,” said Health Minister Christine Elliott.

It’s a step in the right direction, said Sinha. “This investment will help to fix fundamental problems [the Ontario government] created after four years of deliberately starving Ontario’s home care system.”

The Ontario government said this week that it plans to invest an additional $1 billion over three years in home care if re-elected in June. (David Donnelly/CBC)

Meanwhile, the Ontario Liberal Party said that if elected, it would invest a further $2 billion in home care over four years and end for-profit long-term care by 2028. 

The provincial NDP said it would invest up to $1 billion in home care if elected and would also end for-profit long-term care.

A survey by the National Institute on Ageing found that almost 100 per cent of people said they hope to age at home, as opposed to moving to a long-term care facility.

Figures obtained by Ontario’s Ministry of Health show that providing home care is also half the price of a long-term care bed — roughly $100/day compared to $200/day — and far less costly than a hospital bed that costs approximately $700/day.

Home care clients in Canada receive, on average, 4.9 hours of care a week. According to the CMA, even if that number was increased to 22.2 hours per week, to reflect higher need clients, it would still be cheaper than institutionalized care. 

Algie has amyotrophic lateral sclerosis, a debilitating neurodegenerative disease, and needs a home care worker to help start her day. (Tiffany Foxcroft/CBC)

“When you’re delivering care in a long-term care home, you’ve got to buy a piece of land, you’ve got to erect a building, you have to heat and cool it,” said Sinha. 

“You don’t have to be a mathematician to realize that the care that most people actually want is the most cost-effective for the taxpayer and more in line with what everybody hopes for.”

Stuck in bed for most of the day, Algie said she’s tired of struggling with a broken home care system that’s in desperate need of better funding.

“It really gets my goat,” she said. “Everybody knows it. And yet, we’re still in this pickle of being underfunded. I just don’t get it.”

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Why Can’t The Federal Government Eliminate Systemic Racism In The Canadian Military?

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“Racism in Canada is not a glitch in the system; it is the system.

By Harinder Mahil

A recently released report indicates that systemic racism is rampant throughout the Canadian Armed Forces which is putting the country’s national security at risk. 
 
The report released by Defence Minister Anita Anand says that the military has not acted on dozens of previous studies and reviews on racism in the ranks over the past two decades. The report says the military is not doing enough to detect and prevent white supremacists and other extremists from infiltrating its ranks.
 
I have read numerous stories about the racism in the military over the years but never thought it was such a big problem. I am shocked at the extent of the problem as identified in the report.
 
The report concludes that more and more Canadians will have no interest in joining the military until it fixes its long-standing issues of racism, abuse of power, gender discrimination and sexual misconduct.
 
“Unless it is rapidly reined in and addressed, the impact of this toxicity will linger for years, affecting the reputation of the Defence Team to the point of repulsing Canadians from joining its workforce”
 
The report says military leadership must accept that some members will either leave or need to be removed.
 
The report comes after a yearlong review by a panel of retired Armed Forces membersand follows numerous incidents linking some military personnel with violent extremism and hate groups, including white supremacists and neo-Nazis.
 
“Racism in Canada is not a glitch in the system; it is the system,” reads the report by the Minister of National Defence’s Advisory Panel on Systemic Racism and Discrimination.
 
There has been increasing pressure on the military to do more to crack down on hateful ideologies within its ranks.
 
“A common thread was evident throughout these consultations: membership in extremist groups is growing, it is becoming increasingly covert, and technological advances such as Darknet and encryption methods pose significant challenges in detecting these members,” the report said.
 
White men account for 71 per cent of Canadian military members but only 39 per cent of the country’s civilian workforce. The report notes Indigenous Peoples, visible minorities and women are significantly under-represented in Canada’s armed forces.
 

Over the last two decades the military has been seeking recruits from the Indigenous and visible minority communities. Why would Indigenous and visible minority communities’ members join the military if they are discriminated against by others especially those who have links with neo-Nazis?

 
I am of the opinion that the report only scratches the surface of the problem. It talks about consultations but who is consulted. 
 
If the military is serious about dealing with the problem it should monitor the social media posts of its members and weed out those who harbour white supremacist views and recognize those who are likely to be drawn towards extremist groups.
 

Harinder Mahil is a community activist and President of the West Coast Coalition Against Racism (WCCAR).

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Government’s changing vape strategy shifts focus away from cigarettes, advocates fear

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OTTAWA — In the eight years or so since he opened his first vape shop in Ottawa, Ron Couchman said a great sense of community has been lost.

A former cigarette smoker himself, Couchman said he remembers when his store operated almost as a support group for people trying to find a healthier alternative to cigarette addiction.

“We could teach other people how to vape when people were struggling to get off cigarettes, we’d play board games and have movie nights,” Couchman said.

As provincial and federal legislation started to clamp down on those activities, he said the camaraderie has faded.

Couchman is a passionate advocate for the potential of vaping to help people leave more harmful tobacco habits behind. At one point the federal government appeared to be onside with that, he said, but that seems to be changing.

“The last few bouts of legislation (have) really swung the other way to the point that it’s serving as a disincentive to quit smoking,” he said.

The government is in the midst of its first review of the 2018 legislation that legalized vaping, and appears to be veering away from the narrow path between treating vapes as a harm reduction tool, or a danger in and of themselves.

The harms of vaping relative to smoking tobacco cigarettes are still something of a mystery, but the government’s website suggests it’s safer than inhaling cigarette smoke.

Advocates on both sides of the issue say regulations have become tougher on vapes and have more or less abandoned the product as an alternative to cigarettes, leaving them to wonder how the government plans to deal with cigarette smoking in Canada.

“They bet heavily on harm reduction as a way to address tobacco. It hasn’t worked for them, and they didn’t have a more comprehensive plan,” said Cynthia Callard, executive director of Physicians for a Smoke-Free Canada.

Health Canada’s goal is to reduce the number of people who smoke tobacco to just five per cent by 2035, from about 14.8 per cent in 2019.

An audit of the department shows tobacco smoke is declining in popularity, but mainly because young people aren’t picking up the habit and existing smokers are dying.

Tobacco use is still the leading cause of preventable death and disease in Canada, with approximately 48,000 people dying from smoking-related illnesses every year, the government says.

Vaping remains relatively unpopular for adults over the age of 25, with just three per cent reporting that they vaped within the last month in 2020, according to the results of the Canadian Tobacco and Nicotine Survey. That’s about the same it was in the 2017 Canadian Tobacco Alcohol and Drugs Survey.

But vaping has spiked among youth between 15 and 19 years old, to 14 per cent in 2020 up from six per cent in 2017.

In response, the government clamped down on vaping with a range of regulations, banning promotion and advertising of the products in certain spaces and putting limits on the amount of nicotine that can be in them. It’s also expected to restrict which flavours can be sold.

In their most recent budget, the Liberals proposed an excise tax on vape products as of Oct. 1.

Now, it’s as if Health Canada is fighting the war on two fronts, Callard said.

The department has been focusing resources on youth vaping, leaving anti-smoking groups like Callard’s concerned that a tobacco strategy may be falling by the wayside.

The recent audit shows the department has been taking on projects to reduce tobacco use, but it won’t be enough to meet their own targets.

Meanwhile, advocacy groups like Rights4Vapers say smokers are being punished for making a healthier choice.

“It is probably the only addiction currently where we continue to use fear and shame to get individuals to quit,” said Maria Papaioannoy, the group’s spokesperson and a vape store owner.

The strategy does appear to be at odds with the harm-reduction approach the government has embraced when it comes to to drug use, said David Sweanor, chair of the University of Ottawa’s Centre for Health Law, Policy and Ethics.

“We’ve seen the success replicated numerous times simply by giving people alternatives, which is consistent with what we’ve done with things like clean needles, safe injection sites,” said Sweanor, who contributed to the 1988 Tobacco Products Control Act.

The government must table its legislative review this year. The discussion paper the department released touches almost exclusively on how to toughen vaping regulations, Sweanor said, though that’s not what the legislation was primarily set out to do.

“Is it accomplishing what it’s supposed to be accomplishing? Are there ways that you can improve it?” he said.

“Instead, what we got is a document that takes very few aspects of, primarily, their anti-vaping strategy.”

In the paper the government says the review will focus on vaping regulations because the vaping products market in Canada has changed so much in the years since the law was passed.

The review gives the opportunity to examine whether the act offers the government enough authority to address the rise in youth vaping, the paper said.

“A full assessment of whether the measures taken since the legislation was introduced in 2018 have been effective in responding to the rise in youth vaping will benefit from more time and data. Subsequent reviews will continue to monitor youth use along with other dimensions of the Act,” the document reads.

Advocates for and against using vaping as a way to transition people away from harmful cigarette smoke agree, tobacco is being left out of the conversation.

“Tobacco remains the fundamental problem,” said Callard. “It’s tobacco that continues to kill.”

This report by The Canadian Press was first published May 17, 2022.

 

Laura Osman, The Canadian Press

 

 

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Multiple reports say Marner’s SUV was stolen in an armed carjacking in west Toronto

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There are multiple reports that an SUV belonging to Toronto Maple Leafs star Mitch Marner has been stolen in a carjacking in the city’s west end.

The Toronto Sun, Global News and City TV all quoted unnamed police sources as saying Marner’s black Range Rover was taken outside a movie theatre in Etobicoke.

Police confirmed there was a carjacking without any injuries, but would not give any information out on the victims or witnesses.

The Sun says Marner was shaken but not hurt.

Police tweeted they were called to The Queensway and Islington Avenue area around 7:46 p.m. for reports of a man robbed of his car.

Authorities are looking for three suspects armed with two handguns and a knife, who took off in the stolen vehicle.

Marner and the Leafs were eliminated from the playoffs on Saturday in a seventh and deciding game against the Tampa Bay Lightning.

This report by The Canadian Press was first published May 17, 2022.

 

The Canadian Press

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