Provincial policies affecting resident quality of life in Canadian residential long-term care

Abstract

Background The precautions and restrictions imposed by the recent Covid-19 pandemic drew attention to the criticality of quality of care in long-term care facilities internationally, and in Canada. They also underscored the importance of residents’ quality of life. In deference to the risk mitigation measures in Canadian long-term care settings during Covid-19, some person-centred, quality of life policies were paused, unused, or under-utilised. This study aimed to interrogate these existing but latent policies, to capture their potentiality in terms of positively influencing the quality of life of residents in long-term care in Canada. Methods The study analysed policies related to quality of life of long-term care residents in four Canadian provinces (British Columbia, Alberta, Ontario, and Nova Scotia). Three policy orientations were framed utilising a comparative approach: situational (environmental conditions), structural (organisational content), and temporal (developmental trajectories). 84 long term care policies were reviewed, relating to different policy jurisdictions, policy types, and quality of life domains. Results Overall, the intersection of jurisdiction, policy types, and quality of life domains confirms that some policies, particularly safety, security and order, may be prioritised in different types of policy documents, and over other quality of life domains. Alternatively, the presence of a resident focused quality of life in many policies affirms the cultural shift towards greater person-centredness. These findings are both explicit and implicit, and mediated through the expression of individual policy excerpts. Conclusion The analysis provides substantive evidence of three key policy levers: situations–providing specific examples of resident focused quality of life policy overshadowing in each jurisdiction; structures–identifying which types of policy and quality of life expressions are more vulnerable to dominance by others; and trajectories–confirming the cultural shift towards more person-centredness in Canadian long-term care related policies over time. It also demonstrates and contextualises examples of policy slippage, differential policy weights, and cultural shifts across existing policies. When applied within a resident focused, quality of life lens, these policies can be leveraged to improve extant resource utilisation. Consequently, the study provides a timely, positive, forward-facing roadmap upon which to enhance and build policies that capitalise and enable person-centredness in the provision of long-term care in Canada.

Family Involvement Training for Staff and Family Caregivers: Case Report on Program Design and Mixed Methods Evaluation

“…Long-term care residents have medical and physical care needs that cannot be safely provided in their own home or in supported living. People working in long-term care refer to it as the resident’s end-of-life home [ 30 ].…”

Towards equitable representation in long-term residential care: widening the circle to ensure “essential voices” in research teams

“…Similarly, overrepresentation of low-income women and racialized workers in LTRC is also linked to sexist and racist abuse and harassment in LTRC [9,27], which interlocks with and reinforces ageism and ableism [25]. Moreover, where LTRC is organized through top-down governance and restrictive regulations, these structural issues reduce family, staff, and volunteers' capacities to engage in resident-centred care and enhance their quality of life [28][29][30][31][32]. This top-down organization also contributes to systemic inequities that reduce people to objects or purveyors of care, and justify racial and gendered inequalities and inequitable treatment of people chonric health issues [9,23,25], who are overrepresented in LTRC.…”