The Clarity Nursing Brings to Long-Term Care and COVID

Dr. Carole Estabrooks, Professor & Tier 1 Canada Research Chair at the University of Alberta, and Registered Nurse

Old, outdated continuing care facilities. Inadequate staffing levels. Poor quality of life. These are all issues that have received national attention during the COVID-19 pandemic.

But for Dr. Carole Estabrooks, a nurse researcher, they are unfortunately nothing new.

For the past 15 years, Dr. Estabrooks has researched long-term residential care, looking for ways to improve both quality of care and quality of life for older adults living in these facilities. This spring she chaired the Royal Society task force that produced the report Restoring Trust: COVID-19 and the Future of Long-Term Care, gaining national attention.

She says COVID-19 didn’t break the system, it focused “floodlights” on the system. “Canada relative to other countries has the worst record of deaths as a proportion of total COVID-19 deaths in nursing homes in the world – 81 percent, with Quebec and Ontario the hardest hit.”

Dr. Estabrooks shakes her head when she acknowledges that these two provinces are now launching inquiries into those deaths. “We have an insatiable desire for commissions and inquiries. For the COVID-19 report we scanned over 100 reports from the last 50 years – it was a soul-destroying exercise. They all report similar problems and issues, they all make recommendations, but nothing changes fundamentally.”

“But what we need now is an ‘Action Force.’ What we need is federal leadership.”

As a researcher with a doctorate in nursing, she claims a unique lens: “That of care giving, both psychological and physical. There is lots of overlap with other disciplines, but no other is as interested in care. Nurses see it differently; we see the urgency. There is a clarity to what we do.”

What does she see?

“We see that seniors, particularly those with dementia are the area of biggest need. We know they lack a voice. We see their vulnerability. The highest need patients are looked after by the least trained and paid. Half of caregivers in urban areas are immigrant women, vulnerable women looking after vulnerable women.”

She sees families denied visits during the pandemic, and an overall worsening fear and distrust of long-term care. The level of need of residents entering long-term care is only increasing, while resourcing has stayed flat. “It’s scandalous for a G7 country.”

The federal leadership she would like to see is the immediate stabilization of staffing and wages for long-term care, as set by experts, followed by a study of the workforce requirement for long-term care, including the number of RNs and LPNs and other professionals needed to support the front line care aides and residents and families. She notes that there has never been a such a study in Canada. “We just seem to use a Ouija board to figure it out.”

She maintains that we can afford it, that it is about choices and priorities. “We can take immediate actions and those have been well laid out to prepare for a possible wave two of the pandemic. We can start at the same time, to look at longer-term, permanent solutions to redesigning how we think about and support long-term care.”

In the meantime, Estabrooks stays close to those “in the field.” She works with the VOICES advisory panel – individuals living in continuing care, their family, and friends — on research into quality of life in nursing homes. Quality of life is their number one issue: having human contact, good food, sunlight on one’s face, pleasure in living, and joy in moments.

She also works with graduate students at the university, many of whom have received funding from ARNET and will continue to do so as they pursue their research. As a nurse, Carole Estabrooks knows nurses can compete in research circles with the very best. “We can have a strong role in addressing some of these problems if we want it.”