Smaller homes coping, for now, with growing demographic diversity says administrator
Thursday, October 6, 2005 -- Craig Anderson
When Leeanne Hadley is asked to reflect on the changes taking place in the demographic base of long-term care homes, with a growing diversity of both younger clients and clients with unique and challenging care needs, she quickly turns to the topic of the social.

“We’re doing a lot of social work now,” says Leanne, the administrator at Streamway Villa, a small home with a correspondingly tight knit community. “Everything is more medically complex too, but social issues come up much more than before.”

To illustrate this, Leanne points to a resident with a brain injury who is under 60 and the father of three pre-teen children. His wife, who works full time, often leaves the children with her husband, albeit his condition makes it so that consistent child care isn’t always possible. This poses a conundrum for staff, says Leanne. Coupled with this, losing his income due to the injury has been a financial strain on the family.

‘This is a challenge for us from an educational perspective, too” says Leeanne. “We’re becoming more involved with families on different levels.”

Leanne also raises recent ethical dilemmas, such as dealing with spousal abuse. Nursing homes are often not aware of the extent of an abusive situation, especially with complicating factors like dementia. While honouring resident requests to live in the same room as their spouse is an arrangement that Leeanne says is normally embraced, it is incumbent upon the home to ensure that abuse is not present in any manner.

“We can’t let that happen here,” she says.

Unique medical dilemmas are also on the rise at Streamway, along with a growing number of residents with intellectual disabilities or psychological disorders.

A brother/sister pairing (both in their early 50’s) with severe kidney disorders is taxing on the home on both a financial and resource level, says Leeanne, as both require multiple weekly trips for dialysis treatment. They also require wheelchair accessible ambulances – which in Cobourg are private and thus costly, and oftentimes unreliable, she says – but the only option available. This will require homes to more thoroughly negotiate the right type of therapeutic climate for those residents who no longer have a service provider in the health care system that can provide adequate care for them. It is possible that in some cases, a nursing home is not the right therapeutic environment.

“A lot of these people simply don’t fit in anywhere specifically in the new system. They can’t stay alone, there’s no chronic care and psychiatric institutions are generally being closed. But they have different needs than we are accustomed to meeting. It can be very frustrating but that’s the way it’s going to go it seems.”

For elderly residents, the presence of younger residents with psychiatric problems can be “petrifying,” says Leeanne, especially in a small home where the physical plant makes segregation impossible. Staff are also burdened with explaining to families the presence of these younger residents, which can often mean breaching privacy, says Leeanne. Terminally ill patients from hospitals are the other new members of long term care residence’s changing demographic base, as bed shortages force home’s to take on spillover palliative care.

Leeanne, who would embrace a diversification of service providers in order to meet these new challenges, believes that the only way the smaller homes are going to cope is with increased time, resources, and staff education. Otherwise, the tight knit, safe and comfortable community could be compromised, she says.