week 10 - LTC and COVID 19 crisis

prior to the 20th century, were the elderly an identifiable and separate social group?

no

how were the elderly classified prior to the 20th century?

as older members of other social groups based on class, gender, etc

examples of reasons why old people would be institutionalized prior to the 20th century (other than ld age)

poverty, mental illness, disability

example of where old people would be institutionalized prior to the 20th century

almshouses

pre 20th century: upper canada care homes for elderly/poor/insane/disabled were rooted in which laws?

elizabethan poor laws of 1601

pre 20th century: most elderly weren’t institutionalized, they were…

cared for by family members at home

pre 20th century: if elderly didn’t have home or people to care for them, where would they be committed? (3)

workhouses, asylums, hospitals

specialized homes for elderly did not appear until when?

late 19th century

5 types of early canadian care establishments involving the elderly

religious based charitable organizations, secular organizations run by local governments, private domiciles, communal care, hospitals

who did religious based charitable organizations care for? (4)

sick, disabled, mad, poor

what were religious base charitable organizations founded on?

the christian precept of caring for needy and helpless

the care in religious based charitable organizations was not curative or rehabilitative but…

custodial

what were secular organizations run by local governments informed by?

principles of industry

secular organizations run by local governments viewed able bodied elderly as what?

capable of self support

why did secular organizations run by local governments put able bodied elderly to work?

to earn their keep

what religious concepts of un/deserving poor also shaped how secular organizations run by local governments were organized?

work is a religious duty to god, industrious life is a manifestation of god’s favour

private domiciles aka…

home care

who were the elderly most often cared for by?

daughters

very few elderly were institutionalized. if they were, they were usually…

childless and poor

was there a stigma associated with institutionalization?

yes

did home care become increasingly impractical?

yes

how did home care become increasingly impractical?

emotional, social, and geographical changes to nuclear family; led elderly to become separate and outcast social group

what is communal care?

when elderly are placed in the homes of others

communal care is who’s responsibility?

town or village

what do householders doing communal care get?

a small remittance

early to mid 20th century hospitals provided what for elderly?

chronic care wards

were early to mid 20th century hospitals custodial or curative

custodial

did early to mid 20th century hospitals offer food, shelter, and minimal nursing?

yes

did early to mid 20th century hospitals offer PT/OT/RT?

no

early to mid 20th century hospitals are the link between today’s ___________ and early __________

modern nursing homes, LTC facilities

what did 19th century english workhouses offer?

only the essentials for minimal maintenance

why did 19th century workhouses only offer the essentials?

because they believed if they offered more, individuals would lose motivation to better themselves

in 19th century workhouses, people had to work to get motivation to better themselves and receive what?

deserved help

in 19th century workhouses, what was a greater concern than resident’s comfort?

frugality

when was the shift away from use of hospitals for elder care?

late 20th century

why was there a shift away from use of hospitals for elder care?

because chronic wards became too costly to run

late 20th century, hospitals’ chronic care wards went from elder care to what…

treatment and cure of acute conditions

true or false: modern hospitals became highly technological, bureaucratic, rationalized, and cost-efficient

true

what does long term care involve?

ongoing indefinite care for individuals unable to care for themselves in their home

LTC can be for who…

elderly, mentally and physically challenged

LTC straddles ______ , _________, and __________

nursing, medical care, social services

examples of care included in LTC

aid in daily living activities, income supported housing assistance, provision of recreational and social programs

why is provision and funding of LTC in canada problematic?

because it operates at margins of canadian healthcare system

is LTC part of universally insured health services?

no

is LTC included in HIDSA or canada health act (1985)?

no

is LTC considered a medically necessary service?

no

if LTC is not considered a medically necessary service, what is it?

an extended service

who is responsible for funding and regulating LTC facilities?

provinces and territories

LTC is ______ ar a federal level

invisible

LTC is problematic as an extended services because specific services for elderly are not….

a primary concern

why is home care privileged over LTC?

because its much cheaper and costs are downloaded to individuals and families

what are LTC priority services limited to?

post-acute, palliative, mental health care

LTC is problematic as an extended services because governments are reluctant to invest in facilities that…

may not be needed over long term

LTC is unable to respond to _______ population demographics

shifting

why could errors in LTC demand forecasting be costly?

because there could be too many facilities and not enough residents

“do we create all these facilities for the ______ population, but then have no way to fill them after that generation passes?”

boomer

what happened to LTC in the high profile royal commission on canadian health care that called for sweeping reforms?

it was ignored

did federal governments once provide targeted funding money for LTC?

yes

federal governments used to transfer money to _________ and ________ for LTC facilities

provinces, territories

what was abolished in 1996?

LTC targeted funding

now LTC money is lumped in with what? (all competing for same federal money)

post-secondary education, health and social welfare programs

when did contemporary LTC facilities become increasingly specialized?

20th century

< physically and psychiatrically challenged, developmentally delayed, substance addicted, old age and dying > are all types of what?

groups LTC facilities provide care for