Reimagining the Canadian long-term care sector

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About the project

The ways in which Canadians think and feel about, as well as act toward, aging populations—and, especially, aging populations within the long-term care sector—is shaped by intersecting systems of oppression that allow inequities to persist through institutional policies. Ageism (and, particularly, ageism as it intersects with ableism) produces the conditions for which the institutionalization of older adults with (dis)abilities (e.g., Alzheimer’s disease, multiple sclerosis, Parkinson’s disease) seems natural, neutral and normal. This institutionalization results in the exclusion and marginalization of older adults with (dis)abilities from society. Within these institutions, experiences of exclusion and marginalization are further modified by long-term care policies that uphold other systems of oppression such as classism, heterosexism, racism and sexism. Thus, to quickly map out historical and existing long-term care policies as well as the consequences of these policies on residents’ experiences of exclusion and marginalization, and the ways in which a stronger sense of belonging and inclusion can be fostered, we conducted a rapid scoping review in consultation with a health services librarian.

Key findings

• Long-term care residents who are older, identify as women, live with cognitive impairments and/or mental illness, or experience financial insecurity report greater levels of social isolation and loneliness.
• Adults who identify as LGBTQI2SA+ and/or belonging to minoritized ethnic, linguistic or racial group(s) report that they fear they will experience social isolation and/or discrimination if (or when) they become long-term care residents.
• Specific data on the experiences of long-term care residents who are Indigenous, identify as LGBTQI2SA+, and/or belong to minoritized ethnic, linguistic, or racial group(s) are lacking.
• Data on these experiences of exclusion and/or marginalization need to be used to enact meaningful changes within the long-term care sector with consideration for those residents who are most at risk for being excluded and/or marginalized.
• The long-term care sector is underfunded and, subsequently, understaffed, and the long-term care residents who are most adversely impacted by this understaffing are those residents who are already excluded and/or marginalized.
• The long-term care sector also faces high rates of staff turnover due to stress and burnout, and challenges with staff retention mean that long-term care residents are not provided with the continuity in care required to establish meaningful resident-staff relationships built on trust and mutual respect.

Policy implications

Based on the key findings presented in this evidence synthesis, efforts to improve experiences of belonging and inclusion for long-term care residents should focus on the following policy areas:

• Hold ongoing consultations with long-term care residents who are at risk of being excluded and/or marginalized to learn from their lived experiences of institutionalization.
• Regularly collect data on the experiences of residents who are at risk of exclusion and/or marginalization in a way that is acceptable, appropriate and safe.
• Support research that aims to better understand experiences of exclusion and/or marginalization among long-term care residents as well as solutions that mitigate these experiences of exclusion and/or marginalization.
• Academic institutions should provide experiential and service-learning opportunities that offer insight into careers within the long-term care sector as a way of recruiting long-term care staff.
• Incentivize the long-term care sector to invest in the retention of staff and their professional development in the enactment of anti-oppressive policies, practices and programs.
• Support the professional development of long-term care staff by providing anti-oppressive education and training opportunities that are easily accessible and readily available.

Further information

Read the full report

Contact the researchers

Natasha L. Gallant, assistant professor, Department of Psychology, University of Regina: natasha.gallant@uregina.ca

Heather Finnegan, clinical psychologist, Department of Psychology, University of Manitoba: h.finnegan@gmail.com

Atul Jaiswal, postdoctoral fellow, École d’optométrie, Université de Montréal: atul.jaiswal@umontreal.ca