Monday, November 11, 2013

Bob Cohen Remembered

During the past 30 years I have witnessed a consistent transformation of the Canadian staffing industry and its players.   In the early 80’s, the industry was truly “entrepreneurial”.  At the time, Bob Cohen was the founder and President of Staffing Consultants.  He was a leader of the staffing industry’s entrepreneurial spirit.

I originally met Bob Cohen in Toronto in 1983 or 1984 at an Association of Canadian Search, Employment & Staffing Services meeting (formerly FTHS and CATS) and he quickly became a trusted mentor and advisor.  He believed that we could all thrive and succeed in our fledgling industry if we would collaborate together to promote the industry, share best practices, and set standards.  While some owners were naturally untrusting, insular, protective and secretive around competitors, Bob Cohen was the exact opposite.  He set a positive example for openness, sharing and professionalism. His goal was to make it a better industry for us all.

As a newcomer to the industry, I turned to Bob and few other industry greats for guidance, advice and leadership.  If you know a bit about the Canadian staffing industry’s past, you’ll understand why I associate Bob Cohen with Gil Rosen, Bill Coke and Ted Turner.  These guys cared and worked hard to foster the health and growth of an industry that has now become an important and integral part of Canadian business success.

Bob understood that relationships of trust are the key ingredient to successful collaboration. He phoned, he met, he talked, he was professional but most of all, he was personal.  Almost every time that we greeted each other or laughed or departed, Bob was comfortable in putting a hand on my shoulder.   Bob and I had many lunch meetings in Toronto, drinks in Montreal, dinners in Dallas and laughed in streets of Las Vegas.  Some men have the knack for comfortably nurturing relationships of trust and confidence.  He was that man.

With over 40 years in the industry Bob knew and influenced countless others as he did me.  He was instrumental in the staffing industry association merger, various industry public relations projects, government lobbying, conference planning and became the North American expert in staffing business valuations, mergers and acquisitions.

Together with his friend and business partner Sam Sacco, they successfully completed over 140 staffing industry M&A transactions.

Bob passed away peacefully on Saturday.  I know that I speak for many when say that our thoughts and prayers are with Bob and his family, especially his loving wife Debra.  He will be missed and always thought of with tremendous respect for his knowledge, his accomplishments, his values and his friendship.

Bob was instrumental and influential over many of the changes to the Canadian staffing industry. But while the business changed and evolved, the personality, the commitment and honourable nature of the man behind it remained the same.  Bob Cohen – Rest in Peace.

“Cohen, Robert A. (Bob). Passed away on Saturday, November 9, 2013. Beloved husband of Debra Joy Eklove. Devoted father of Paul Cohen, Julie and Corey Chandler. Adoring grandfather of Hudson Davis and Smith Beckett Chandler. Brother of Michael Cohen and Stephen Cohen both of California. Bob was born in Brooklyn, New York and moved to Toronto to begin a business in the staffing industry. His passion as a teacher was expressed through his work in schools, as an entepreneur and leader in the Staffing industry for 40 years, as a baseball coach, mentor and scout for the Major League Baseball Commissioner's Office. His strength and courage, and feisty character will be sorely missed by family, many lifelong friends and colleagues.”

Friday, October 11, 2013

Canadian Labour Market Survey - September Surprise Data!

Finally, Statistics Canada reports believable numbers suggesting that employment was relatively unchanged in September.  The unemployment rate dipped under 7% as fewer youth searched for work.   

Shockingly, the numbers bureau reported a decline in youth job seekers during September when students returned to university and college.  So much for seasonal adjustments but common sense prevails over their typical strange revelations. 

In recent months, Statistics Canada’s has portrayed a roller coaster of economic ups and downs.  The wonky monthly data has proven to be unreliable and inaccurate. It is important to note that the Canadian Labour Market Survey is just that… a “Survey”. The monthly report is not intended to be a fact but that doesn't stop money traders and stock brokers from overreacting to the numbers, It's best to just stand back and observe the silliness.

Unemployment Rate


If the economy was really as volatile as the numbers suggest, we would all be in a persistent state of anxiety. The agency reported 11,000 jobs created in September, with 59,000 created in August, job losses in July and a massive 95,000 jobs gained in June.   

Employment and staffing industry professionals know there are far more reliable sources of information than the Statistics Canada Ouija Board Report.  For starters, the Canadian Staffing Index produced by ACSESS (Association of Canadian Search, Employment and Staffing Services) is the largest Canadian sample of actual hours worked and should be viewed as one of the more reliable job indicators.  

According to StatsCan, Canadians gained 212,000 since last September, representing an increase of 1.2%. The number of workers in the job market also grew a similar pace.   Disappointingly, job creation continues to grow faster in part-time employment than full time.  

From the ACSESS website, “The Canadian Staffing Index was 113 in August. The index was unchanged from August a year ago, when the index was also 113.”    The Canadian Staffing Index is based upon actual hours worked for a significantly large sampling of temporary staffing providers in Canada. It is based upon the number of billed hours and is not seasonally adjusted.
"The August value of 113 is unchanged from a year ago, which implies flat or slightly positive growth in demand given that there was one fewer working day this August compared to a year ago. For most of 2013, the index has shown a trend of very minimal year-over-year growth in overall demand," says Timothy Landhuis, Research Analyst at Staffing Industry Analysts.

It will be interesting to see how the markets react to the ho-hum information.  My advice continues to be “Buy low, sell high and don’t read too much into the Statistics Canada Ouija Board report on the Labour Market”.

Thursday, September 05, 2013

Best Baseball Song - The Pitcher

This is Harry Hildebrand's original song and performance of "The Pitcher".  The Best Baseball song ever.   Hildebrand is a Mississauga, Ontario resident and mechanical engineer specializing in commercial HVAC systems.  He's hit a home run with "The Pitcher", a ballad describing the hopes and heartbreaks of every kid with the promise, talent and chance to go to the show.    Rumour has it that some of America's musical greats are already showing interest in re-recording this song which will surely be recorded time and time again throughout the future as one of the best baseball songs ever written.. 

Congratulations Harry!    Are those cameo performances by Bob Skeates?  Whoa! 

Wednesday, August 14, 2013

Toronto In-Home Care Blog

Evaluate Your Options Using the Ontario Health Care Website

Posted by Steve Jones
Mon, Aug 12, 2013

Leaving_hospital_Saikofish_PhotoPin_smallWe shouldn't feel frustrated and discouraged when searching for Ontario health care. However, many of us do. We end up having more questions than answers. Is the website credible? Which doctors are accepting new patients? What are the wait times for surgeries?
Start with the Health Care Options website. As a division of the Ontario Ministry of Health and Long Term Care website, the website offers us many Ontario health care resources. You can find the right health services and nearby facilities, connect to a new doctor, get surgery wait times, and learn about the Ontario Health Insurance Plan all through one website.
Health Care Options Directory
The Health Care Options Directory puts you in touch with the health care service and facility you need. Using the interactive directory tool box, you select the services and facilities you or your loved ones are looking for in Ontario. You can further narrow your search by selecting a language preference and distance.
If you are unsure of what type of service or facility you need, the Health Care Options Directory includes a reference list on care centres below the directory tool box.
Health Care Connect

For those of us without a doctor, Health Care Connect connects us with family health care providers accepting new patients. Health Care Connect is a referral program with steps from ensuring eligibility to registering in the program and from finding a doctor to booking an appointment.

Health Care Options Searchable Tools

Ontario Wait Times has two searchable tools to make scheduling procedures and waiting in the emergency room bearable.

The Ontario Wait Times for surgeries, MRIs and CTs provides wait times for adult and paediatric procedures. Through a series of easy click-and-answer prompts, you can get access to wait times for multiple procedures scheduled throughout the province. This tool is a convenient search option when comparing procedure wait times at different hospitals and facilities.
The Ontario Wait Times for emergency rooms provides wait times for ER visits. Emergency room wait times represent the total time for the visit, from initial registration to final release or hospital transfer.

To note, Ontario Wait Times does not provide real-time information. All waits times are based on the wait times for 9 out of 10 patients. You can learn more about Ontario Wait Times on the frequently asked question pages for surgeries and diagnostic imaging and ER visits.

Learning Health Care Options

Learning about health care options before needing them alleviates some of the stress associated with finding the right Ontario health care for you or your loved ones. The Health Care Options website offers a user-friendly reference guide. On the Learn about your options webpage, you and your loved ones can access information on types of care centres and watch videos.
More Valuable Resources

The Health Care Options website connects you to more valuable health resources. Scroll down to the bottom of the homepage to find links to:
  • the 24/7 TeleHealth Ontario line to speak with a registered nurse.
  • Health Care Options Fact Sheets to understand health care in Ontario and read about health services in other languages. 
  • Ontario's Health Insurance Plan (OHIP) to get updates and eligibility requirements.
  • ColonCancerCheck to learn about the screening program.
The Health Care Options website takes the guesswork out of searching for Ontario health care. The website also alleviates the uneasiness some of us experience when browsing the internet for health services and resources; we never know what to expect. So, start with this list of resources. Or, explore Health Care Options on your own.

Sunday, August 04, 2013

Our NEW Toronto In-Home Care Digest

The Toronto Home Care Digest for August 2, 2013

Posted by Steve Jones
Fri, Aug 2, 2013


Get the latest home health care tips, news, and updates!



4 Ways For Patients with Rheumatoid Arthritis to Avoid Infection

Sometimes, prevention is the best medicine.
  • Reduce comorbidity
  • Use anti-bacterial practices
  • Provide good skin care
  • Shift positions frequently

Home Care Services to Help You Live Longer, Happier, More Fulfilled Lives

Many people who would benefit from homecare services don't take action because they don't know about their options.

149_14447495506_9909_n5 Dietary Tips to Help Manage COPD Symptoms

Chronic Obstructive Pulmonary Disease (COPD) symptoms can be manageable via your diet. Here are five nutritional tips to manage your COPD symptoms and avoid exacerbating your condition.


Province Changes Physio Rules

Cutbacks in spending from the Ontario Ministry of Health means less government-provided physiotherapy treatments that many senior Ontarians need.

5 Moves for Seniors that Improve Balance and Coordination

These five exercises, provided by author Karen Peterson, can help seniors stay in shape and reduce the chance of injuries and falls.

This Weekend: Things to Do in Toronto

It's the August Civic Holiday this weekend! Don't miss out on concerts, music festivals, foodie fests, and more.

Subscribe to our blog to get new articles directly in your inbox!

Monday, July 22, 2013

Be a Superhero for Your Family

Be a Superhero for Your Family

Wed, Jul 17, 2013
Where do superheroes go when they get too old to work? It looks like they all join this retirement home.
One time my family went out to the lake at our cottage. My daughter climbed onto this battery-powered floaty. She drove circles around us for hours. At one point she started to drive away from me. I thought I could swim fast enough to catch up to her. So I let her get about 10 yards away, and then I started to swim towards her. I realized that the speed of that device was about the same speed that I could swim and I couldn't catch up to her.

I swam as hard as I could until I had to quit. She had thought it was a game, and when she saw me quit she eventually stopped and turned around. But my heart was broken. I honestly thought that I had this 'Superhero Syndrome', that if my daughter's life was ever in danger, nothing could stop me from protecting her.

As a family member, when we're caring for someone we love, we honestly think, and we convince ourselves that we can take care of the ones we love. We tell ourselves things like, I can look after them; I can stay up all night with them at the hospital; I can feed them, care for them, lift and move them; I can do everything they need from me.

People naturally want to care for their families and they will try after grandpa is diagnosed with dementia or grandma ends up in the hospital after a serious fall. But you know what? We're all human. We're not superheroes. As the family caregivers, we have the best intentions and hugest of hearts, but we get tired, hurt or sick. We could get angry and suffer all kinds of emotional stress.

Sooner or later, caregivers realize they can't do everything on their own. By recognizing their own Superhero Syndrome sooner rather than later, caregivers can ask for help and everyone will be better for it. Getting help in their mission to care for their loved one is often the greatest superhero act they can commit.

That's why we're in this business. We're glad to provide every day superheroes with relief. We create a care plan that includes the family caregivers as part of the care plan, without being the only part. Adding additional caregivers or a Personal Support Worker (PSW) to the care plan balances out the balancing act, allowing the family members to be involved an an appropriate level and still take care of themselves. They can feel good about caring for their loved ones without the burden of having a second full-time job.

Of course, everybody has their reasons for needing help or a caregiver. It could be because a family caregiver is overly stressed with caring for a loved one on their own. It could be because a patient wants a few hours of help after receiving outpatient cosmetic surgery. It could be because it's a palliative situation and the patient prefers to be at home rather than in the hospital. Or, it could just be because they're alone and need help with daily living. Everyone has their reasons so we don't focus so much on the reasons. We care about providing a solution that works for everyone involved.

To learn more about the services Qualicare provides and the level of care we show, call us at 416-628-0360.

Image courtesy of

Friday, July 12, 2013

When Allison Hunt found out that she needed a new hip -- and that Canada’s national health care system would require her to spend nearly 2 years on a waiting list (and in pain) -- she took matters into her own hands.
"So by now I was walking the lobby, and of course, that hurt, because of my hip, and I kind of needed a sign. And I saw a sign. In the window of the hospital's tiny gift shop there was a sign that said, 'Volunteers Needed.' Hmm. Well, they signed me up immediately. No reference checks. None of the usual background stuff, no. They were desperate for volunteers because the average age of the volunteer at the hospital gift shop was 75."

Allison Hunt has worked in advertising and marketing for 20 years, developing human insight and persuasion into an art for her clients. Six years after getting an artificial hip, she decided to try something new.

Moral of the story - What goes around comes around -  Volunteerism can help transform business, government, systems or process into organizations with soul.  It's always about the people.

You can also read my Steve Jones Leadership Blogs on the Qualicare home healthcare website at 

Wednesday, June 26, 2013

5 things you need to know about home care

More and more Ontarian families are turning to high quality private home care companies like Qualicare to receive the quality of in-home care that our parents deserve. Our parents have lived, worked and prepared their entire life so that they can afford to enjoy a comfortable and dignified retirement. Unfortunately, an aging population also means challenges for the Ontario health care system which is not fully prepared to meet the growing demands.

This week CBC has been running stories that shed a light on the growing demands, challenges and short comings of a system that is not designed to deliver what families want and need. Here's is one story.

Re-post from CBC

The number of people over the age of 65 in Waterloo wellington is projected to grow by 36 per cent by 2021.
The number of people over the age of 65 in Waterloo wellington is projected to grow by 36 per cent by 2021. (Chris Young/Canadian Press)
Ontario kicked off its seniors strategy in 2012 to address a demographic crunch as its population ages and health costs balloon.A key plank of the strategy involves keeping patients and those who need care out of hospitals and long term care homes. The solution? Providing health and personal support care at home.
  1. Home care service is provided by healthcare workers to people who have clinical needs in their homes. Services are administered and assessed by Community Care Access Centres (CCACs) in Ontario. The CCAC arranges services like physiotherapy, occupational therapy and the arrangement of medical supplies and equipment. Waterloo Region and Guelph are served by the Waterloo Wellington CCAC.
  2. Home care service is viewed as a key element to ensuring the health care system remains sustainable with an aging population. Just under 15 per cent of Ontarians are over 65, and they account for just under half of all health and social care spending. There are 1.9 million people in Ontario over the age of 65; by 2030 that is projected to grow to four million.
  3. The number of seniors in Waterloo Wellington is growing at a faster rate than the provincial average. The projected growth rate of those over 65 in Waterloo Wellington between now and 2021 is 36 per cent. In Ontario, that rate is 32.6 per cent.
  4. A day in a hospital costs the healthcare system about $1,000 per day. A day in a long term care home costs about $133 per day. A day of home and community care costs about $55 per day.
  5. Fifty six per cent of clients served by the Waterloo Wellington CCAC are over the age of 65. Just under 28 per cent are between the ages of 19 and 64, while 16 per cent are 18 years or younger.
 View the original post CBC : Jun 23, 2013 11:12 PM ET
 Last Updated: Jun 24, 2013 1:18 AM ET

For Nurse Managed Private Home care Services in Toronto call me - Steve Jones (416)628-0360  or email  For the rest of Canada 

Monday, June 24, 2013

Long-term health care: 

A look inside the often-baffling system 

By: Health, Published Toronto Star on Fri Jun 21 2013

Howard Cohen was told he had five days to find a long-term care home and move his mother out of hospital. Is this any way to run a health-care system?

Last July, Howard Cohen was thrown into a tailspin that many Ontarians find themselves in when an elderly loved one suddenly falls ill.His 91-year-old mother, Norma, was diagnosed with colon cancer at North York General Hospital.

Cohen, a doctor, decided against surgery, given his mother’s quick and marked deterioration, her age, and the fact she has dementia and had recently suffered a heart attack.
After informing the hospital of his decision, he says he was told she had only five business days to vacate her bed and find a long-term care (LTC) home, formerly known as a nursing home.

Norma Cohen has been at North York General Hospital for almost a year, waiting to move to a long-term care facility. 
Vince Talotta / Toronto Star
Norma Cohen has been at North York General Hospital for almost a year, waiting to move to a long-term care facility.

Last July, Howard Cohen was thrown into a tailspin that many Ontarians find themselves in when an elderly loved one suddenly falls ill.His 91-year-old mother, Norma, was diagnosed with colon cancer at North York General Hospital.

Cohen, a doctor, decided against surgery, given his mother’s quick and marked deterioration, her age, and the fact she has dementia and had recently suffered a heart attack.
After informing the hospital of his decision, he says he was told she had only five business days to vacate her bed and find a long-term care (LTC) home, formerly known as a nursing home.

Cohen recounts how he was given a list of local homes, told to pick five and rank them in order of preference. Three would have to have short waits and his mother would have to go to the first home with a bed available.

Cohen started to climb what would be a steep learning curve, researching and touring homes. He was perplexed by the disparities, particularly when it came to what the homes had to offer residents with dementia. These same disparities result in some homes having empty beds, while others have waits as long as 14 years.He was stunned to discover, he says, that he had been misinformed and given inadequate information about how to select a home by a hospital social worker and a case manager from one of the province’s 14 community-care access centres (CCACs), which control entry into LTC homes.

After intense research that involved talking to seniors’ advocates and even consulting the Long-Term Care Homes Act, Cohen discovered he did not have to choose as many as five homes, including three with short waits. Nor did he have only five days to make a decision. Nor was he limited to choosing only from the list of homes he was given at the hospital.

“You’re turned upside down. This is a priority because in five days’ time you have got to choose where your loved one will live for the rest of their life and probably will die. You want to make sure it’s the best and that you can advocate for them.”
“I felt pressured, there is no question about it, in trying to make a decision,” he says.
The experience highlights some of the biggest problems in Ontario’s health system today. The hospital sector is rapidly shrinking, with patients moving in and out of fewer beds faster than ever. Ontario has 2.4 hospital beds for every 1,000 residents, the lowest ratio of any province and most developed countries.

There is enormous pressure to quickly discharge seniors like Norma.
At the same time, a growing and aging population is fuelling demand for long-term care. The number of people waiting for beds jumped by almost 85 per cent between 2005 and 2012, when there were 19,000 waiting for placement, according to the provincial auditor. But the number of beds increased by only 3 per cent during that time.

The home- and community-care sectors are growing, helping seniors to stay in their own homes longer, but not fast enough to keep up with demand. Meantime, families are coming up against health officials who are trying to keep the flow of patients moving by bending rules in the face of limited resources.

Felt ‘coerced’

For Howard Cohen, it was a baffling and distressing time. His mother was too ill to return to her retirement home and needed the 24-hour health care of an LTC facility. It was a world of which he knew little, but he had to find her a new home — fast.

“I didn’t know what my rights were, I didn’t know anything about special dementia programs, or how old homes were. I didn’t even know to ask these questions,” he says.

Cohen says he now feels he was being “coerced” into making a quick decision that was not in his mother’s best interests. He has agreed to tell his story to help others in the same situation learn about their rights.Believing he had only five days to find his mother a home, he researched, phoned and toured facilities in between seeing his own patients. He was on call at the time, working overnight, with shifts as long as 36 hours.

“You’re turned upside down. This is a priority because in five days’ time you have got to choose where your loved one will live for the rest of their life and probably will die. You want to make sure it’s the best and that you can advocate for them,” he says.
North York General Hospital spokesperson Marcelo Gomez-Wiuckstern says privacy laws prevent him from discussing individual patients. But he went on to explain that last year the hospital had a process in place to “encourage” patients to temporarily move to LTC homes with short waits until beds became available in the homes where they really wanted to move.

That has since changed and the new process involves discharging patients to their own homes, with home-care support, until a bed becomes available in a LTC facility of their choice.
“In some cases, families do not feel they are prepared to take their loved one home and prefer to have them stay in the hospital while waiting for their preferred facility,” Gomez-Wiuckstern says.
But Jane Meadus, a lawyer with the Advocacy Centre for the Elderly, says she constantly hears from families like the Cohens who have been misinformed and pressured to move loved ones to homes with short waits. This reporter has heard similar stories.

“The rules are being broken. People are being lied to, no question. They are being told they have to do things that are not in accordance with the law, in order for hospitals to get them out of beds,” Meadus says.
Applicants can choose fewer than five homes if they wish, Meadus says. They must be given “reasonable time” to make their choices. They are also free to apply to any home in the province and are not limited to choosing from a pre-selected list.

And while they are not required to choose homes with short waits, Meadus says they might want to consider doing so because hospitals don’t provide the programming and type of care available in LTC homes and patients are at risk of acquiring hospital-borne inflections.

The squeeze is so great at both ends — hospitals and long-term care — that many ailing seniors are wrongly told they must go home from hospital before they can even apply to a nursing home, Meadus says.  “I have issues with them putting people into the community who shouldn’t be going because it’s not safe,” she says. 

In 2011, the province cracked down on hospitals that were breaking the rules. As reported in the Star, hospitals were threatening patients with daily charges of up to $1,800 unless they moved to the first available bed from a pre-selected list of homes with short waits.The issue of LTC waits is so problematic that provincial auditor Jim McCarter dedicated a chapter of his annual report to it last December. 

He wrote that there were about 2,000 Ontarians waiting in hospital beds for LTC in March last year. Of the 1,000 in acute-care hospital beds, some 90 per cent were placed in LTC within 495 days, with waits being longest for the hardest-to-serve patients, including those with dementia.

McCarter pointed out that applicants waiting in hospital for LTC beds — like Norma — generally have no priority over applicants from the community. He recommended they be given priority since it costs the health system more to operate a hospital bed than a LTC bed.

One day in a hospital costs $1,000; one day in LTC costs $130; and a day of home care or community care costs $55.
The auditor said that by freeing up beds occupied by patients waiting for LTC, there would be more available for other patients, including those coming in through the ER, where waits can be long.

McCarter wrote that even though Ontario gives individuals the right to freely choose what homes they want to apply to, other provinces have stricter policies and allow hospitals to force patients to move to the first vacant long-term care bed. He suggested Ontario consider this.

But removing applicant choice would be a politically unpopular idea and it’s not on the radar in Ontario. “The primacy of choice and consent” is entrenched the Long-Term Care Homes Act, says Sheamus Murphy, director of communications for Health Minister Deb Matthews.

“Nobody can be forced into any particular long-term care home,” he says. 
Murphy notes that the Liberal government has taken many steps to address LTC waits, including opening 9,000 new beds. As well, a recent investment of $260 million in home and community care is taking pressure off the LTC system by helping seniors get care in their own homes.

‘It was appalling’

During his search, Howard Cohen saw homes where he would never want a loved one to live, particularly one with dementia. “They were terrible. The patients I saw weren’t stimulated. I saw a lot of people sitting around a television set. They were in wheelchairs and left alone. Maybe it was isolated, but it seemed to be repeated in institutions I went to,” he says.

“It was very appalling. This is not what you would like to see happen in a facility that is supposed to be taking care of you.”

According to an analysis undertaken last year by the Ontario Association of Community Care Access Centres (OACCAC), 21 per cent of Ontario’s 640 long-term care facilities have fewer than five applicants on their wait lists.

There are actually beds sitting empty in some of these homes. That’s because there are different wait lists for different types of beds — basic, private and semi-private, male and female — and no one has applied to get into some of them.

Meantime, 12 per cent of homes have more than 150 people on their waiting lists.The OACCAC analysis also shows that one in five applicants chooses only one home.Many homes with short waits are older. They haven’t been renovated and don’t look as nice as newer homes, but the quality of care is comparable, argues OACCAC spokesperson Gabriella Skubincan, echoing an oft-heard sentiment.

Offering an analogy, she says Toronto General Hospital provides good care even though it is old and not pleasing to the eye.
“Often people don’t have a choice as to which hospital they get admitted into for care, depending on what they need, but they can choose their LTC home and can make choices based on very different criteria, including location,” she says.

But preference for newer homes is clearly about more than esthetics. New and recently renovated homes are better designed to meet the needs of seniors, for example, with wider doorways for wheelchairs and layouts that are easier to manage for residents with dementia.

Newer homes offer residents more privacy. A basic bed in an older home can be in a four-person ward, whereas in a newer home it can be in a room for two, separated by a partition, or even in a private room
In 2009, the province announced plans to renovate 329 older homes. But to date, only 4,000 of 35,000 beds in need of renewal have been approved for redevelopment, says Candace Chartier, CEO of the Ontario Long-Term Care Association.

“We believe additional investment is needed to meet growing need,” she says, adding that renovating older homes would make them more attractive options.Meantime, seniors’ advocates like Meadus argue there are simply not enough homes and more need to be built. 
Geriatrician Dr. Samir Sinha, who is heading up the Health Ministry’s seniors’ strategy, says there is no question Ontario will eventually have to build more LTC homes, an extremely costly endeavour.

In the meantime, investments should continue to be made in home and community care, he says, explaining this can help reduce the LTC demand. He cites studies showing a third of LTC residents could remain in their own homes with support from home- and community-care services.

“Are there challenges in long-term care? Absolutely, (especially) as the patient population becomes much more high-needs,” he says. “We just need to make sure we have the right mix of services in the right place to meet that need.”

Disparities exist

While preference for newer homes is indisputably a big factor gumming up wait lists, Howard Cohen’s experience shows there is a lot more to the disparities between facilities.

Among the most desirable are Baycrest’s Apotex Centre, Jewish Home for the Aged and Kensington Gardens, the only two homes Cohen ended up applying to on behalf of his mother, in that order of preference. He did so despite the protestations of the hospital social worker and CCAC case manager.
“I was told under no uncertain terms, ‘Do not choose Baycrest because their waiting list is (years) and it’s not realistic,’” Howard recounts. “They were angry. I was told, ‘(You) can’t do that. The hospital is going to be very upset.’”

But Cohen stood his ground, armed with research material showing he was within his rights.
He says he picked Baycrest and Kensington because they are best suited to his mother. Both have specially trained staff working in dedicated units for residents with dementia.

Baycrest is a designated Jewish home and the Cohens are Jewish. Kensington doesn’t have this designation but has a large Jewish population. Both facilities are modern.
“As far as I was concerned, those are the best to handle dementia patients. You try to query the CCAC about which are the best centres for dementia and they don’t give you any help,” he charges.
Cohen is right to be concerned about dementia care. Earlier this month, the Alzheimer Society of Ontario and the advocacy group Concerned Friends of Ontario Citizens in Care Facilities called attention to what they say is a failure of Ontario’s long-term care system to meet the needs of those with dementia.
Not only is there a shortage of beds and long waits for these residents, but staff are often not equipped to meet their needs, the groups charge.“There is no guarantee they will receive care from staff who are trained and who have the skills to respond to the needs of residents with dementia or cognitive impairment,” argues Gale Carey, CEO of the Alzheimer Society.

Charitable homes

Another factorbehind differences in waits between homes is their different corporate structures. This is something health officials don’t seem to want to talk about.
The ratio of applicants to beds is greatest at homes run by charities and non-profit entities, like Baycrest and Kensington, respectively, according to an analysis of Health Ministry data by the Ontario Association of Non-Profit Homes and Services for Seniors (OANHSS). That is followed by municipally run homes and then private, for-profit homes.

Charitable and non-profit homes account for only 25 per cent of all homes in Ontario, but are sought after by 42 per cent of applicants. Municipal facilities account for 17 per cent of all homes and are sought after by 26 per cent of applicants. Private, for-profit facilities account for 58 per cent of all homes and 32 per cent of the waiting list.

But just because there is more demand for the charitable and non-profit sectors doesn’t mean those homes are better than those in the municipal and for-profit sectors, Meadus cautions: “I don’t really take a position on that because I think there are good and bad in (all of them).” Many charitable homes like Baycrest were created for seniors of certain ethnic or religious backgrounds and are particularly popular. They tend to have strong community connections, a big volunteer presence and lots of fundraising.

That, in turn, translates into extra resources for modern upgrades, more activities, higher staffing levels, additional amenities and, simply put, more pleasant and comfortable surroundings.
OANHSS CEO Donna Rubin says non-profit and municipal homes also tend to have more funding to hire extra staff.So who ends up in the homes where few others want to go? Residents include seniors with no family, no advocates and those who don’t have the wherewithal to advocate for themselves, Meadus charges.

Also getting short shrift, she argues, are seniors who opt to move into expensive, unregulated retirement homes because they can’t get into long-term care. They can end up spending more than $5,000 a month on both rent and private health care.“Retirement homes are becoming the new long-term care homes,” she says. “The use of retirement homes to care for persons who need long-term care is a form of two-tiered medicine where there is not the same type of oversight (and) level of care.”

Growing demand
The main underlying pressure on the LTC system is growing demand, provincial auditor McCarter wrote in his annual report. The median wait time tripled between 2005 and 2012, to 98 days from 36. During that time, the number of Ontarians 75 and older jumped by more than 20 per cent. Their numbers are expected to grow by another 30 per cent by 2021, increasing pressure even more.

McCarter found that crisis applicants wait a median of 94 days. This includes frail seniors whose caregivers have suddenly fallen ill and can no longer tend to them at home.

Meantime, those with moderate needs wait 10 to 14 months and most others “for years.”
But the ever-optimistic Sinha has a different take on the numbers, choosing instead to look at trends since 2009-2010, when waits were at their worst. Since that time, the number of people waiting for LTC dropped to 19,000 from 25,000. The number of patients waiting in hospital for LTC dropped by 32 per cent, to 2,141 from 3,145.

The province has made a dent in the problem by investing more in home and community care. That has allowed 30,000 seniors who might otherwise have ended up in LTC to continue living in their own homes, Sinha says.  Still, he acknowledges LTC demand will continue to grow and cites a Conference Board of Canada study that projects the need will increase to 238,000 Ontarians by 2031. Currently, 112,000 Ontarians are served annually.

The province can keep LTC demand in check by continuing to beef up home and community care, he says, adding there is also a huge need for more supportive housing.  “These are really tough, thorny issues. These are issues that can’t be solved overnight,” Sinha says.

Work in progress

Old and sick, the average resident lives in long-term care for about three years before death, an amount of time that is expected to decrease given that it’s harder than ever to get into a home these days.
That, in turn, means about one-third of the province’s 76,000 long-term care beds become available for new placements annually.

To make the navigation process easier, the auditor urged Ontario’s 14 CCACs to publicly post wait times. Nine are now doing so and it’s a work in progress. But Meadus says the lists don’t give at true picture because they only provide overall median waits, not waits faced by applicants in different priority levels, something McCarter advocated. Priority levels are assigned, for example, to applicants in crisis, veterans and those moving to homes where spouses already live.

Applicants also get priority for homes that serve their ethnicity or religion, but because these facilities are so popular, waits are as long as 14 years, according to the auditor.
Another factor affecting waits is the ability of homes to care for residents with behavioural problems, caused by such things as dementia, psychiatric or cognitive impairments. Some may need to be in secure, locked units.And some residents need higher levels of care because, for example, they have conditions requiring ventilation or they use feeding tubes. 

Wait lists are also affected by the fact that some homes just have bad reputations. Though less than perfect, Health Ministry inspection reports show which homes get a lot of complaints and which ones have failed inspections.

Another tool that shows how well — or not — homes are performing is Health Quality Ontario’s Long-Term Care public reporting website. It offers a glimpse into how residents in individual homes are faring by tracking the level of falls, pressure ulcers, incontinence and use of restraints. This is also a work in progress and not all homes are publicly reporting results yet.

Lastly, another factor affecting waits is the ability to pay extra for private and semi-private rooms. Those who can afford it get in faster. Even though only 40 per cent of applicants apply for “preferred accommodation,” homes can designate up to 60 per cent of beds for those who pay more.

Still waiting

Almost a year later, Norma is still waiting in North York General. Howard Cohen recognizes there is a good chance she could die before an LTC bed becomes available.
In fact, 15 per cent of applicants pass away while still on the waiting list, according to the auditor.

The latest wait time Cohen has been given is 1.5 years for Baycrest and four to five years for Kensington.
Waiting in a hospital bed is not what he wants for his mother, but he feels he’s making the best of a bad situation. He has hired a full-time personal support worker to help feed her, get her out of bed and give her the extra help and stimulation that hospital staff cannot.
“It’s a terrible situation because the population is aging and they don’t have the facilities to care for them,” he says.

“The system is probably stretched to the seams . . . It is a very unfortunate reflection on our health system.”
Reporter Theresa Boyle can be reached at .   
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