Reg Sears, a tall, slender man, leans slightly on his cane, brings his right arm back and sends a black ball spinning toward the pin at the opposite end of the green. It is a sparkling July morning - warm, sunny and full of birdsong - and Sears, 85, is enjoying a favourite pastime, lawn bowling, for the first time this summer.
Three months earlier, he and his wife Vera, also 85, sold their condominium in Bobcaygeon, Ontario, about 150 kilometres northeast of Toronto. She took an apartment in the nearby town of Port Perry, and he moved into the Community Nursing Home-Port Perry, where he would have access to 24-hour-a-day medical attention, if necessary. "It was quite a change," he says, "but I'm taking it in stride and I'm quite happy to be where I am."
He can also keep himself as busy as he wants to be. Staff at the three-storey, brown-brick home, which can accommodate up to 107 residents, run social and recreational programs from 9 a.m. till 8:30 p.m. daily. They provide exercise and games, help residents maintain a garden in the summer, put on barbecues for family members and organize fundraising bazaars.
They also arrange some ambitious outings and excursions. On two occasions over the past several years, small groups of residents have travelled to Florida. They have also gone on a Caribbean cruise, accompanied by a physician, and each summer there is an overnight trip to a destination in Southern Ontario, chosen by the residents.
"We go to great lengths to accommodate individual needs and wants," says Lyna Bradley, owner of the Port Perry home. "Our philosophy is that you come to a nursing home to live, not to await the inevitable. Just because you need medical attention doesn't mean your life is over."
Social and cultural programming are now a core part of what's offered at long-term care facilities and, according to many observers, are key contributors to the physical and emotional well-being of residents. Karen Sullivan, executive director of the Ontario Long Term Care Association, points out that the provincial government funds and regulates all long-term care homes in the province. The funding must be used to cover the cost of nursing, accommodation and to provide programs, including recreational activities.
"We got an increase this year in our program funding, but we feel there is a need for additional funding," Sullivan says. "It's important we have money for nursing so people are bathed and get their medications. At the same time, we're not running hospitals. People live in our homes. It's really important that we receive enough funding to support their recreation and social needs."
While the provincial government funds and regulates long-term care, the facilities themselves are run by a range of operators, including private companies, municipalities, charitable groups and non-profit organizations. There are currently 550 homes in the province and the entire sector is in the midst of a major expansion as the province adjusts to an aging population. Five years ago, the Ontario government announced $1.2 billion in capital funding to boost the number of beds from 57,000 to 77,000 by the end of next year.
"There's been an unbelievable increase in capacity in a short period of time," Sullivan says.
Significant changes are also occurring in the resident population. In general, Sullivan says, the elderly are remaining in their own homes or in other types of retirement facilities as long as possible before entering long-term care facilities. As a result, incoming residents are, on average, 86 years old and need medical attention. Most are women, with several health problems, she adds.
The changing demographics of Canadian society are also going to have a big impact on long-term care providers. Current residents are the parents of baby boomers, a group that has had the numbers and buying power to shape consumer goods and trends for half a century.
"The boomer group has been big enough to demand changes in products and services throughout their lives," Sullivan says. "They've changed whatever part of life they're in, and they're already making changes in long-term care and services for seniors in the province of Ontario. We're going to see more of that."
In short, they want top-notch care and a good quality of life for their aging parents. In response, administrators are trying to make their homes welcoming environments and program directors are tailoring activities to the tastes of individual residents.
Yves Mallette, administrator of the Extendicare facility in the northern community of Timmins, Ontario, says he and his staff design programs that cater to a clientele of 120 that includes anglophones, francophones, aboriginals and people of Finnish descent. They have hung a banner above the entrance bearing the English, French, Cree and Finnish words for welcome.
Mallette and his staff bring French-language entertainers to the home, provide church services in French and encourage residents to attend the annual francophone winter carnival. They provide aboriginal residents with tapes of native music, enlist native volunteers to work with the residents and escort them to the local friendship centre. The home also works with local Finns to ensure its Finnish residents can enjoy activities in their language and specific to their culture.
Cathy Fiore, program manager at Toronto's O'Neill Centre, a four-storey facility with 162 beds, says she and her staff organize special outings periodically for those capable of participating. This summer, they arranged a two-night, three-day excursion to Wind Reach Farms, a recreational centre in the village of Ashburn, Ontario, north of Oshawa, that allows school kids and seniors to experience a taste of rural life through hayrides, horseback riding and feeding farm animals.
The O'Neill Centre also wants residents to keep up familiar activities and routines to ease the transition from independent living to long-term care. They keep daily copies of Metro, a free newspaper, on hand for those who want to stay abreast of current affairs, and they allow residents to work alongside staff in the laundry room folding towels and sheets. "Living in a long-term care facility is part of the continuum of life," Fiore says. "But the change is a big issue for many residents, so we try to keep some things constant. We bring in elements they would experience in their own homes."
Long-term care inevitably leads to a loss of control for an elderly person, which can lead to anger and reduce self-esteem, says Deborah Greeley, life enrichment co-ordinator at the Leisureworld Caregiving Centre in Creemore, Ontario, about 40 kilometres west of Barrie. She tries to compensate by ensuring that activities will be enjoyable and suit the tastes of residents. Greeley and her staff have also adapted games so residents in wheelchairs or walkers can participate. They have a version of basketball, for example, in which the hoops are laid on the floor.
"We strive for failure-free activities," she says. "Our programs are all geared around choice. We get terrific participation."
Provincial regulations stipulate that upon entering a long-term care facility, elderly people or their families must complete questionnaires so that staff are familiar with their interests. Nancy Whisken, administrator of the Community Nursing Home in Pickering, Ontario, outside Toronto, says this allows program directors to design activities that suit the capabilities of a diverse population with a range of ailments, ranging from memory loss to being physically incapacitated. Whisken's facility 4employs a staff of seven to develop programs and has 100 community volunteers who work with residents, including a local piano player who has entertained residents for 20 years.
The staff organizes activities as varied as wine tasting for small groups all the way to bingos for groups of up to 100. This year, they started a horticultural program, built seven raised flower beds and have allowed residents to plant annuals and maintain them, an activity that has proved popular. "We had 58 residents helping out with the planting," Whisken says. "One lady said 'It's great to touch and smell the soil.' I was amazed how many residents were gardening enthusiasts. They were teaching us."
The staff also recognizes that many people coming into the home loved animals, so three cats - Prowler, Riley and Jackson - now roam freely about the corridors. There are also three birds in cages at strategic locations and an aquarium with 11 Japanese koi.
"The goal is to keep our residents physically, cognitively and spiritually active," Whisken says. "We often have residents come up to us after an activity to say it was wonderful. They love to go on outings. It is amazing to see them when they are out of their routines."
Mississauga-based Regency Care owns or manages 13 homes; nine of them have on-site day-care centres run by the YMCA. Lisa Brentnall, administrator of a Regency property called The Wellington Nursing and Retirement Home in Hamilton, says the proximity of boys and girls allows staff to run a number of programs that get young and old together. The Wellington has 204 beds; half of them for long-term care, and the elderly occupants often eat lunch with the children. They also read to the youngsters, go on outings together, such as an annual Grand River boat cruise. "We've found that the children really enrich the lives of our seniors," Brentnall says.
The Kensington Village Retirement Residence and Nursing Home in London, Ontario has developed some unique offerings to serve residents from both urban and rural backgrounds. Lynda McNabb, director of activation and volunteer services, says her facility draws people from London, as well as smaller surrounding communities. She has established a seven-member welcoming committee of residents to help ease the transition for newcomers. "Some make the change readily," McNabb says, "but others need a little help."
She has also built up a committed group of volunteers, including a 24-member palliative care team who are on call for those who have entered the final stage of life. She ensures that the resident has someone with them 16 hours a day, to fill in when family members leave and, most important, to ensure that the resident is never alone. "Most people's biggest fear is that they will die alone," she says. "Our volunteers will sit by someone's bedside right till the very end."
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