Deliver pharmacare

Fix Employment Insurance.

It should, for instance, reform the labour code so all workers get a minimum level of paid sick leave.

After decorating Halloween cookies together, Han brings his own masterpiece, smothered in smarties and sprinkles, to Clark and encourages her to try it. Few words are exchanged, but smiles and giggles are constant at the intergenerational program at Youville Residence, a long-term care facility for seniors in Vancouver. Han Jr. is among a half dozen children visiting this day from the Montessori Children's Community - a daycare located on the same site as Youville, at 33rd and Heather.

Montessori Children's Community administrator Kristina Yang said it's a win-win situation. "Even if there is not a lot of communication with words you can see the beautiful smiles on everyone's face. Many of the children come to know a lot of the seniors and when they pass by our window they'll be excited waving and saying 'Hi ,'" Yang said.

Youville occupational therapist Sheralyn Manning said the children's visits are a big part of the seniors'day. Besides planned events, such as doing crafts together, every so often the children will visit when the weather is bad and they are not able to play outdoors. Manning pointed out the friendship between Clark and Han has been particularly touching to watch and Clark has a recent craft project Han gave her prominently displayed in her room. When most people think of nursing homes the image that comes to mind is a stand-alone building offering residential care only for the aged.

It's a place seldom visited unless you are a family member, friend or volunteer. But these days more homes are trying to build bridges to the wider community. Of B. C.'s 460 government and private nursing homes, only a handful have daycares or doctor's offices on site, said Daniel Fontaine, CEO of the B. C. Care Providers Association, which represents 60 per cent of the privately-operated homes. But none are attached to a facility that offers a large variety of community services. One of the best Canadian examples of a nursing home that achieves just that, said Fontaine, is Niverville Heritage Centre, near Winnipeg. It is home to 116 seniors but is also a gathering place for major community events.

The centre hosts 100 weddings each year. As well, about 50,000 visitors drop in at the centre annually to access their doctor's office, dentist and pharmacist or visit the full-service restaurant and pub. "We found seniors don't want to be retired to a quiet part of the community and left to live out their lives. They want to live in an active community and retreat back to their suite when they want that peace and quiet ," said Niverville Heritage Centre's CEO Steven Neufeld.

Before the centre opened in 2007, he said, members from the non-profit board that operates the centre visited traditional nursing homes and discovered that the lounges that were built for seniors were seldom used. "I remember going to one place where there was a screened-in porch that was packed. The seniors were all there wanting to watch the soccer game of the school next door ," he said. Having services like doctors'offices, dentists, a daycare, a full-service restaurant, and hair styling shop on site fulfil the centre's mission of being an "inter-generational meeting place which fosters personal and community well-being." Fontaine said it's worth noting that Niverville was able to "pull all of this together in a community with a population of less than 5,000 people." He hopes more B. C. nursing homes follow Niverville's lead.

Elim Village in Surrey, which offers all levels of residential senior care on its 25-acre site, is on that track. There are 250 independent living units, 109 assisted living units and 193 traditional nursing home beds. The village also has a 500-seat auditorium, located in the centre of the village, that hosts weddings and is available for rent for other public events. Elim Village also rents out space in one of its 10 buildings to a school, which allows inter-generational programs to take place easily between students and seniors. Another "continuing care hub " at Menno Place, in Abbotsford, has a public restaurant called Fireside Cafe, popular with staff from nearby Abbotsford Regional Hospital and Cancer Centre. There's also a pharmacy and hairdresser on its 11-acre "campus " site but these services are available only to the 700 residents and staff. "We purposely try to involve the community as much as possible ," said Menno Place CEO Karen Baillie. "It's Niverville on a smaller scale." She said Menno Place partners with high schools and church groups and hundreds of volunteers visit regularly. "Seniors are often challenged with isolation and fight depression. That's why we have different programs to encourage them to socialize ," she said.

Research shows 44 per cent of seniors in residential care in Canada have been diagnosed with depression, and one in four seniors live with a mental health problem, such as depression or anxiety, whether they live in their own home or are in residential care. A 2014 report by the National Seniors Council found socially isolated seniors are at a higher risk for negative health behaviours including drinking, smoking, not eating well and being sedentary. The report also found social isolation is a predictor of mortality from coronary disease and stroke, and socially isolated seniors are four to five times more likely to be hospitalized.

Since more seniors now remain in their own homes longer those who move into care homes are often more frail and need a higher level of assistance, said Menno Place director of communications and marketing Sharon Simpson. Seniors with dementia, in particular, can be socially isolated as friends and family often find it more difficult to visit them as they decline, she said. But Simpson said an intergenerational dance program, run by ballet teacher Lee Kwidzinski, has been a wonderful opportunity for seniors with dementia to be connected to the community. The program is also offered in four other nursing homes in the Fraser Valley. "For them it's an opportunity to see children. You can see the seniors come to life, smiling and giggling at the girls'antics. It's very engaging ," she said. "Some may not be verbal but they are still able to connect. They feel their emotions and they know whether someone is good to them. They feel these girls and become vibrantly alive. It's one of the most powerful things I've ever seen."

Creating community connections is key as Providence Health begins its planning stage to replace some of its older nursing homes in Vancouver, said David Thompson, who is responsible for the Elder Care Program and Palliative Services. Providence Health operates five long-term-care homes for approximately 700 residents at four different sites in the city. "It's always been our vision to create a campus of care on the land ," said Thompson, of the six acres owned by Providence Health where Youville is located.

He said the plan is to build another facility nearby, with 320 traditional nursing home beds. One of the ways to partly fund the cost is to include facilities that could be rented out by the larger community, which would be a benefit to the seniors as well, he said. There is already child care on site, and future plans to help draw in the community include a restaurant, retail space and an art gallery. He said another idea is to partner with nearby Eric Hamber Secondary School by providing a music room for students to practise.

"Cambie is at our doorsteps. If you have people coming in (to a residential care facility) it brings vibrancy and liveliness ," Thompson said

inevitably taken, minimal care is given and more family involvement is required for basic care. Staff shortages in all areas touching patient care contribute to errors, which directly impact patient care. Nicole Beggs retired RN, Ottawa

But let's not be too hard on those economists. The rest of us don't pay that much attention to workers such as Shireen Luchuk either - not, at least, until our families need her. And not until someone such as Elizabeth Tracey Mae Wettlaufer is charged with murdering eight residents in Ontario nursing homes. Then we have lots of questions: Who is overseeing the care of our seniors? Are our mothers and fathers safe? Will we be safe, when we end up there?

The question we might try asking is this: If the care that Luchuk offers is so valuable, why don't we treat it that way? Dr. Janice Keefe, a professor of family and gerontology at Mount Saint Vincent University and director of the Nova Scotia Centre on Aging, says "the emotion attached to these jobs removes the value."

Caregiving, Keefe says, is seen "as an extension of women's unpaid labour in the home." Those jobs are still overwhelmingly filled by women. And, while times are changing, the work they do is still mostly for women - whether it's the widows needing care who are more likely to outlive their husbands, the working moms who need child care or the adult daughters who are still most likely to carry the burden of aging parents.

Yet it's as if society wants to believe that professional caregivers should do their work out of love and obligation - as if care would be tainted by higher pay and better benefits. That's an argument you never hear for lawyers and accountants. It's certainly not one that Adam Smith, the founding father of political economy, made for the butcher or the baker.

In last year's book, Who Cooked Adam Smith's Dinner?, Swedish writer Katrine Marcal argued that the market, as Smith and his fellow economists conceived it, fails to accept an essential reality: "People are born small, and die fragile." Smith described an economy based on self-interest - the baker makes his bread as tasty as he can, not because he loves bread, but because he has an interest in people buying it. That way he can go to the butcher, and buy meat himself. But Smith missed something important. It wasn't the butcher who actually put the dinner on his table each night, as Marcal points out. It was his devoted mother, who ran Smith's household for him until the day she died.

Today, she'd likely be busy with her own job. But care - the invisible labour that made life possible for the butcher and the baker (and the lawyer and the accountant) - still has to be provided by someone. Society would like that someone to be increasingly qualified, regulated and dedicated, all for what's often exhausting, even dangerous, shift work, a few dollars above minimum wage. One side effect of low-paying, low-status work is that it tends to come with less oversight, and lower skills and standards. That's hardly a safe bar for seniors in residential long-term care, let alone those hoping to spend their last days being tended to in the privacy of their homes. We get the care we pay for.

It's not much better on the other end of the life cycle, where staff at daycares also receive low wages for long days, leading to high turnover. "I am worth more than $12 an hour," says Regan Breadmore, a trained early-childhood educator with 20 years experience. But when her daycare closed, and she went looking for work, that's the pay she was offered. She has now, at 43, returned to school to start a new career. "I loved looking after the kids. It's a really important job - you are leaving your infants with us, we are getting your children ready to go to school," she says. But if her daughter wanted to follow in her footsteps, "I would tell her no, just because of the lack of respect."

It's not hard to see where this is going. Young, educated women are not going to aspire to jobs with poor compensation, and even less prestige. Young men aren't yet racing to fill them. Families are smaller. Everyone is working. Unlike Adam Smith, we can't all count on mom (or a daughter, or son) to be around to take care of us. Who is going to fill the gaps to provide loving labour to all those baby boomers about to age out of the economy? Right now, the solution is immigrant women, who, especially outside of the public system, can be paid a few dollars above minimum wage. That's not giving care fair value. It's transferring it to an underclass of working-poor women. And it doesn't ensure a skilled caregiving workforce - all the while, as nurses and care assistants will point out, the care itself is becoming more complex, with dementia, mental illness and other ailments.

Ideally, in the future, we'll all live blissfully into old age. But you might need your diaper changed by a stranger some day.

Maybe robots can do the job by then. Rest assured, you'll still want someone such as Luchuk to greet you by name in the morning, to pay attention to whether you finish your mashed-up carrots. When she's holding your hand, she will seem like the economy's most valuable worker. Let's hope enough people like her still want the job.

That's the premise of a new book from public policy expert, Richard Saillant. A Tale of Two Countries focuses on the impact of our aging population and warns that without a big boost in funding, the region's health-care system could collapse under the strain within a decade.

Day’s outreach efforts — like his legal battle — have contributed to shifting the public debate. Whenever he can, Day argues private health care must be expanded in our province.

The Who Cares? campaign wants to see the creation of a Community Care Services Authority modeled after the province’s health authorities. Bringing community care service providers under direct public administration will help eliminate administrative duplication and help focus increasingly limited public funds on front-line service delivery and better working conditions for workers.

There's no guarantee that a coroner's investigation would have uncovered the alleged medication murders of eight elderly residents in Woodstock and London. Ontario Provincial Police announced this week that 49-year-old registered nurse Elizabeth Wettlaufer is facing eight first-degree murder charges related to deaths in homes from 2007 to 2014. Cheryl Mahyr, spokesperson for the coroner's office, said the requirement for an investigation in every 10 deaths was added in the mid-1990s because government oversight was lax. It was dropped in 2013 after the office concluded that the 2010 long-term care legislation had "robust investigation requirements." Ministry inspections do expose problems. The issue, say critics, is that Ontario's long-term care system is so cash-strapped and short-staffed that systemic failures - filthy unchanged diapers, resident-on-resident violence - are never really fixed. For the past two days, Premier Kathleen Wynne and Health Minister Eric Hoskins have been grilled in the legislature on the issue. NDP leader Andrea Horwath asked "exactly what's being done by the premier to ensure that something this horrific and heartbreaking never happens again?"

In response, Wynne said the government might conduct an independent review "at some point not because of political pressure from the NDP, but because we all need to have the answers." Wynne committed to improvements on Sept. 23 - six days before Wettlaufer's arrest - when she sent Hoskins his new "mandate letter." Long-term-care goals were to include: "Increased safety (and) an ongoing commitment to annual inspections." Earlier this year, the ministry said its inspections - which were supposed to include private interviews with roughly 40 residents and families - will be done every three years, instead of annually as promised around the time when the coroner's office made its changes. (The ministry continues to do shorter inspections every year.)

By law, all deaths in nursing homes must be reported to the local coroner, who can decide whether further investigation is needed. The number of coroner investigations has fallen by more than half since it dropped the one-in-ten-deaths requirement - in 2013, there were 2,027 investigations, followed by 890 in 2014.

This painful issue should not become a political football. The crimes of a rogue nurse, if that is indeed what is involved here, cannot be blamed on any particular party or government. No one will respect a politician who tries to score cheap points on the backs of murdered seniors. But neither should Ontarians be expected to wait silently for months before hearing more specifics of what went on, whether any weaknesses in the system can be identified, and what steps might be taken to reduce the likelihood of anything remotely similar from happening again. The stakes are too high for that.

In that light, Health Minister Eric Hoskins' blanket assurance that there is no danger to any care home resident and his assertion that Ontario has one of the best oversight systems for nursing homes "in the world," fall short of what is needed. There are legitimate questions that can and should be addressed without getting into the details of the Woodstock case or interfering with the police and judicial processes. For example: Does the province need to take another look at how often coroner's inquests are held into the deaths of people in care homes? As recently as three years ago the provincial coroner's office automatically investigated every tenth death in every care home. It was intended as a way of identifying any problematic patterns in the deaths of residents.

But in 2013 that was stopped on the grounds that it turned up no useful information. At the time, critics said it was a short-sighted move. In light of the Wettlaufer case, should that be re-visited? And are there any gaps in the system for reporting residents' deaths to the province or local coroners? Are there gaps in the system for making sure drugs are accounted for in nursing homes? According to police, the eight seniors who died were given fatal overdoses of a drug.

There are supposed to be fail-safe systems for ensuring that drugs cannot go unaccounted for in care homes. How exactly do they work, and can improvements be made following this tragedy? Are there adequate systems to monitor the stability and mental health of medical professionals? Wettlaufer apparently had problems with addiction and she was reportedly identified by police when she shared information about the deaths with staff at the Centre for Addiction and Mental Health in Toronto. Were there measures in place that might have picked up earlier on any problems she was experiencing?

There are much broader concerns, too, about the general condition and funding of the long-term-care system. There's no question that the needs are enormous and growing and more robust staffing would improve service all around. But for now, the focus should be on reassuring care home residents and their families.

Premier Kathleen Wynne says the government is prepared to conduct an independent review or inquiry into safety procedures in nursing homes "at some point, if there is a need." In the meantime, her government would do everyone a service by more clearly addressing specific points directly relevant to the sickening allegations in Woodstock and London.