Expert suggests developing
specialty to address workforce challenge
Professionals key to delivering quality care, Baycrest chief
of staff says
An internationally-recognized leader in long-term care suggests
that creating a long-term care home medical specialty could help
address challenges facing the sector.
“I think we are at a crossroads,” Dr. Paul Katz says,
commenting for a Morning Report series on the future of
Katz, who recently became vice-president of medical services and
chief of staff at Toronto’s Baycrest health-science centre,
is a preeminent expert in geriatric medicine, geriatric education
and long-term care. He is also a research scientist focusing on
medical staff organization and quality.
He is new to Canada, working previously at the University of Rochester
School of Medicine and Dentistry and at a well-known, academic long-term
care home in the U.S. called Monroe Community Hospital.
Katz sees similar trends developing in Canada and the U.S.
Dealing with greater numbers of increasingly frail residents with
multiple and complex health conditions is “putting incredible
stresses on a sector that is already constrained in terms of resources,”
These resources include not only funding but also a workforce that
Katz says is aging and struggling to recruit and retain professional
caregivers, particularly physicians and nurses, for geriatric residents
“If we don’t stabilize our workforce — that means
recruitment, retention and education — then the care is going
to slip because the workforce is the core of how quality is delivered
in the end. That, to me, is a huge issue,” he says.
Katz says there are a host of causes for the shortage but three
major ones include a question of professional credibility, the ability
to make a competitive wage and a lack of emphasis on long-term care
as a practice during medical training.
As a potential remedy, he suggests developing a long-term care home
medical specialty. It has stirred controversy, in part because of
a belief that there is no specific body of knowledge for it.
“I say that’s hogwash,” Katz says, adding a very
specific body of knowledge exists in caring for long-term care residents
that is different from other health-care settings, family medicine
and pure geriatrics.
He likens it to the hospitalist movement where specialty has emerged
based on a site of care — a hospital. The same rationale can
apply to long-term care, as there is a site of care with its own
regulatory and care issues and practitioners with skills to address
Katz notes that family physicians in Canada can undertake specialized
elder-care training but there are too few for the need, which is
poised to grow as the population ages.
To care for people with more complex health needs, long-term care
staff will need an expanded skill set.
This would be enhanced with more opportunities to experience long-term
care practice during nursing, physician and social-work training,
Katz says. He also suggests a balance must be struck between the
current medical model’s focus on technology, cure, and quick
turnarounds and the importance of care in the long-term care sector.
“Sometimes very small changes without curing someone can allow
someone to return home and lead an independent life versus having
to live in a long-term care home. It’s very small changes
and we need clinicians to have an appreciation of what those changes
are and how to do it.”
Katz notes that he’s impressed with the physician community
involved in long-term care in Ontario and across Canada, as they
are “very engaged and committed to the field.”
— More to come
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