Expert suggests developing specialty to address workforce challenge
Professionals key to delivering quality care, Baycrest chief of staff says
Friday September 24, 2010 -- Lisa Bailey
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 long-term care.

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,” Katz says.

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 and patients.

“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 specific conditions.

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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