Supporting Diversity and Inclusion in Long-Term Care
COVID-19 has not had an equal effect on all people and communities. As NIA research has shown, over 80% of all COVID-19 related deaths in Canada have occurred amongst older adults in long-term care (LTC) and retirement home settings. Indeed, older adults are more vulnerable to COVID-19, in general; however, we are also witnessing the disproportionate (and potentially compounding) impact of COVID-19 within communities that are continually marginalized within Canadian society, including Black, Indigenous, and People of Colour (BIPOC) communities (who are also more likely to be employed as care workers in LTC homes), as well as the LGBTQI2S community.
Existing social inequities associated with gender, socioeconomic status, race, and ethnicity play an important role in the risk of COVID-19 infection, according to emerging research. Of course, people can embody more than one marginalized social identity—also referred to as intersectionality. A recent study by Egale Canada, for example, found that BIPOC-identifying LGBTQI2S[1] individuals experienced greater impacts of COVID-19 on their physical, mental and overall quality of life—when compared to the general Canadian population. As we learn more about COVID-19 and how some communities and individuals are more affected than others, there is a growing emphasis and need for the provision of equitable care and supports to the most vulnerable communities of Canadians.
Taken together with ongoing calls for the provision of enhanced care and support provided throughout later life—and especially within LTC settings —it is clear that we must turn our collective attention towards providing care and support for the most vulnerable, including culturally sensitive and safe care.
Within the context of LTC settings in Ontario (and across the country), there is a growing need for inclusive care and support that acknowledge and affirm the immense diversity that exists among older residents. For diverse older adults, culturally sensitive, safe, inclusive care and support could mean the difference between living “out and proud” versus going “back in the closet” for LGTBQI2S older adults or having cultural traditions celebrated versus unacknowledged for Indigenous elders living in LTC homes, for example.
As we continue to see the impact of recent and unprecedented events on the wellbeing of older Canadians, it becomes increasingly clear that we can no longer delay efforts to address the massive gaps in equity, diversity, and inclusion within LTC homes across Ontario. It is the responsibility of LTC homes to respond to the resurgence of calls for equity by making changes that ensure programs, policies, and practices contribute to inclusive, welcoming, and affirming environments for all members of the diverse populations who live, work, and visit in LTC homes.
The Supporting Diversity and Inclusion in Long-Term Care Initiative
With that goal in mind, the Ontario Centres for Learning, Research, and Innovation in Long-term Care (CLRI) developed a Supporting Diversity and Inclusion in Long-Term Care Initiative to educate and share resources that support LTC homes in delivering culturally sensitive care that acknowledges diversity amongst residents and care workers.
As a member of the Advisory Committee for this Ontario CLRI initiative, I contributed to the development of Embracing Diversity: A Toolkit for Supporting Inclusion in Long-Term Care Homes. Acknowledging that LTC homes are at varying points along their journeys towards equity and inclusion, this interactive toolkit combines print and online components to provide practical steps for improving equity, diversity, and inclusion practices in the following seven impact areas within LTC homes:
Planning and Policy;
Organizational Culture;
Education and Training;
Human Resources;
Community Capacity Building;
Resident and Family Engagement; and
Service Provision
We have designed this toolkit to facilitate individual and collective team reflection, assessment, and action in each of the seven impact areas. Specifically, the toolkit begins with a self-reflection questionnaire which prompts individuals and teams to reflect upon and explore their own unconscious biases as a way to increase sensitivity, create awareness, and move closer to the provision of care that better meets the needs of the diverse populations in LTC settings.
Next, the Equity, Diversity and Inclusion in Long-Term Care: Assessment and Planning Tool—along with the accompanying online resource library—helps organizations consider the unique diversity of needs and concerns that arise in everyday life and work in LTC settings. By modelling a series of Promising Practices within each impact area, the assessment tool was designed to help individuals and teams within LTC settings identify and assess what they are doing well, areas for improvement, guide the development of quality improvement plans, and inform organizational strategic planning to incorporate equity, diversity and inclusion. An example from Impact Area 3: Employee Education and Training is provided below.
Following the assessment tool, the toolkit provides strategies and suggestions for supporting LTC homes in beginning or deepening conversations about equity, diversity and inclusion in their organizations. For example, the What Would You Do? Poster Activity was created to spark conversation following reflection on a series of illustrations that depict microaggressions that commonly occur in LTC settings, such as the infantilization of residents by care workers (e.g., referring to a resident as “sweetie”). Alongside the strategies and suggestions, the toolkit also highlights some of the ways that LTC homes in Ontario celebrate their diverse populations and reinforce affirming practices, policies, programs, and services.
To learn more about the toolkit and what it has to offer you and/or your organization, please register for our upcoming webinar on September 15, 2020 from 1:30 to 2:30 EST.
Ashley Flanagan is a Research Fellow at the National Institute on Ageing. She will soon complete her PhD in Ageing, Health, and Wellbeing at the University of Waterloo, where her research focuses on 2SLGBTQIA+ ageing and old age with the goal of advancing comprehensive health and wellness policy, programs, and services for older adults with diverse gender and sexual identities. Ashley is also a member of the Ontario Centre for Learning, Research and Innovation in Long-term Care’s (CLRI) Supporting Diversity & Inclusion in Long-Term Care Advisory Group.
[1] LGBTQI2S (also LGBT+, LGBTQ+) is a commonly used umbrella term referring to individuals who are lesbian, gay, bisexual, transgender, queer, intersex, and/or Two-spirit.