"There are better ways of doing many things regarding long-term residential care, more creative ways,” says Armstong. She is confident that the study will come up with ideas on how to improve conditions for workers and residents. “Long-term residences need to be a positive option, not the last resort as it now seems to be in Canada."

Armstrong says people feel shame when they have to admit a family member to a long-term care facility. “People see long-term care as a failure of themselves, their family and the health-care system. The main goal is always to keep them out of long-term care homes, rather than saying how can we make them attractive interesting places to be and work.” People are apologetic for not being able to care for their loved ones at home, but home care is not necessarily ideal either, Armstrong says. There can be issues with caregiver burnout and elder abuse, and it’s often just not a viable option as many women – still the main caregivers – work full time.

Right: Pat Armstrong

“How we treat this vulnerable population and those who provide their care is a critical indicator of our approach to equity and social justice, as well as to care,” says Armstrong. “Long-term residential care is a barometer of values and practices.” It raises questions regarding fundamental human and social rights, the role of the state, as well as the responsibilities of individuals, families and governments.

"Reimagining Long-Term Residential Care: An International Study of Promising Practices" is a seven-year project with $2.5 million in funding from the ’s program. Armstrong will lead an international team of researchers seeking to identify the most promising practices for long-term residential care, ones that treat both providers and residents with dignity and respect. The team is less interested in pointing out what’s broken in the system, than in coming up with promising practices to improve it.

Up until now, there has been little research on residential care in Canada or elsewhere that has taken this kind of approach, says Armstrong. What has been done tends to focus on issues such as patient abuse and under-staffing rather than on issues related to gender and diversity, the relationship between the conditions of work and conditions of care or on policies that will lead to quality care. Meanwhile, the need for long-term residential care in Canada is expected to grow in the face of psychiatric, chronic care and rehabilitation hospital closures, the shift in hospital focus to short-term acute care and outpatient services, and with an aging population, she says.

The research team, which includes physicians, architects, sociologists, philosophers, social workers, historians, political scientists and economists, along with representatives of competing interests, such as employers and unions, will compare practices in Canada, the United Kingdom, the United States, Norway, Sweden and Germany. They will look at four different themes – work organization, accountability, approaches to care, and financing and ownership.

Left: An elderly woman sits by a window. Photo by Chalmers Butterfield.

In the area of work organization, researchers hope to find care models that better meet the needs and balance the rights of residents, providers, managers, families and communities. Under accountability, they are looking for structures which nurture care and inspire quality workplace relations. They will also investigate financing and ownership models to identify the contexts, regulations, funding and conditions that allow residents and providers to flourish and that ensure equitable access to quality long-term residential care.

“We’re hoping to get the pieces of a kind of mosaic to guide us to a better place for all the countries…to producing an integrated picture of long-term residential care and how to do things differently,” says Armstrong. “In many ways, the approaches to care are the most important.” In this country, the emphasis seems to be more on finances, but it is imperative that approaches to care provide a viable, desirable and equitable option for individuals, families and those who provide care. Both providers and residents need to be treated with dignity and respect in the approaches to care, she adds.

The plan is to have researchers work in all four thematic areas, not just their area of expertise, to help generate new ideas and novel ways of approaching problems. “I emphasize the ideas because we're not just thinking about the residents, but the families, the workers and the governments,” Armstrong says.

Long-term care raises many complex issues dealing with gender, diversity, aging, sexuality and providing medical care once the domain of hospitals. Typically, long-term care residents have been mostly women, currently about 80 per cent, but the number of men in care has increased. So has the number of younger people needing constant care and not served by a hospital. Most care workers are also women, many of whom are from racialized communities. Trying to find the most promising practices is not an easy task and one size will definitely not fit all, but at the same time there is much room for improvement, Armstrong says.

Armstrong, who holds a Canadian Health Services Research Foundation/Canadian Institutes of Health Research Chair in Health Services & Nursing Research, expects the project to create readily usable research.

“We hope the research will make a difference long before the project is done.”

Armstrong is a professor of sociology in the Faculty of Liberal Arts & Professional Studies and an executive member of both the 91ŃÇÉ« Institute for Health Research and the Graduate Program in Health Policy & Equity.

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Two teams led by 91ŃÇÉ« University researchers have received $5 million in research funding from the Social Sciences and Humanities Research Council of Canada (SSHRC).

Their multinational research teams, involving multiple universities and community partners in a large-scale collaboration, have each received $2.5 million to examine long-term residential healthcare and global suburbanization.

The funding is part of ’s $10-million investment in critical issues of intellectual, social, economic and cultural significance through the (MCRI) program, the largest award competition SSHRC currently runs.

The program contributes to the deeper understanding of people and society while providing graduate students with research training opportunities. Royal Galipeau, MP for Ottawa–Orléans, made the announcement in Ottawa this morning on behalf of Gary Goodyear, Minister of State for Science and Technology.

Pat Armstrong, professor of sociology in the Faculty of Liberal Arts & Professional Studies and an executive member of both the 91ŃÇÉ« Institute for Health Research and the Graduate Program in Health Policy & Equity, will lead a study to identify promising practices for understanding and organizing long-term residential healthcare.

Right: Pat Armstrong

Although many of Canada’s most vulnerable citizens live in long-term residential care, it is often characterized as a last resort rather than as a positive option where both providers and residents can thrive. Armstrong’s project seeks to learn from and with other countries to understand the approaches, structures, accountability practices, and ownership arrangements that create conditions prompting respectful and dignified treatment for both residents and caregivers.

Twenty-five researchers, eight partnering institutions, and 17 universities in six countries will work across disciplines to capture and share data and best practices. Armstrong is Chair in Health Services and Nursing Research, co-funded by the (CHSRF) and the (CIHR).

Roger Keil, professor in the Faculty of Environmental Studies, director of the City Institute at 91ŃÇÉ«, and director of the , is working with 44 researchers at 29 universities, and 16 partners in 12 countries to better understand the challenges suburbanization poses in a globalizing world.

Right: Roger Keil

Based on the experience of Canadian suburbanization, but ranging from North America’s wealthy gated communities to Europe’s high-rise-dominated suburbs, the exploding outskirts of Indian and Chinese cities to the slums and squatter settlements of Africa and Latin America, this project is the first to systematically take stock of worldwide suburban developments while analyzing their governance models, land use, infrastructure and suburban everyday life. The project also includes collaboration with the on documentaries about life in suburban high rises.

Of the four $2.5-million grants awarded, 91ŃÇÉ« was the only institution with two successful projects, building on its strong track record in leading large, interdisciplinary collaborative research projects. Prior to today’s announcement, 91ŃÇÉ« researchers held nine major SSHRC collaborative grants worth a total of $13.6 million in research funding.

“As the only institution to win multiple awards in this category, 91ŃÇɫ’s researchers have clearly demonstrated their national and international excellence and leadership in large-scale, SSHRC research projects,” says Stan Shapson, vice-president research and innovation. “Leading major research initiatives allows us to address key social issues facing our society. As global populations expand and age, suburban research and new approaches to long-term residential healthcare are increasingly important to the well-being of Canadians and nations around the world. These projects provide unique opportunities for Pat, Roger, and their research collaborators to conduct groundbreaking research with significant impact on real-world issues.”

“These grants highlight the excellence of our country’s talented researchers and recognize the importance of fostering international collaboration to keep Canada at the forefront of research, development and innovation in the 21st century,” said Chad Gaffield, president of SSHRC.

91ŃÇÉ«'s other major SSHRC-funded interdisciplinary collaborative research projects

• “Assets Coming Together for Youth: Linking Research, Policy and Action for Positive Youth Development”, led by social work Professor Uzo Anucha in the Faculty of Liberal Arts & Professional Studies (LA&PS) is developing a comprehensive youth strategy that will outline how marginalized urban communities like Toronto’s Jane-Finch neighbourhood can use their community assets to support positive youth development.
• The , led by Professor Emeritus Wesley Cragg in the Schulich School of Business, is mobilizing the University’s business expertise by bringing University researchers together in dialogue with leaders and researchers in business, government and the volunteer sector.
• The , led by Professor Stephen Gaetz in the Faculty of Education enhances the impact of research on homelessness and the housing crisis by increasing collaboration and discussion among researchers, policy-makers and community workers.
• The , led by LA&PS social work Professor Susan McGrath, studies refugee and forced migration issues to find solutions to the plight of refugees worldwide.
• “Monitoring the Human Rights of People with Disabilities in Canada”, led by health policy & management Professor Marcia Rioux in the Faculty of Health, monitors and records human rights violations to put together an accurate picture of the daily lives of Canadians with disabilities.
• The Toronto Immigrant Employment Data Initiative, led by geography Professor Philip Kelly in LA&PS, assists community organizations whose mandate includes the better integration of immigrants into Toronto's labour force by providing these organizations with free access to statistical data and analysis on various aspects of immigrant labour market integration.
• “Slavery, Memory, Citizenship”, led by Distinguished Research Professor Paul Lovejoy, includes a team of more than 50 Canadian and international scholars who are researching the global migrations of African peoples under conditions of slavery and how the resulting racism arising from the exploitation of African peoples has shaped modern societies.
• “The University as a Civic Change Agent: Community-Based Knowledge Mobilization”, led by David Phipps, director of the Office of Research Services, is developing a community-focused input model for that seeks first to identify community knowledge needs and then focus university research expertise to help fill that need by creating a self-sustaining cycle of knowledge production and its uptake for policy, practice and community capacity building.
• “Work in a Warming World”, led by social science Professor Carla Lipsig-MummĂ© in LA&PS, studies the challenge presents to Canadian employment and workplaces by examining seven Canadian employment sectors to seek policy, training, employment and workplace solutions to effectively assist Canada’s transition to a low-emission economy.

For complete competition results, visit .

By Elizabeth Monier-Williams, research communications officer, with photos courtesy of YFile – 91ŃÇɫ’s daily e-bulletin.

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