More than three years have passed since COVID-19 swept through the country’s long-term care (LTC) homes, taking the lives of over 14,000 frail residents. Almost all agree that the cruel suffering and deaths inflicted on frail older adults was as much about deep and long-standing problems in LTC, as it was about the virus.
Over the years preceding the pandemic there were dozens of provincial reports, scientific papers and news stories noting decades of underfunding, neglect, poor accountability and inadequate or misaligned regulation. Our 2020 report, with colleagues from the Royal Society of Canada, Restoring Trust: COVID-19 and The Future of Long-Term Care showed how these shortcomings, combined with a resident population with complex health challenges, outdated infrastructure, and a staff who weren’t supported and were mostly unregulated, low-paid and poorly trained care aides and personal support workers – helped COVID-19 devastate LTC homes.
The fissures were there prior to COVID-19; the pandemic poured through them.
In response, our federal and provincial governments have earmarked some new funds to address issues. But Canadians are still waiting for substantive root and branch reforms to fundamentally overhaul quality in LTC homes, so that no-one is afraid to live their last years in care.
What will it take? More than just words. And more than just modest injections of cash.
The federal government’s plan is to table a Safe Long-Term Care Act, premised on new national standards for LTC services. The title of the proposed legislation sounds like it will be a catalyst for real change. But for this to happen, federal legislation must offer up more than nice thoughts about what high-quality LTC should look like. It must have teeth in terms of the funding involved and the consequences for failing to meet national standards.
The good news is we have made advances on what new national standards for LTC should be.
Earlier this year both the Health Standards Organization (HSO) and the Canadian Standards Association (CSA Group) released their efforts at defining national standards. The HSO standards focus on ways to provide evidence-based, high-quality care that is resident centred, enable a competent and healthy workforce, promote quality improvement and continuous learning, and uphold strong governance practices. The CSA Group standards cover the design, operation, and infection prevention and control practices in LTC homes.
But these standards are voluntary and provincial and territorial governments, which are responsible for regulating LTC, are under no obligation to incorporate them into their regulations and policies. After the catastrophe that unfolded in LTC across Canada during the pandemic, this is simply not good enough.
To drive change the federal Safe Long-Term Care Act must condition new funding to meeting national standards in LTC. For example, it could require each province to meet national standards defined by a pan-Canadian agency or a province could set up its own arm’s length LTC commission to establish and enforce its own set of standards so long as they are substantively equivalent to the national requirements. Critically, federal and provincial governments must report transparently and regularly on performance in meeting safety standards.
Of course, we all know that normally the task of regulating health care is one for provinces and territories. But it is legitimate for the federal government to use its massive spending power to drive national change, spurring provinces and territories to implement reforms that ensure that there is consistent, good-quality care in LTC homes everywhere in Canada.
For this kind of plan to work, the federal government will have to put more financial skin in the game.
The current federal commitment of $3 billion over five years to support provincial and territorial improvements is not nearly enough. Canada’s Parliamentary Budget Officer estimates the cost for LTC reform to be about $13.7 billion per year. It is, no doubt, a significant investment, but the scope of the problems in LTC demands it.
Canada’s population is aging and the need for LTC will increase. While most Canadians would prefer to age at home, and the federal government is keen to support this, many older people will require the type of care that only a LTC home can provide. It is inefficient for all of us to save for the possibility of needing 24/7 care when, in truth, even among the very elderly, only a relatively small percentage of us will need that support.
There will be no true change without a concrete mechanism to define national safety standards in LTC on an ongoing basis and federal funding tied to LTC homes across Canada. Federal legislation, promising “safe” LTC in its name must require, in return for real and sustained funding, accountability from the provinces and territories.
Lofty aspirational statements for safer LTC will not make Canadians living in LTC safer. It also will not assure those worried about how they may have to spend the last years of their lives secure.
We surely owe it to the memory of residents, staff and families who suffered greatly in LTC during the pandemic to take decisive action. Words alone are not the answer.
Dr. Carole A. Estabrooks is Scientific Director of the pan-Canadian Translating Research in Elder Care (TREC) and Professor & Canada Research Chair, Faculty of Nursing at the University of Alberta.
Dr. Colleen M. Flood is Dean, Faculty of Law, Queen’s University.
Dr. Sharon Straus is Professor & Canada Research Chair, University of Toronto & Physician in Chief, St Michael’s Hospital, Toronto