The federal government will unveil Tuesday new national standards for long-term care aimed at addressing systemic problems exposed by the coronavirus pandemic, but there is no plan to make the standards mandatory.
Ottawa asked a non-profit group, the Health Standards Organization (HSO), to develop the new standards to address gaps in infection prevention and control, staffing and quality of care in nursing homes.
The standards are intended to be used by policy-makers and leaders in nursing homes to set the bar higher for quality and safe care by promoting good governance, fostering a healthy and competent work force and upholding resident-centred care. Residents, for example, should be free from neglect, protected from abuse, have their privacy protected and their lifestyle choices respected, including living with risk.
The federal government is not planning to introduce legislation to make the standards mandatory, said Guillaume Bertrand, a spokesperson for Health Minister Jean-Yves Duclos. As a result, Canada will continue to have a patchwork of practices, with some provinces – Quebec, British Columbia and Alberta – requiring homes to be accredited and adhere to standards of excellence while accreditation is voluntary for nursing homes in Ontario.
Canada had the worst record for COVID-19 fatalities in nursing homes among wealthy countries during the first wave of the pandemic. The virus was particularly lethal in Ontario and Quebec, where thousands of vulnerable people died alone in understaffed homes.
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During the federal election campaign in 2021, the Liberals pledged to enforce the new standards, which took two years to develop, through legislation. In mandate letters to his ministers, Prime Minister Justin Trudeau has said they need to collaborate with the provinces to improve care in nursing homes and “ensure seniors get the care they deserve.”
Mr. Bertrand said the standards will not be on the agenda when Mr. Trudeau meets with provincial and territorial leaders next month to hammer out a new health care funding agreement. Long-term care falls under provincial and territorial jurisdiction.
Samir Sinha, the head of geriatrics at Sinai Health System and chair of the HSO’s technical committee, told reporters that the new standards are only useful if they are actually implemented by the provinces and territories.
“We would have an opportunity to not repeat several of the mistakes that we unfortunately had to live through over the past few years,” Dr. Sinha said.
The HSO sets criteria that Accreditation Canada, the largest accreditation body in the country, uses when it audits health facilities. The organization accredits 94 per cent of nursing homes across Canada that are publicly owned, including by municipalities, but only 36 per cent of privately owned facilities, including for-profit ones.
In Ontario, 16 per cent of nursing homes choose not to undergo accreditation, Leslee Thompson, chief executive officer of Accreditation Canada, said during her testimony two years ago at an independent commission that examined the devastating effect of the coronavirus on the province’s nursing homes. She said accredited homes receive extra government funding of 36 cents a day for each bed.
“That strikes me as alarming, actually, that rather than be accredited, you would choose to give up money,” Frank Marrocco, chair of the commission, responded.
Dr. Sinha said that nearly 90,000 Canadians participated in creating the standards, including residents in nursing homes and experts in long-term care. For those homes that are not accredited, he said, “this is your best bet” to deliver high-quality care.
In Canada’s most populous province, he said, the standards are not at all compatible with a law that allows some elderly hospital patients to be forced into a nursing home they did not choose. Ontario Premier Doug Ford’s government introduced the legislation last August to help ease pressures on hospitals that have been overwhelmed by emergency visits and surgical backlogs.
A shortage of community-based care has made hospitals the default place for many elderly patients. These patients, known as alternate-level-of-care (ALC), no longer require medical intervention and are waiting to be placed in home care, a rehabilitation program or a nursing home.
Bill 7 allows hospitals to override patient consent to secure a long-term care bed as far as 70 kilometres away in southern Ontario and 150 kilometres away in northern regions. Hospitals can charge a mandatory fee of $400 a day to ALC patients who refuse to go to a home arranged on their behalf.
Since the bill came into effect on Sept. 21, hospitals have placed 4,745 ALC patients into long-term care, said Jake Roseman, press secretary to Long-Term Care Minister Paul Calandra.
As of Jan. 15, there were 5,600 ALC patients in hospitals across the province, including one-third who were waiting for a long-term care bed, the Ontario Hospital Association said. This is down from an all-time high of 6,100 in mid-September.
The rights of these patients were probably not respected, which is a key component of the new long-term care standards, Dr. Sinha said. “There’s nothing about Bill 7 that’s reflected in the care that we would recommend in a long-term care home,” he said in an interview. “You’re basically filling homes with people who didn’t actually want to be there.”