Ottawa and provinces are on a collision course over long-term care

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Canada’s premiers are calling on the federal government to transfer more money for health care to the provinces with no strings attached, putting them on a collision course with Ottawa over its proposed national standards for long-term care.

The provincial and territorial premiers are holding a virtual meeting on Friday, and federal transfer payments for health care will be at the top of the agenda. In a statement, they said Ottawa must increase its share of every dollar they spend on health care to 35 cents from 22 cents, and the funding must be unconditional.

However, experts and advocates for elder care want any additional money to be contingent on the provinces complying with national standards that are enforceable through legislation.

“Any increase in the health transfer payments must have some accountability mechanism built in,” said Pauline Worsfold, a registered nurse and chair of the Canadian Health Coalition.

The provinces and territories will receive $45.2-billion this year under the Canada Health Transfer, up 4.8 per cent from last year.

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In December, Prime Minister Justin Trudeau told Health Minister Jean-Yves Duclos and Seniors Minister Kamal Khera to negotiate agreements with the provinces and territories to improve the quality and availability of long-term care across Canada.

Mr. Trudeau said in mandate letters to the ministers that they need to collaborate with the provinces to improve infection prevention and develop national standards “to ensure seniors get the care they deserve.”

The 2021 federal budget earmarked $3-billion over the next five years to help the provinces improve elder care. Ottawa asked a non-profit group, the Health Standards Organization (HSO), to develop new standards, which were released in draft form last week.

During the federal election campaign last fall, the Liberals pledged to enforce the standards through new legislation. Mr. Trudeau’s government has not said when it plans to introduce a bill.

But Ottawa’s initiative, intended to address systemic problems exposed by the pandemic, could lead to a clash with the two most populous provinces.

Ewan Sauves, spokesperson for Quebec Premier François Legault, said the province opposes any national standards in health care.

“Health is solely a Quebec jurisdiction and the federal government does not handle care or the management of nursing homes,” Mr. Sauves said in an e-mail.

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Ontario Premier Doug Ford also asserted his province’s jurisdiction over health care this week, but declined to respond when asked by reporters if he will support national standards.

“We have a strong, strong group of premiers, all different political stripes, but we’re all united on making sure that the federal government pays their fair share,” Mr. Ford said.

B.C. Health Minister Adrian Dix said his government is reviewing the draft standards for long-term care, but he does not expect to see any financial strings attached.

The HSO’s draft proposals outline principles that would require facilities to make sure residents are properly assessed for their cognitive capacity, and to have contingency plans for emergencies and appropriate medical oversight.

Samir Sinha, the head of geriatrics at Sinai Health System and chair of the HSO’s technical committee, said Ottawa has supported the standards, but he is concerned jurisdictional issues will slow “desperately” needed progress, including legislation.

“I don’t know of any Canadian who is impressed with our current standards of long-term care in any province or territory,” Dr. Sinha said in an interview.

The HSO sets criteria that Accreditation Canada uses when it audits health facilities. Several provinces – Quebec, British Columbia and Alberta – retain Accreditation Canada to assess their long-term care homes. In Ontario, it is a voluntary process for the facilities.

During an inquest last year into the COVID-19 death toll in Quebec nursing homes during the first wave of the pandemic, coroner Géhane Kamel, and Jacques Ramsay, a medical expert assisting her, criticized the Accreditation Canada inspection process.

Dr. Ramsay noted that some nursing homes that passed their review “with flying colours” were nevertheless overwhelmed by the coronavirus. “Perhaps this reveals some important shortcoming in the way facilities are assessed,” he said.

Since promising national standards in the 2020 throne speech, the Trudeau government has done little to follow up, Don Davies, the federal NDP health critic, said in an interview.

“They promised to bring in long-term care standards and to bring in legislation. Two years later, they have done neither. … I don’t think the federal government is acting with the urgency that the situation calls for.”

With reports from Justine Hunter in Victoria and Kristy Kirkup in Ottawa

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