Samir Sinha is the director of health policy research at the National Institute on Ageing (NIA) at Ryerson University, and the director of geriatrics at Sinai Health System and the University Health Network in Toronto.
Michael Nicin is the executive director of the NIA.
Canada’s armed forces have bravely endured and seen far worse things abroad than at home – or so we thought. A clear and utterly disturbing dispatch released by the military this week brought to light the horrific and unimaginable working and living conditions of staff and residents at five long-term care homes in Ontario. An additional report outlined gaps in care at some nursing homes in Quebec. While the military had been sent in to support the fight against COVID-19, armed forces personnel discovered damage far beyond what the virus had caused.
While many of us knew that these and many other homes were struggling, we likely allowed ourselves to believe that these issues were exceptions and only at the hands of a few bad actors. But what our military found were deeply ingrained behaviours and practices born of chronic “systemic vulnerabilities.” A long-standing culture of fear and desperation among overworked and burnt-out staff cannot lead to the provision of high-quality care in settings charged with the responsibility of looking after our most vulnerable citizens.
Some have been quick to assign blame to others along partisan or ideological lines, but the truth of who’s responsible is clear. We all are.
So how did it all come to this? Well, for one, we acted like and hoped that we’d never get old. When we established Medicare more than 50 years ago, the average Canadian was only 27 and didn’t live beyond their 60s. It’s understandable that long-term care was not an original priority. But while other aging countries acted clearly and decisively in recent decades to meet their population’s evolving needs, Canada didn’t.
Our inaction, founded in deep societal ageism and persistent under-funding, cumulatively sowed the seeds of the tragedy we have been witnessing. Canada currently spends, on average, 30 per cent less of its gross domestic product on long-term care than the other Organization for Economic Co-operation and Development countries, and prioritizes its limited funds on warehousing older adults rather than helping them stay in their own homes.
The National Institute on Ageing at Ryerson University (NIA) has demonstrated that 81 per cent of Canada’s deaths to date from COVID-19 have occurred in long-term care settings, where there is a 103-times greater chance of dying from the disease than for older Canadians living in their own homes. In these regards, Canada is an unrivaled international leader.
Even before the pandemic, our long-term care system was failing to meet our needs. At least 430,000 Canadians reported having unmet home-care needs to the NIA in 2019, while 40,000 more were on waiting lists for long-term care homes. Funding inadequacies have resulted in nurses and personal-support workers in these settings making far less than they would in our hospitals. As a result, 80 per cent of care homes – before the pandemic – reported trouble recruiting and retaining staff.
Indeed, the majority of the workers being recruited are often racialized women who don’t have many other options. We owe a debt to them and the more than 10,000 long-term care workers who have contracted COVID-19, including nine who have died so far. They are caring individuals trying to make ends meet, and have been willing to keep doing dangerous work under extraordinary circumstances. If any of us think our current staffing strategy is the right way to set up the long-term care system for success in the future, then we are deluding ourselves.
Ontario and Quebec have tried to stabilize their situations with the help of hospitals, the military and even school-board employees, but we learned this week that this is not a solution for what our leaders have described as a “broken” system that has lost the faith of its residents, families, caregivers and workers.
So where do we go from here? The substance of our ensuing public discourse and action should focus on two core issues.
First, how do we deliver the highest possible care in line with the needs, preferences and values of older Canadians, their families and care providers, in the most cost-effective and sustainable manner?
And second, how can we, and should we, improve our provision of long-term care immediately and over time?
We mustn’t be guided by ideology or partisanship, but by the ample evidence that exists from places that have better addressed their needs. We must also be open to every legislative, regulatory and policy option available to produce the best outcomes while efficiently using our public resources.
Much of what we need to do has been known for years and, luckily, it isn’t rocket science. But it will take political will, in addition to co-ordination at the federal, provincial and territorial levels. Our soldiers have shown us that we have been our own worst enemies. Let’s not waste any more time in finally marching together in the right direction.
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