One of the reckonings Canada must face in the eventual aftermath of the COVID-19 pandemic is the failure of many long-term care facilities to protect their residents from the disease.
How bad is it? To date, 81 per cent of the people who have died from COVID-19 in Canada have been residents of nursing homes. In comparable countries, the toll has been much lower, according to a new report from the Royal Society of Canada: 27 per cent in England and Wales; 49 per cent in Scotland; 28 per cent in Australia; 34 per cent in Denmark and Germany; and 49 per cent in Sweden.
The question that needs to be asked is whether this horror show was specific to the times and could be avoided in future with reforms brought in by provincial governments, which have jurisdiction over long-term care, or whether the virus exploited systemic problems that need to be addressed at the national level.
The Royal Society of Canada, the country’s national academy of arts and sciences, believes the latter is true. The pandemic, it says in its report, “exposed long-standing, widespread and pervasive deficiencies in the sector.”
Those deficiencies include: a lack of consistent standards from province to province for training personal-care workers, who are the main providers of care in nursing homes; the low pay, usually without benefits, those workers receive; and a lack of integration across the health care sector and the long-term care sector.
That last one means that, even though the most vulnerable patients routinely transfer between hospitals and nursing homes, there is little co-ordination between the two. “If a whole-system approach had been in place, then hospitals would not have discharged people who tested positive for COVID-19 back to nursing homes without proper infection control,” the report says.
The report also points out that there is no standard in Canada for the minimum number of hours of daily care a nursing-home resident needs in order to have a reasonable quality of life. But one study in the United States pegged the number at 4.1 hours a day, which is significantly higher than the Canadian average of 3.3.
This lack of consistent standards, and the reliance on the lowest-paid and least-trained employees to provide as much as 90 per cent of the care in nursing homes, is set against the demographic backdrop of a country in which 25 per cent of the population will be 65 or older by 2036, with the most rapid growth in people 85 and up, the report says.
As well, dementia is now a “major driver” of admissions to nursing homes. According to the report, 3 per cent of the Canadian population will have some degree of dementia by 2036. But low-paid nursing home workers don’t have the training to care for these patients, and they often have to endure the verbal and physical abuse that dementia can trigger.
Perhaps the most telling detail in the report is the fact that Canada’s long-term care system grew out of the Elizabethan Poor Law of 1601. It’s a system based on the belief that caring for the elderly is the role of churches and charities, and as such it remains outside of medicare.
And yet, Ottawa and the provinces spend hundreds of millions of dollars every year subsidizing beds for the elderly in a system of homes that are run by charities, governments and private companies. The funding varies from province to province, as does the availability of beds. People who desperately need nursing-home care must wait months, or even years, for a spot. All too often, they wind up in acute-care beds in overcrowded hospitals.
One way or another, taxpayers are on the hook for the care of elderly Canadians who don’t need a hospital bed but do need a high level of care. Yet that care fell tragically short when it was most needed.
There is a consensus developing among provincial politicians and advocates for senior citizens that only Ottawa can provide the funding needed to better train and better pay care workers. The Royal Society of Canada agrees, and says the work-force issue is the most pressing one facing the sector.
But if Ottawa is going to pony up, then it can and should set national standards. It’s high time that caring for our most fragile senior citizens stops being seen by Canadians and their governments as a make-do system based on an outdated charitable model, and starts being treated with some of the same rigour applied to the medicare system.