A draft report released last week on improving conditions for long-term care residents should be seen for what it represents: a sidebar to a discussion this country has put off for far too long, and which the COVID-19 pandemic made clear can no longer be avoided.
The report comes from the Health Standards Organization, an independent, not-for-profit body, and was produced at the request of the federal government. It focuses on giving people in LTC more control over their lives and medical treatments, on providing better recreational options, and on letting them choose the level of risk they are willing to live with, as long as it doesn’t affect others.
The latter was clearly spurred by the isolation suffered by many LTC residents during the repeated lockdowns of the past two years. Over all, the report is an effort to ensure that seniors aren’t subject to low-quality, one-size-fits-all care that results in them being little more than warehoused.
The report is well intentioned. After all, isn’t the well-being of the aging Canadians who occupy our country’s approximately 200,000 LTC beds the utmost priority?
Yes. But given that this is a federally commissioned report, it’s worth noting that the federal government lacks direct jurisdiction over long-term care. Ottawa can produce as many recommendations about the management of LTC residences that it likes, but it can’t implement them.
That’s up to each province. And sadly, as the pandemic made horrifically clear, provincial governments have repeatedly paid lip service to the need to provide their seniors with an adequate supply of LTC beds, in properly staffed homes where residents are treated with dignity and compassion, and where they are safe from infectious-disease breakouts.
Well before the arrival of the novel coronavirus, Canada’s long-term care system was in crisis.
A report from BC Care Providers Association in May, 2019, found that British Columbia was then 3,000 beds short of demand. Ontario at the time had an LTC waiting list of 43,000 people. Quebec’s underfunded and overcrowded system of homes was on the brink of a disaster that would, one year later, see the province call in the Canadian Armed Forces to help in residences where people, abandoned by overwhelmed staff, died in their beds.
Even before COVID-19, the LTC sector was failing to meet the challenge of an aging population. According to Ontario’s Financial Accountability Office, the number of LTC beds in Ontario increased by only 0.8 per cent from 2011 to 2018, while the number of people over 75 grew by 20 per cent.
And from 2005 to 2015, the number of LTC beds for every 1,000 Canadians over the age of 65 actually fell by 12.2 per cent, according to the OECD.
As one consequence of this, elderly patients with a variety of problems, including dementia, often wound up on gurneys in hospital hallways, or in one of Canada’s insufficient number of acute-care beds, while waiting for a space in an LTC facility.
Staffing was another issue. When COVID-19 struck, LTC homes in Canada – whether for-profit, private non-profit or state run – were largely reliant on low-wage, poorly trained part-time workers. Throw in the explosive demand for LTC beds that forced homes to operate at full capacity, and the stage was set for tragedy.
Three months into the pandemic, in May, 2020, LTC residents accounted for 81 per cent of Canada’s reported COVID-19 deaths, compared with an average of just 38 per cent in other OECD countries.
Canada did improve its performance, and by last summer the share of LTC residents among total monthly COVID-19 deaths was just 3 per cent, according to data from the Canadian Institute for Health Information. That was almost entirely because of the early rollout of vaccines in LTC homes.
But not much else has changed. The discussion that has to happen is about whether the provinces, with Ottawa’s financial help, are willing to invest in more LTC beds – the Canadian Association for Long Term Care said in 2018 that as many as 42,000 more were needed by 2023 – and in staffing them with workers who are more numerous, better trained and better paid.
We can talk about all the ways care ought to be improved in our existing overcrowded homes, and we should. But without an adequate supply of long-term care beds, the crisis that existed before the pandemic will still exist after it.
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