COVID’s Tragic Toll in Canada’s Long-Term Care Sector Must Lead to Action
The long-term care sector has been especially devastated by the COVID-19 pandemic. Of the over 22,000 Canadian lives claimed by COVID-19, more than 70% were residents of long-term care facilities and retirement homes. Canada has the highest reported national proportion of COVID-19 deaths for long-term care residents in the world.
The unresolved consequences of decades of underfunding and understaffing problems in long-term care (LTC) have been accumulating for years, even as the demands for such care has grown. The pandemic pushed the sector into an unsustainable situation and now we must reckon with the sad state of elder care in Canada. Despite all the reports into lessons learned during the first wave of COVID-19, in some parts of the country, there has been little reprieve for residents of long-term care homes during the second wave.
Long-term care homesThe Canadian Institute for Health Information characterizes nursing homes, continuing care facilities, residential care homes, and CHSLDs as long-term care homes. in Canada are excluded from the Canada Health Act and as a result are a mixed system of for-profit, non-profit and public nursing homes with limited government oversight and accountability to residents and caregivers. With health and seniors’ care services failing to keep up with the demand for many years, a significant gap remains between what is needed and what is available. This gap has unfortunately led to substandard and aging facilities, the inequitable treatment of LTC care providers, workforce shortages, resident overcrowding, and inadequate infection control capabilities.
This brief provides HealthCareCAN members with recommendations that have been put forward to address the devastation of COVID-19 in long-term care and improve elder care across the country.
THE FEDERAL GOVERNMENT CALL FOR NATIONAL LTC STANDARDS
There has been a growing call in Canada for the federal government to establish national long-term care standards. In the supplementary mandate letters released in mid-January, the Minister of Health and the Minister of Seniors were tasked with working with the provinces and territories to set new, national standards for long-term care.
Training and resources for infectious disease control and prevention, including optimal use of personal protective equipment, and;
Protocols for expanding staff and restricting visitors during outbreaks.
The Premiers have repeatedly said that to meet new national standards and deliver better elder care, the provinces and territories need enhanced financial support from the federal government and an increase to the Canada Health Transfer (CHT). The Prime Minister has said that the federal government will partner with provinces and territories to help cover the costs of improvements to meet long-term care standards, however, the federal government has thus far resisted calls to increase the CHT.
A NATIONAL HEALTH WORKFORCE STRATEGY
Canada needs a national health workforce strategy. Such a strategy would include all personnel working in the health care system, including the long-term care sector. A national plan would help address the workforce shortages that have hindered the delivery of high-quality long-term care and ensure the sector does not find itself in a workforce shortage during the next health care crisis.
Personal support works (PSWs), care aides, nurses and other long-term care staff provide necessary care to some of the most vulnerable people in our society. Care aides and PSWs provide the majority of care in nursing homes. PSWs and care aides are for the most part in unregulated jobs, receive some of the lowest wages in the health sector and are given variable and minimal formal training in long-term care. A national strategy would ensure that equitable pay and benefits, better training, and safe workplace requirements are in place.
AGING IN PLACE
In the supplementary mandate letters released in January, the Minister of Health and Minister of Seniors have been asked to take additional action to help seniors age in place and stay in their homes longer.
Aging in place means having the right services and supports to care for seniors at home and for seniors to live safely and independently in their home and community for as long as they wish or are able. Aging in place is associated with improved quality of life, lower risk of contracting communicable illnesses and hospitalizations, decreased mortality, and reduced health care costs.1
COVID-19 has certainly transformed our healthcare system and health organizations are developing innovative solutions to care for older adults and keep seniors out of the hospital and long-term care, if possible. These solutions strive to increase access to health services at-home, including leveraging services through social services and community supports.
LTC INFRASTRUCTURE INVESTMENT
Canada’s outdated health infrastructure puts the health of Canadians at risk and nowhere has this been more evident than in long-term care. In many LTC facilities it is nearly impossible to comply with physical distancing measures and isolation protocols. Many LTC homes in Canada are aging and not designed for the complex needs of today’s residents (e.g., the frail elderly, dementia care) or for containing communicable disease outbreaks.
In the last fiscal update, the federal government committed up to $1 billion for a Safe Long-Term Care Fund. The Fund enables provinces and territories undertake more pandemic preparedness activities, like making improvements to ventilation systems. Funding allocation is contingent on each province and territory laying out a detailed spending plan. Reports suggest that several provinces have yet to show a detailed plan to access this funding.
MENTAL HEALTH SUPPORT FOR LONG-TERM CARE WORKFORCE
Studies have shown that the long-term care workforce is at high risk for burnout and injury. The Royal Society of Canada has called on provincial and territorial governments, with federal funding support, to provide mental health supports for all nursing home staff.2 The shortages of personal protective equipment during wave one of the pandemic, the stressful working conditions, and dealing with the death of residents and colleagues have all combined to have detrimental and traumatic effects on long-term care staff. Support must be accessible to address a growing mental health care crisis.
IMPLICATIONS FOR HEALTHCARECAN MEMBERS
With the upcoming federal budget and the possibility of a federal election shortly, we believe the time for increased federal action is now.
We are extremely concerned about the current situation in long-term care homes, a situation that has persisted and worsened throughout the pandemic. These devastating circumstances are a clarion call to rethink long-term care and older adult care more broadly, and we are pleased that the federal government has heeded this call.
HealthCareCAN is engaging with cabinet ministers and Members of Parliament from all parties to meet to discuss long-term care and older adult care, and when suitable opportunities arise HealthCareCAN will request to appear before standing committees to advocate for better long-term care and seniors care.
HealthCareCAN’s 2021 budget submission calls for investments in infrastructure, including upgrading long-term care facilities to be more pandemic resistant. The submission also calls on the government to implement a national health human resource strategy for all personnel working in the healthcare system, including a specific mention of the long-term care sector.