Health-care advocates across Canada are calling on the federal government to tie funding for long-term care facilities with compliance to rigorous national standards.
The demand comes as COVID-19 continues to expose long-standing issues in the sector, which is partially funded by the federal government through federal-provincial-territorial transfer payments.
Unlike hospital care, long-term care is not covered under the Canada Health Act, which is the basis for the country’s publicly funded health-care system. As a result, each province or territory has a unique approach to care provision in the system serving one of Canada’s most vulnerable communities. This has created inconsistencies in the level of care provided, governance models, and resource allocation policies across the country even before the pandemic.
Prime Minister Justin Trudeau expressed his commitment to nailing down national standards in long-term care in late 2020.
“There is no short-term fix for long-term care,” said Steven Staples, acting national director of policy and advocacy at the Canadian Health Coalition, in an online news conference Monday.
“We want to see the federal government put the cards on the table — What are the national standards going to be to fix this problem.”
What the standards should look like
Groups including the Canadian Health Coalition and Canadians4LTC have worked with lawyer Steven Shrybman to map out what these standards should look like.
In a document titled Proposed National Standards for Long-Term Residential Care, Shrybman outlines how long-term care facilities should be regulated. Some of the recommendations have been highlighted by advocates before, such as setting a standard ratio of patient to care provider and requiring minimum hours of care per patient.
Other recommendations include creating a home-like environment for residents that supports their well-being and respects their culture, requiring certification and professional qualifications for all employees at a long-term care home, and providing semi-private or private rooms.
To enhance accountability, the group demands ensuring surprise inspection reports are made available to the public, and providing meaningful recourse for staff, families, and residents when they believe standards are not being met.
The proposal also recommends creating an independent national long-term care advisory panel with annual reports to Parliament on whether the standards are met. Not abiding by the standards means the facility gets no funding from the government.
Nova Scotia facing consistency issues
In Nova Scotia, 57 people have died from COVID-19 in long-term care, making up about 86 per cent of deaths from the disease in the province. That’s close to 20 per cent higher than the 67 per cent national average, according to the latest data tracker from the National Institute on Aging at Ryerson University.
“Even with a strong pandemic response overall, long-standing problems in long-term care cost lives,” said Chris Parsons, provincial co-ordinator at the Nova Scotia Health Coalition.
Nova Scotia has the highest number of private for-profit and not-for-profit long-term care facilities in Canada, second only to New Brunswick, he added.
“With so much of the system run outside of government, problems with standardization, with inspections, and ensuring money is spent on care is a particular challenge in Nova Scotia,” said Parsons.
Need for legislation
Trudeau said in an interview with the Canadian Press last December that he’s willing to partner with and fund any province or territory that wants to improve standards in long-term care.
It was followed by a letter to Health Minister Patty Hajdu, issued in January 2021, where he directs her to work “with the Minister of Seniors, work with the provinces and territories to set new, national standards for long-term care so that seniors get the best support possible.”
While few details are available on how these standards will be implemented, Shrybman said a federal-provincial agreement should not be on the table.
“The obvious problem is that such agreements simply lack permanence,” he said.
“When the crisis goes away and the public attention turns to other things and the agreements expire, we no longer have what a statutory commitment will ensure, which is that the federal government takes responsibility on an on-going basis.”
The group expects that bringing these standards through legislation ensures the government continues to fund long-term care, in addition to “shifting societal expectations so that long term care becomes understood as a necessary element of Canada’s commitment to providing health care to all Canadians.”
Taking profit out of long-term care
The advocates are also demanding that the federal government reduce and eventually eliminate for-profit providers in the long-term care sector. They claim that for-profit providers further complicate issues in the sector as they don’t prioritize optimizing the quality of care that patients receive,
“Their … first legal obligation as corporate entities is to return profits to their investors,” said Shrybman.
The federal NDP tabled a motion Monday that calls on the federal government to transition existing for-profit long-term care homes to not-for-profit by 2030.
“We know that for-profit means less care. It means less hours of care. It means less quality food,” NDP leader Jagmeet Singh said at another online press conference Monday.
Instead of playing political games, I invite the NDP to join us in the difficult work of advancing and championing national standards to strengthen all long-term care homes. /6
— Deb Schulte MP (she/her) (@_DebSchulte) March 22, 2021
Deb Schulte, Minister of Seniors, said she opposes the motion, pointing to provincial jurisdiction over health care.
“The federal government does not have the legal authority to do what the NDP is proposing,” Schulte said on Twitter.
Parsons said the document produced by the group “lays out a path forward” for the federal government to enact change it comes to long-term care.
“Let’s say no more … vaguely pointing to federalism as a short-cut to dodge explanation, debate or accountability.”
Nebal Snan is a local journalism initiative reporter, a position funded by the federal government.