Will 2022 be the dawn of a new era for long-term care in Canada? Yes, with federal leadership

Like a category five hurricane, the trail of devastation left by COVID-19 is clearly illustrated by the all-too-familiar epidemic curves and graphs of the cumulative deaths from COVID-19 in Canada. Yet, even amid another wave brought on by Omicron, many of us are cautiously optimistic about the pandemic’s end and have started to plan our path to recovery. Those who work and live in long-term care homes are perhaps the most eager among us to see the pandemic end. COVID-19 has not only highlighted the vulnerability of the people who need long-term care but also the vulnerability of a sector within our healthcare system that has long been overlooked. The issues facing long-term care extend beyond infrastructure, although there is an indisputable lack of beds and facilities. A 2017 Conference Board of Canada report suggests that the need for long-term care beds will be double our current capacity by 2035. The demand for more care, as our population ages, must also be met by an adequate supply of health human resources. Even before the pandemic, the sector has experienced a persistent shortage of healthcare workers needed to meet the care required by residents in long-term care homes. There is, however, a silver lining to the fateful impact of the pandemic on long-term care. The pandemic has prompted the development of new national standards on long-term care; an investment of $1-billion from the federal government through the Safe Long-term Care Fund to address the immediate needs of the sector; as well as a commitment of $3-billion over the next five years to ensure provinces and territories can meet the national standards set out for long-term care. Provincially, new legislations and infrastructure funding programs have also been introduced to address deficiencies, including staffing levels, that have existed for at least a decade before the pandemic. While provincial and territorial governments hold jurisdiction over how long-term care should be administered and decide how the committed funding should be used to meet the needs of their constituents, we need federal leadership to ensure all Canadians needing support in long-term care receive the same high-quality service. Along with the proposition of new federal legislation for long-term care to hold provinces and territories accountable to the national standards, we need to consider the option of amending the Canada Health Act to bring long-term care under its definition of insured health services. Although an amendment to the Canada Health Act would not provide the federal government opportunities to enforce the national standards on care, it offers defence against two-tiered care that currently exists within long-term care. For example, recent research has found that residents who can afford accommodation in a private room within long-term care experienced less fatal outcomes over the pandemic than residents in shared accommodation. There is an undeniable need for more beds. A key barrier to entry, especially for independent and non-profit operators, is the capital required to plan, purchase and develop land to build a facility. On top of the current commitments to enforce the newly formed national standards, the federal government—in partnership with the provinces and territories—could provide infrastructure funding or create low-cost capital financing options for non-profit, charitable and municipal or health authority operators, which have demonstrated superior outcomes for residents in their care in comparison to their for-profit counterparts. Recognizing that current investments in infrastructure and the labour force may not yield positive returns for the sector in the next three to five years, the federal government can also leverage existing initiatives to engender immediate impact. Within our National Dementia Strategy and the Framework on Palliative Care, several actionable recommendations and promising practices exist to improve the health and quality of life for persons living with dementia in Canada and those at the end of life in long-term care. Federal support for these frameworks through the Common Statement of Principles on Shared Health Priorities, and the recent $3-billion commitment in the 2021 budget, can be leveraged to develop new performance indicators specific to long-term care that align with our new national standards. For example, indicators on access to behavioural support services to enhance care for residents living with dementia, reduction in the use of antipsychotic medication in residents not living with psychosis, and adequate pain and symptom management for residents approaching the end of life are a few of the quality indicators that have been used and reported at provincial and regional levels to inform health system planning. Even with the uncertainty of when this pandemic will end, we can be confident that the time for action to fix long-term care is now. Dr. Amy Hsu is the University of Ottawa Brain and Mind-Bruyère Research Institute Chair in Primary Health Care Dementia Research, an investigator at the Bruyère Research Institute, and a faculty member in the Department of Family Medicine at the University of Ottawa. Her research utilizes large, health administrative databases to understand the health-care needs and use by older Canadians across the long-term care continuum, from home care to the end of life. The Hill Times

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Will 2022 be the dawn of a new era for long-term care in Canada? Yes, with federal leadership

The demand for more care, as our population ages, must be met by an adequate supply of health human resources.

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