October 27, 2020
Hon. Judith G. Seidman rose pursuant to notice of September 30, 2020: That she will call the attention of the Senate to weaknesses within Canada’s long-term care system, which have been exposed by the COVID-19 pandemic.
Honourable senators, in the early stages of the COVID-19 pandemic, Canadians were staggered to learn that the vast majority of COVID-related deaths occurred in long-term care homes. As of June, according to the International Long-Term Care Policy Network, 85% of all COVID-related deaths in Canada – 6,236 out of a total of 7,326 deaths – were residents in long-term care settings. These figures spurred a serious policy discussion, begging the question: how did this happen?
Canada is not an anomaly; many countries experienced high long-term care mortality rates. In June, the Canadian Institute for Health Information released a report titled, “Pandemic Experience in the Long-Term Care Sector: How Does Canada Compare with Other Countries?” They examined the similarities and differences between Canada’s pandemic experience in long-term care and that of 16 other OECD countries, including Australia, Spain, Germany and the United Kingdom. The proportion of deaths that occurred in long-term care homes varied substantially across countries, ranging from 28% in Australia to 66% in Spain with an overall OECD average of 38%.
The Canadian Armed Forces report, released on May 14, 2020, unveiled disturbing and unacceptable conditions found in five Ontario long-term care homes, which were overwhelmed by COVID-19 cases and in desperate need of humanitarian relief. Their observations included rampant cockroach infestations, rotten food, and unchanged soiled beds. Canadian Armed Forces personnel witnessed employees re-use unsterilized medical supplies and detailed the ways in which residents were neglected by ill-trained staff.
While these findings paint a grim picture of the state of our long-term care system, it should come as no surprise. Canada’s long-term care system was wholly unprepared and underequipped for the COVID-19 pandemic; very few homes had strategies in place to protect their residents in case of a public health emergency. For decades, health experts have warned us about the dire state of Canada’s long-term care system. One only needs to look back at the last 20 years to find countless inquiries, expert-led panels, and task forces mandated to study the shortcomings of the long-term care system at great length. There is no shortage of expert recommendations to create higher standards of care.
I am especially reminded of the Special Senate Committee on Aging, created in November of 2006 to “examine and report upon the implications of an aging society in Canada.” Over the course of two and a half years, the committee studied the issue of aging in our society in relation to housing and transportation needs, abuse and neglect, and health promotion and prevention. The three-phase study aimed to identify key public policy issues and present a set of potential solutions to address these issues. In their final report, “Canada’s Aging Population: Seizing the Opportunity,” the Committee published 32 recommendations, shaped by the wisdom of expert witnesses, on how to better embrace the challenges of an aging population.
Honourable colleagues, it is evident that Canada is not short of sound evidence on how to achieve lasting change within the long-term care sector; many, like the Special Senate Committee on Aging, have paved the way for constructive policy discussion and information-sharing. And yet, despite this, tragic events continue to happen, deep-rooted issues remain unchanged, and concern for the well-being and safety of our frail elderly deepens even now with each passing week.
The purpose of this inquiry is not to shout into the void, but to highlight, with great urgency, the need to implement real solutions to the issues that have plagued our most vulnerable population. Long-term care is a fractured sector and there is no question that these issues, exacerbated by the COVID-19 pandemic, call for extraordinary and immediate measures.
At the very least, we must begin by examining clear, simple fixes that are easy to implement. In June 2020, the Royal Society of Canada’s Task Force on COVID-19 released a report titled, “Restoring Trust: COVID-19 and The Future of Long-Term Care,” which outlines the need for national standards for staff working in long-term care homes. They write, “Workforce reform and redesign will result in immediate benefit to older Canadians living in nursing homes and is necessary for sustained change. It will also improve, at a minimum, quality of care so that nursing homes are able to reduce unnecessary transfer to hospitals, reduce workforce injury claims, and interface more effectively with home and community care.” They advise provincial and territorial governments, supported by funding from the federal government, to implement appropriate pay and benefits, including sick leave, for the large and critical unregulated workforce of direct care aides and personal support workers. The report also recommends minimum education standards for the unregulated workforce in long-term care homes, with an emphasis on continuing training and orientation.
Several other health experts in long-term care have advocated for similar recommendations. At the beginning of April, the Standing Senate Committee on Social Affairs, Science and Technology was mandated to study the federal government’s response to the COVID-19 pandemic. Expert witnesses emphasized that the pandemic has highlighted issues that have long existed within the LTC sector, such as understaffing, inadequate training, low wages, unregulated support workers, and the lack of a mandatory national accreditation process. Witnesses suggested that federal legislation could require mandatory accreditation of long-term care, as well as national standards for equal access and consistent quality in long-term care across Canada. One witness, Miranda Ferrier, the President of the Canadian Support Workers Association, and its Ontario chapter, the Ontario Personal Support Workers Association, noted that the organization has been “actively advocating for self-regulation of the personal support workers in Ontario for the past five years.”
In fact, Quebec and Ontario responded to the LTC crisis of the first wave over the summer. The Premier of Quebec launched a project to hire and train 10,000 new long term care staff and the Ontario government pledged to increase funding, implement better working conditions and modernize the regulatory framework. But already, now in October we see more COVID outbreaks in long term care homes, just on the verge once again of being out of control.
In addition to the long-term care workforce crisis, there are other areas that demand our attention. For example, it is widely known that much of the long-term care infrastructure is outdated; in some long-term care homes, as many as four residents are housed together in a single room, with a thin curtain as the only option for privacy. A report published in the Canadian Medical Association Journal on August 17, 2020, found that “the risk of an outbreak of COVID-19 at a long-term care home was related to the COVID-19 incidence rate in the public health unit region surrounding the home, its total number of beds and older design standards.” The report analyzed 623 long-term care homes in Ontario, some of which still adhere to design standards from 1972.
Another report, titled, “Re-imagining Long-term Residential Care in the COVID-19 Crisis,” published in April of 2020 by the Canadian Centre for Policy Alternatives, highlights the need to redesign long-term care homes. They write, “It is important though that these new designs not only allow for private rooms and outdoor spaces, non-slip floors and smaller units, good sight lines and communication systems as many do, but also that they have appropriate space for in-house food, laundry and cleaning services that ensure the safety of staff.” Long-term care homes should not be warehouses or storage units for our elderly, but warm-living spaces, that provide them with a sense of community.
While we examine these clear, attainable short-term solutions, we should take the opportunity to think about creating long-term, deep-rooted change within the sector. The COVID-19 pandemic has rejuvenated and inspired policy discussion by health experts across the nation. Many will look to us, Parliamentarians, for guidance and the initiation of the important conversation about the ways in which we can re-imagine and re-shape the long-term care sector. Some may question why this inquiry was launched in the Senate, in this specific moment of time. We will remind them that while there was temptation to launch an inquiry at the onset of the pandemic, we realized that we needed distance and perspective to properly evaluate the situation. That sense of perspective is the epitome of independent, sober second thought, the guiding principle of our institution. We have a duty to review legislation and policy decisions in ways that are free from electoral pressures; we are able to embody futuristic thinking, influenced by well-rounded and distinct perspectives. The Senate is the ideal place to consider the ways in which we tend to the elderly in our society.
So, we must ask ourselves: how do we deliver healthcare services to our aging population? Why do we invest more in acute, hospital care, and less in community care? There must be a critical analysis of the status quo.
A report, titled, “Seniors in Transition: Exploring Pathways Across the Care Continuum,” released by the Canadian Institute for Health Information in 2017, posed a number of questions to help understand the care paths of seniors over time through the continuing care system. They found that 1 in 5 seniors in their study who entered residential care might have been able to be supported in home care. They also found that seniors disproportionately rely on hospital services; based on their analysis, seniors represent 34% of hospital cases and 58% of the hospital delays. They write, “If we assume that health services will be provided in the future as they have been in the past, health systems would need to double existing residential care capacity over the next 20 years to keep with population growth. Clearly, this is not a feasible or appropriate option. Ensuring there is capacity to meet the pending demand for a growing population of seniors requires more than just building new beds; it means transforming the way care is provided across the continuum.”
Canada has a growing aging population, with a spectrum of needs. Long-term care is part of a larger framework, which also includes aging-in-place, wellness, health and social services. While it is important to invest in the sustainability of the long-term care sector, we should also think about supporting community-based care options that will allow seniors to remain at home or in their communities as long as possible. If given the choice, over 85% of older adults would prefer to age in place within their own homes and communities according to the National Institute on Aging 2019 White Paper.
As my colleagues will note, aging in place is a subject close to my heart. My vision for the future includes the creation of a Healthmobile, a mobile team of multi-disciplinary healthcare professionals who would circulate in the community and provide health and social services to seniors on a regular basis: they would be able to get prescriptions renewed, have access to a multitude of easily administered tests with mobile equipment, and consult with a number of allied health professionals. A service like a Healthmobile would enable seniors to receive immediate medical attention within the comfort of their home or community and keep them away from emergency rooms. Community-based care would also help them manage activities of daily living better.
Honourable colleagues, I recognize that the federal government cannot dictate the ways in which health-care services are delivered; this is not within our jurisdiction. However, the high mortality rates being recorded in our long-term care homes is the price we pay as a society for our refusal to act on all those studies that have come before. This is a collective, national failure.
The Special Senate Committee on Aging dedicated their final report to “the seniors who have not had the support they need, as our society has tried to come to terms with monumental societal shifts, which have inadvertently shunted them to the sidelines, and the ones who have held onto the hope of a better world in which to age.” So, I too, dedicate this inquiry to the very same seniors who served as our caregivers, veterans, and nation-builders, and who deserve a better and more dignified aging experience, not tomorrow or within a decade, but now.
Honourable Senators ———- The urgency is now!