Statements & Speeches

Senator Seidman concludes debate on her Inquiry calling the attention of the Senate to weaknesses within Canada’s long-term care system, which have been exposed by the COVID-19 pandemic.

June 29, 2021

Honourable senators, I rise tonight at this late hour, during Seniors Month, to conclude debate on my inquiry, which calls the attention of the Senate to weaknesses within Canada’s long-term care system that have been exposed by the COVID-19 pandemic.

I would like to express my gratitude to all my colleagues who have extended their voices to look at the state of long-term care in their regions: Senators Martin, Pate, Bovey, Plett, Boehm, Boniface, Dasko, Moodie and Dean.

The social and economic impacts of the COVID-19 pandemic have been far-reaching, but the devastation that occurred within our long-term care sector stands as a paramount tragedy of this pandemic. In March, the Canadian Institution for Health Information released a report that examined the impact of COVID-19 on long-term care residents and staff during the first six months of the pandemic and provided early comparisons of outbreaks, cases and deaths between the first and second waves. They found that between March 1, 2020, and February 15, 2021, more than 2,500 care homes across the country experienced a COVID-19 outbreak, resulting in the deaths of over 14,000 residents and close to 30 staff. That represents more than two thirds of Canada’s overall COVID-19-related deaths.

Other reports and investigations have exposed the underlying conditions responsible for the disproportionate number of deaths among residents in long-term care homes: insufficient resources, shortage of personnel, outdated infrastructure and poor quality of care. These persistent challenges have fuelled a national conversation about the causes of and solutions to the challenges faced by the long-term care system. That in turn has encouraged Canadians to think about where they want to live as they age.

In late 2020, the National Institute on Aging, in partnership with the Canadian Medical Association and Ipsos, conducted an online survey to better understand the concerns and perspectives of Canadians regarding the state of Canada’s long-term care system. The survey found that 86% of Canadians surveyed and 97% of those aged 65 years and older reported that they are concerned about the challenges faced by Canada’s long-term care systems. Meanwhile, 85% of Canadians of all ages who participated in the survey and 96% of Canadians aged 65 years and older report that, as they get older, they will do everything they can to avoid moving into an LTC home.

The results of the survey are clear: A majority of Canadians wish to live safely and independently within their own homes for as long as possible.

It is important to note that the desire to age in place is not new; for years, surveys and studies have reported similar findings. In 2005, the Atlantic Seniors Housing Research Alliance conducted a five-year research project to understand the future housing needs of aging Atlantic Canadians and to develop policy recommendations for alternative housing solutions to meet those needs.

The final report, published in 2010, entitled Seniors’ housing: challenges, issues, and possible solutions for Atlantic Canada, made two fundamental conclusions. The first is that as we age, we want to stay in our homes for as long as possible, and the second is that having support in and around us in our communities is essential to fostering successful conditions for this to occur.

They explained that the reasons for the desire to stay in our homes for as long as possible include:

. . . fear of the unknown and change, and comfort with what is known (familiar); wanting to be in control of their lives; and a desire not to be a burden on others.

According to the report, the number of seniors who want to age in place is over 90%.

Somewhat incongruently, reports show that Canada spends a disproportionately low amount on home care compared to the OECD average. According to a report released by Queen’s University in November 2020, entitled Ageing Well, Canada spends a mere 0.2% of GDP on home care, the lowest outlay in the OECD. They write:

And even worse than that, the ratio of more than 6 dollars spent on institutional care for every dollar spent on home care is one of the most imbalanced resource allocations in the developed world.

Results from a study commissioned by the Canadian Medical Association published in March found that:

. . . demand for long-term care, is expected to reach 606,000 patients in 2031, up from 380,000 in 2019. Similarly, demand for home care will increase to roughly 1.8 million patients in 2031, up from close to 1.2 million in 2019.

As a result, the total cost of care is projected to nearly double, from $29.7 billion in 2019, to $58.5 billion in 2031.

They also found that long-term care utilization has been on a downward trend in recent years. They write:

If we can sustain that trend, by making better use of home care, we can move 37,000 Canadians out of long-term care, saving the health care system an estimated $794 million a year by 2031.

Finally, they estimate that there are currently more than 9,400 patients in hospitals waiting to be transferred to other care settings, and predict that if some of these patients were transferred to home care and long-term care, an additional $1.4 billion a year could be saved by 2031.

To accompany these findings, the study recommends two policy solutions to improve care, one of which is shifting more long-term care patients to home care. However, at present, most government action is directed towards addressing the glaring and immediate issues pertinent to the beleaguered long-term care sector; namely, the creation of standards, recruitment of personnel and renovation of infrastructure. While these actions are important, they will not adequately respond to the long-term care crisis on their own. The fundamental issue is the chronic underfunding of senior home care and community services that will allow seniors to age within their community in the home of their choice.

Honourable senators, we should ask ourselves: Why is so much of our collective effort and money being spent on care that our seniors do not even want?

As part of this inquiry and to better understand the work being done across the country to enable aging in place, I embarked on a search for creative pilot projects. My research shows a number of initiatives across Canada operative within the past five years. While there are likely more, I identified 21 notable projects, 9 of which are in Ontario, 2 in Quebec, 3 in the Atlantic provinces, 3 in the Prairie provinces, 2 in British Columbia and 2 in the territories. Some of these projects derive their funding from private sources, while others are federally, provincially or municipally funded. The focus and intent of the projects are to support healthy aging in place through the integration of age-friendly housing, health and social support services, transportation, volunteering, telemedicine and emerging technology.

As an example, in my home province of Quebec, the Hôpital Saint-François d’Assise has been operating a mobile clinic in Quebec City since February of 2019. The aim of the pilot project is to conduct geriatric follow-up at the homes of patients after they’re discharged from the emergency department.

Meanwhile, the Ontario government announced that they are spending up to $15 million to expand the Community Paramedicine for Long-Term Care program, which launched in October 2020. The aim of the program is to delay the need for long-term care for seniors by providing them with at-home health services.

In P.E.I., a new pilot project, Hospitals Without Walls, launched in November 2019, funded by the Centre for Aging + Brain Health Innovation. The aim of the project is to use technology to allow seniors and their family caregivers to stay connected to their health care team from the comfort of their homes.

In British Columbia, the Better at Home program is funded by the government of B.C. and managed by the United Way. The program mobilizes volunteers, contractors and paid staff to provide a range of support services, such as friendly visits, yardwork and grocery shopping to help seniors live independently within their community.

On a national level, the federal government, in partnership with the Government of New Brunswick, instituted the Healthy Seniors Pilot Project in 2018. This program will support a range of applied research initiatives to examine how seniors can be better supported in their homes, communities and care facilities. As of January, 39 projects were launched.

Lastly, the National Research Council of Canada developed the Aging in Place Challenge program in October 2020. The program intends to partner with the private and public sectors, along with academic and research organizations, with an objective to support seniors and their caregivers to live healthy and social lives in their homes and communities of choice.

These are but a few examples of visionary initiatives that promote and invest in aging in place.

Honourable senators, as parliamentarians we have a responsibility to provide leadership on this pivotal issue related to aging and seniors. On the local, provincial and national levels, we can find commonalties among these initiatives and encourage ones that have worked in one place to take root in another. We can find best practices and perhaps even ensure a centralized oversight clearing house.

In my introductory speech for this inquiry, I examined several clear, attainable, short-term solutions that can be and already have been implemented across the country. At the same time, I encouraged us to think about long-term solutions that will create lasting, deep-rooted change within the LTC system.

The conclusions one draws will depend on one’s ultimate definition of the problem. Is it fundamentally a long-term care home problem, or do we need to transform the way health and social services are provided across the health care continuum?

It is evident that the creation of policies at all levels of government, which focus solely on the LTC sector, will not be sustainable to meet the demands of the growing population of Canadian seniors. In order to meet these needs, there must be a shift in the status quo, away from a system that prioritizes acute hospital care and towards one that focuses on the housing, social and health needs of seniors.

As it is written in the Ageing Well report published by Queen’s University:

Seniors require 4 primary types of support. The current model gives predominance to care to alleviate physical and mental limitations; housing, lifestyle and social needs lie many tiers down. The new approach must recognize that the four are interrelated and must be advanced together if seniors are to age well.

The COVID-19 pandemic has provided a timely opportunity for parliamentarians, provincial and territorial governments, associations, and the public and private sectors to collaborate and strengthen our collective support for home and community-based care while ensuring that the LTC sector can adequately care for our most vulnerable seniors.

Honourable senators, I encourage you to reflect on what the concept of home means to you. For many of us, the definition of home is complex, embedded in personal meaning that exceeds a physical space. It is a place of many dimensions, including comfort, independence and connection. This concept of home should be at the heart of our policy-making.