Long-term Care System
Inquiry--Debate Continued
June 1, 2021
Honourable senators, I would like to take this opportunity to thank Senator Seidman for initiating this inquiry and for all fellow senators who have spoken on this issue.
As you know, this is a very important issue for all Canadians. How we treat our vulnerable is a signal of the kind of country we are. Sadly, in my province of Ontario we’ve seen the devastation that befell long-term care homes during the first wave of the pandemic. The military’s intervention in Ontario in our long-term care homes brought into sharp focus the shortcomings of legislation, policy, guidance and, indeed, competence within the system. In the Royal Society of Canada’s, or RSC’s, report Restoring Trust: Covid-19 and The Future of Long-Term Care, published last July, key problems were identified. The report also noted that Canada’s long-term care facilities have a much higher incidence of COVID-19 deaths in homes compared to countries such as Australia, the United States and Spain. The RSC explains that because seniors in Canada are moving into homes at a later age, combined with the increase in life expectancy and more complex diseases to be treated such as dementia, many factors contribute to the complexity of care patients require.
Senators, there is much to be done. Statistics Canada reports that by 2030, seniors are expected to number over 9.5 million, making up 23% of our population. Over the next two decades, Canada’s senior population will grow by 68%. The over-75 age group will double.
I’d like to draw your attention to the broader issue, which is the support we give to all seniors who need only some care. We have long heard the call to allow seniors to stay in their own homes as long as possible, and this is laudable. It is often, however, a lot of talk and a shortage of action, either in policy, guidance or research by all levels of government.
I have experienced and listened to the anguish of families who try to be both children and caregivers. The unpaid caregivers are the unsung heroes of this story.
I have a friend who has cared for her mother for 10 years. She started that care the day she retired. She shared with me the significant coordination required to get personal caregivers to her home to give her relief from her 24-hour caregiving. She lives in a small town in northern Ontario, and she found it almost impossible to get ongoing support, even though her free, unpaid labour was saving a significant amount of expense and burden on the senior care system. Without my friend’s caregiving, her mother would have been in someone else’s care.
In my own experience five years ago, my father declined quickly from dementia at 95. He and my mother, up to that point, had been living alone and relatively independently. If not for the fact that they had eight children, we would not have been able to keep him at home until he passed. It was a full-time job to coordinate caregivers and family members to ensure that both he and my mother had care.
Caregivers who came from outside the family were kind, gentle and compassionate. However, the care provider would routinely call at the last minute to advise that someone had called in sick, they were short of staff and that no one would be able to come. That left my mother, at 88 years of age, to care for a dementia patient.
The hours that my parents qualified for care were constantly being re-evaluated despite the fact that my father would not be getting better. We were fortunate that my father passed at home and, while we were grateful for that, we were also exhausted and concerned that the burden of living with a dementia patient would take a toll on my mother. This is not how it should be for families and spouses of loved ones but, for many families, this is their struggle.
In London, Ontario, it was reported a few months ago that a gentleman in a wheelchair was left for three days before his replacement caregiver was sent to the home. I can assure you that these situations replicate themselves across the country.
I raise this to ensure that we don’t conclude that the alternative to living in long-term care is working any better. It is not. For so many, it is only out of love for a parent or a grandparent that they have persevered, but it is not any easier.
Senators, we need a comprehensive national strategy to address the future of the care of our aging population. We need to listen to the workers on the front lines who deal with these challenges every day, and we need to listen to families who find themselves between a rock and a hard place.
This is not about pointing fingers. This is about designing a future for almost a quarter of our population. What do we as Canadians need to do? How might we learn from all these reports? How might we work together to create national standards, proper training and proper remuneration? What about identifying best practices? How will we deal with the complexity of care in a single facility?
Honourable senators, this is the road we must take. We owe it to the most vulnerable, and we owe it to the future of all Canadians. Thank you.
Honourable senators, I rise today to speak to Senator Seidman’s inquiry calling the attention of the Senate to weaknesses within Canada’s long-term care system that have been exposed by the COVID-19 pandemic. I want to thank Senator Seidman very much for launching this important inquiry. I also want to thank those honourable senators who spoke before me for their analyses of the situation and for sharing their personal experiences with long-term care.
I think I should consider myself lucky. My parents lived and received care for four years in a non-profit care facility in Peterborough, Ontario, and I feel that they were treated very well. My mom had Alzheimer’s, and I have to say that the staff at St. Joseph’s did the best they could with patients suffering from this most difficult and heart-wrenching disease.
Both of my parents passed away in 2018. Looking back, I am satisfied with the choices that our family made. However, I recognize that others have had entirely different and terrible experiences with long-term care. I recall, for example, Senator Pate’s sad story of instances of abuse at her mother’s care home.
Whether our personal experiences were positive, negative or mixed, the fact is that deep, systemic flaws exist in Canada’s long-term care sector. While my experiences did not expose the cracks in the system, they were there in 2018 and have been there for far longer.
According to journalist André Picard, over 150 task forces, inquiries and commissions conducted since Medicare was introduced have documented the sorry state of long-term care in this country. As Picard says:
One can’t help but be struck by how the same problems are exposed and the same solutions are suggested, time and time again.
As the title of Senator Seidman’s inquiry suggests, COVID has indeed exposed the system’s weaknesses with catastrophic results and has washed over the system not once but twice.
After the first wave, we learned from the National Institute on Ageing that 77% of deaths across Canada from COVID occurred in long-term care and retirement homes, including 80% of Quebec’s deaths and 73% of Ontario’s.
A report from the Canadian Institute for Health Information released this past March found that the situation did not improve overall for the sector in the second wave. In Manitoba, a series of outbreaks at long-term care homes, some of them chronicled by Senator Bovey in her speech to this inquiry, resulted in 480 deaths during the second wave — an increase from 3 deaths in the first. In Alberta, the second wave brought more than 1,000 deaths in long-term care, and British Columbia followed the same pattern.
In Ontario, a recent commission on long-term care found that government inaction meant that the virus gained another foothold in long-term care homes and resulted in a second wave that was far more deadly than the first. The commission’s report found that the elderly died at an alarming rate in Ontario this past winter. At one home, 118 of their 119 residents tested positive, resulting in 34 deaths. Ontario’s second wave killed a total of 3,758 residents in long-term care homes, which was up from just over 2,000 during the first wave. Nationally, Canada has lost more than 15,000 long-term care residents since the pandemic began.
As of this spring, according to the Canadian Institute for Health Information, deaths in long-term care homes represented close to 69% of overall fatalities in Canada, which was the worst record among wealthy countries, and 28% higher than the international average.
It is a great shame that, even after the calls for urgent action during the first wave, the second wave still caught our long-term care sector woefully unprepared. Colleagues, we would have to conclude that had it not been for the timely distribution of vaccines in long-term care facilities this year, the sector would have suffered a third time during the third wave.
The pandemic highlighted in red the underlying, long-standing and systemic issues in Canada’s long-term care sector. These include underfunding, weak government oversight, limited data collection and information sharing, profit-oriented decision making, overcrowding, aging infrastructure and underpaid, undertrained and overworked staff. This workforce is mostly women, many of whom are racialized, and many of whom are new Canadians.
To fix our systems, we need higher standards for elder care. To achieve this, governments need to increase their funding and they need to regulate more.
Let me start with those higher standards. Experts in the field, including Dr. Pat Armstrong of York University in Toronto, and others, have identified a number of conditions in the long-term care sector that must be changed. These include expanding access to quality long-term care for all Canadians, not just the most affluent; establishing enforceable minimum staffing levels, as well as staff employment and retention policies; dramatically improving the conditions of work in the sector; addressing physical environments, including things like PPE, waste removal, room size and ventilation; improving education and training for paid staff as well as volunteers; and establishing strong, enforceable reporting mechanisms rooted in data collection and transparency.
When it comes to funding the system, the federal government has indeed made several commitments. Last September, the government announced $740 million for long-term care in its Safe Restart Agreement. They announced the Safe Long-term Care Fund in the Fall Economic Statement, which set out $1 billion to be distributed over two years. Half of that funding was delivered via Bill C-14 when it passed last month. Finally, they announced an additional $3 billion in Budget 2021 that will roll out over five years.
Many provincial governments have also committed more spending on long-term care, which, of course, is a provincial jurisdiction. Ontario, for example, has promised $2.7 billion for new long-term care beds and $2 billion annually to hire new personal support workers.
So let’s acknowledge that more funding has been put on the table, and Canadians are also onside when it comes to more spending. An Abacus poll of Canadians conducted last year, in May 2020, about three months into the pandemic, found that 78% of Canadians supported increased funding for long-term care.
But it’s also essential that higher standards be set. Governments need to create better standards in the sector through better and more effective regulation in a sector that is currently already highly regulated.
Several experts in long-term care have called for national standards that would be implemented by the federal government in return for federal dollars. We heard this from several witnesses appearing before the Standing Senate Committee on Social Affairs in the committee’s review of the federal response to COVID last year.
For example, Dr. Réjean Hébert, former Quebec health minister, testifying at the committee last June 10, explained the necessity of federal legislation that would create such standards. This, in his view, would give the federal government legitimacy to assist the provinces in implementing services and assisting in responding to crises like COVID. “Giving more money is not enough,” he added.
National standards might be implemented via amendments to the Canada Health Act or through a new piece of legislation that would follow the structure of the CHA but focus specifically on long-term care. Yet another way to achieve national standards is through a policy framework built by a regulator or by a health standards organization that would be linked to federal dollars accessible to those provinces that demonstrate compliance and progress toward those goals.
Finally, the federal government could, in fact, scrap the concept of national standards altogether but still make bilateral agreements with the provinces to improve conditions, as they did in the Safe Restart Agreement last fall.
These are all the ways the federal government could assist the provinces in fixing the sector by way of the federal spending power.
Colleagues, make no mistake: the federal government has put national standards front and centre in their messaging on this topic to date. National standards have been promised in last year’s Speech from the Throne and in this year’s budget. With a strategy that appears to involve the Canadian Standards Association and the Health Standards Organization, who presumably will build a set of national standards that the government will seek to implement with the provinces in return for federal dollars. The budget further stipulates that funding is to help:
. . . Health Canada to support provinces and territories in ensuring standards for long-term care are applied and permanent changes are made.
In this federal system of ours, imposing federal standards on the provinces, even with substantial federal dollars, is especially challenging. As Finance Minister Freeland stated here in our chamber last November:
To have standards that work for the country, to have standards that have real buy-in from all levels of government is going to require a real process of discussion and negotiation between the provinces, territories and the federal government.
Whichever way you look at it, whether it is national standards, consistent standards or better standards, there is much work left to do.
In conclusion, colleagues, the problems of our long-term care systems are well documented, and the solutions are well understood. Canadians support more spending and they want better standards. We have lost too many of our family, friends, neighbours and fellow citizens due to inaction. I say to our federal and provincial governments, let’s get it done. Thank you, meegwetch.
Senator Dasko, would you take a question?
Yes, I will. Thank you.
In your research, did you look at the partnership that resides in long-term care facilities and retirement homes where entrepreneurs and a consortium of investors are owners of these long-term care facilities and retirement homes? Did you do any research in this part of your work?
Senator Moncion, I think you are asking about the private providers in the system. I think that is what your question is about.
This is a real issue in Ontario with 58% of our care delivered by the private sector. Many experts think that one of the ways to deal with the system is to phase out the private operators.
