Canada’s promised new national standards for long-term care homes have now been released, part of Ottawa’s bid to avoid a repeat of the alarming deaths in long-term care homes that marked the early phase of the pandemic.
The Health Standards Organization (HSO) published 60 pages of comprehensive standards on Tuesday to complement the 115-page release of standards from the Canadian Standards Association Group (CSA) in December. The federal government launched the standards project in spring 2021.
Both organizations were tasked with creating standards to improve the quality of care in long-term care (LTC) homes across the country. HSO focuses on the care itself and CSA on the physical infrastructure.
Although the new standards are voluntary, health experts say they won’t do the trick unless long-term care homes adopt them all without exception.
“It’s kind of all or nothing.” Basically, that should be the standard of care,” said Dr. Sameer Sinha, director of geriatrics at Sinai Health and University Health Network in Toronto and chair of the HSO technical committee that drafted the standards.
“My biggest fear is that if we don’t take these standards to heart and make sure they are at the heart of inspections, enforcement, quality improvement and accountability … I worry that these standards will just sit on the shelf.” “
The pandemic has exposed fatal weaknesses in the durable services sector. In the first few months of the pandemic, more than 80 percent of known COVID-19 deaths in Canada occurred in long-term care and nursing homes — the highest rate among nations in the Organization for Economic Co-operation and Development (OECD).
More than 17,000 residents of long-term care homes in Canada have died of COVID-19 as of July 2022, according to the National Institute on Aging.
Thousands of staff members in long-term care facilities have also been infected; more than 30 have died as a result. In some provinces, the Canadian Armed Forces had to be called in to assist in LTC homes.
Members of the Canadian Armed Forces at Residence Yvon-Brunet, a long-term care home in Montreal, on May 16, 2020. (Graham Hughes/The Canadian Press)
Dr Sinha said the standards introduced today would have saved many lives if they had been in place when COVID-19 struck.
“If these standards had been put in place before, I believe we would not be the world’s worst performer in long-term care. I think, honestly, we would have been one of the best,” he said.
The two sets of standards are intended to complement each other. They go beyond pandemic preparedness and address everything from fall prevention and maintaining flexible meal schedules (some LTC residents went without food during staff shortages during the pandemic) to end-of-life care and emergency plans for catastrophic events.
Friends and family members visit confined residents at Extendicare Guildwood in Toronto on June 12, 2020. (Evan Mitsui/CBC)
The new standards also directly address how COVID-19 has affected the quality of long-term care. So they include recommendations for flexible visitor policies, for rules that balance the rights of LTC residents with the health and safety of others, and for maintaining social interaction with family even during public health emergencies—along with page after page of infection prevention and control standards.
“These standards will primarily improve the quality of care for their residents, but they will also improve the business of care if these homes can demonstrate that they are making these improvements,” said Alex Michailidis, a professor at the University of Toronto’s Institute of Biomedical Engineering and chair of the CSA Group technical subcommittee that developed the infrastructure standards.
New standards for LTC buildings
The standards set a new bar for long-term housing construction and renovation. They state that single rooms in long-stay homes must have dedicated 3-piece bathrooms for residents, while shared rooms must have access to dedicated privacy rooms for “intimate acts”.
CSA standards require dedicated hand hygiene sinks and access to an outdoor space for each level of a long-term care home. They offer guidance on waste management, CCTV, signage and staff room design.
“Changing infrastructure and building infrastructure is expensive,” Mihailidis said. “But … time is of the essence as there are plans across the country … to build new long-term housing. We hope they will look to our standard.”
Much of the pressure on long-term workers’ homes due to the pandemic is due to staff shortages and staffing struggles. The standards do not require a specific staff-to-resident ratio and do not prescribe a specific amount of hours of care. But they point out that the evidence strongly supports the need for an average of 4.1 hours of daily care.
“The biggest challenge for many long-term care homes right now is retaining and recruiting staff, especially when hospitals are also facing significant staff shortages and paying much higher salary levels,” Dr Sinha said.
For many of those still grieving the loss of a loved one in long-term care during the pandemic, the standards are a welcome step forward, but only a first step.
Eddie Callisto-Tavares celebrates his birthday with his father in 2017 (Submitted by Eddie Callisto-Tavares)
Eddie Callisto-Tavares’ father Manuel Callisto was one of 56 people who died at Maples Long-Term Care Home in Winnipeg in the fall of 2020 during the second wave of COVID-19. It was the worst hit home in that province.
“How do families like mine get these standards (implemented)? They are beautiful in writing, but how do we make them enforceable? And then how do we make these homes accountable?” Callisto-Tavares asked.
Callisto-Tavares struggled to gain access to her father when he became ill with COVID-19 in late October 2020. She arranged to self-isolate in a hotel so she could continue to visit and care for him. She said what she saw at his LTC home still haunts her.
“I could hear people shouting. They were hungry… they were so cold. They were shouting that they were thirsty,” she said. “There was nothing I could do but say, ‘Help is coming, help is coming,’ knowing that very little help was coming.”
Although the standards are mandated by the federal government, health care delivery falls under provincial jurisdiction. Some critics and family members of LTC residents have called on Ottawa to legislate the standards to make them mandatory.
A $13.7 billion problem
Seniors Minister Kamal Khera said the government is still in the very preliminary stages of developing the Safe Long-Term Care Act, which the Liberals promised during the last election campaign. She argued that the introduction of the standards was in itself an important milestone.
“These standards will matter, and it’s a step in the right direction and making sure we’re improving the lives of Canadians and seniors across Canada,” she said.
In the 2021 budget, Ottawa set aside $3 billion to help provinces implement the standards. According to experts, the work will cost much more.
The Parliamentary Budget Officer estimated the cost of fixing long-term care at $13.7 billion a year on top of what is being spent now. Many advocates for long-term care clients hope that a long-awaited new health care agreement between the federal government and the provinces can cover at least some of those costs.
“What kind of carrots and sticks will be involved? Will it be the Canada Health Transfer and the money associated with it? Is every province going to be a signatory to these standards and providing the funding needed to implement these standards?” asked Terry Lake, CEO of the Care Providers Association of British Columbia, an industry association that represents long-term care and assisted living providers in British Columbia
Lake, a former provincial health minister, said he fears the issue of long-term care has “fallen off the political radar.”
Paramedics take a man from the Revera Westside long-term care home in Toronto on Dec. 7, 2020. (Nathan Denette/The Canadian Press)
“Of course, during the pandemic it was the number one issue … and now we’re seeing it kind of fall down the priority list. And we can’t let that happen,” he said.
Much of the debate over long-term care in Canada revolves around whether for-profit facilities should be allowed to operate. Lake said the results of for-profit homes and for-profit homes in British Columbia were about the same.
The process of developing the standards saw a very high level of input from the public – suggesting that policymakers need to catch up with the public’s desire for change, a union representative said.
“If there’s any resistance from premiers across the country on any of these standards or any federal intervention on this file, I think they’re significantly misreading the will of the people they represent,” said Candice Renick, CUPE’s national secretary-treasurer. one of the main unions representing tens of thousands of long-term care workers in Canada. She has worked in long-term care homes in various positions.
“People want standards that are enforceable. They want penalties and consequences for people who don’t follow the rules. They want to know that when they send their loved ones to these facilities, they will spend their final days with dignity and respect. And that’s not happening.”
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