Long-Term Care reform in Canada – Resource Round-up
12 June 2020
By Sara Pon
The hardest hit population from COVID-19 has been older adults living in long-term care. This has led to great media attention on long-term care. Issues receiving media attention include the low staffing levels, poor compensation for health care workers, and issues monitoring quality of care. However, these issues are not occurring only because of COVID-19; they are ongoing issues.
During this time of great media attention, it is important to have reliable and accurate information. This blog will provide links and descriptions to policy papers discussing current and ongoing issues in long-term care. This blog will also provide resources for general law and policy information on long-term care topics.
Led by Pat Armstrong
This seven-year, inter-disciplinary, comparative research initiative explores issues related to regulatory regimes, accountability mechanisms, financing, ownership, and approaches to delivering long-term care. The work has resulted in a number of papers and presentations, including the most recent, “Re-Imaging Long-term Residential Care in the Covid-19 Crisis”.
Office of the Seniors Advocate (2019)
The Seniors Advocate report examined the funding of contracted long-term care providers, both for-profit and non-profit. The report examined the per-diems given to long-term care providers, and the reported expenditures of the providers. The report found high building costs and high profits for for-profit facilities, and insufficient reporting requirements. The report concluded that the current funding model needs to change to reduce the financial incentives which lead to inadequate care in the contracted long-term care sector. The report makes several recommendations for improving the funding model and reporting requirements to increase the level of care in contracted long-term care. For a longer summary of the report, you can read the CCEL’s blog on this report.
Margaret McGregor (Posted May 20, 2020 on Policy Options)
This policy article discusses the increase in long-term care being contracted out to for-profit companies. The author notes that this is problematic because evidence shows public and non-profit facilitates have better outcomes. Health outcomes are better when a facility has more staff, and for-profit facilities tend to have lower staffing, lower wages, and high staff turnover. The policy article describes the strategies BC has used to try to combat the outbreaks in long-term care. The article argues that more research is needed on how to better control outbreaks and argues for increased public ownership and oversight.
Andrew Longhurst and Kendra Strauss (Posted April 22, 2020 on Policy Note)
This policy article describes the strain the long-term care system was already under when the pandemic hit and exposed the problems. The long-term care system is characterized by a great deal of subcontracting all types of services, contracting for-profit companies to provide long-term care, and increases in corporate chains. Publicly funded care is limited to people with the most acute medical needs. This leads to long-term care with insufficient staffing and residents with great care needs. The policy article argues that the health care system should stop contracting with for-profit companies. The article also recommends creating standardized reporting, banning subcontracting, and increasing tenancy protections in assisted living.
Tamara Daly, Ivy Lynn Bourgeault & Katie Aubrecht (Posted May 14, 2020 on Policy Options)
This policy paper examines how long-term care has been an undervalued form of work, and the impact of this devaluation on staff and residents. Long-term care staff are highly skilled and cannot be easily replaced. This work requires relationship-centred care, which other health care professionals or outside people brought in during the pandemic do not have the skills for. Long-term care requires the right balance of staff, including enough health care workers, nurses, and rehabilitation staff. Additionally, health care workers need to be better compensated, including increased wages, paid sick leave, and full-time positions.
Andrew Longhurst (Canadian Centre for Policy Alternatives, 2017)
This policy paper examines access to care services. The paper shows that access to care has been declining, including access to home and community care, assisted living, and long-term care. The health care system has been increasing contracting with for-profit facilities to deliver long-term care. BC has been reducing its per capita health care spending compared to other provinces. The policy paper makes recommendations for increasing quality of care in BC. These include stopping contracting with for-profit companies and improving access to home and community care provided by the government or non-profit organizations.
National institute on Ageing (2019)
This policy paper is part of a series produced by the National Institute on Ageing prior to the COIVD-19 pandemic. The paper outlines the pre-existing care needs of older adults, the varying approaches to long-term care across the country, and some of the flaws in the long-term care system (including what services are available, the process for entering long-term care, funding models, and levels of care). This policy paper outlines some possible options for improving long-term care and what approaches should be taken in developing new long-term care policy, such as using an evidence-informed and person-centred approach.
Bonnie-Jeanne MacDonald, Michael Wolfson, and John P Hirdes (National Institute on Ageing, 2019)
This policy paper is part of a series produced by the National Institute on Ageing prior to the COIVD-19 pandemic. This policy paper projects the future costs of long-term care, assuming the same model for care continues. The paper examines costs of publicly funded long-term care and home care, costs to family caregivers, and costs of hospital care when a person is unable to access long-term care. The paper found that costs would increase greatly and discusses the factors for this. The policy paper argues for creating a new approach to care to make long-term care sustainable.
Marcy Cohen, Jeremy Tate, and Jennifer Baumbusch (Canadian Centre for Policy Alternatives, 2009)
This report examines the changes that have happened in assisted living, long-term care, and home care from 2001 to 2008, and what the impacts are of these changes for older adults, families, and the health care system. These changes include the shifting of beds from long-term care to assisted living and the increase in for-profit care. This report critically examines the result that home and community care is now focused on people with higher needs, and the acute system and family members have to pick up the unmet needs. The report gives ten recommendations for improving home and community care.
Honourable Eileen E. Gillese, Commissioner (2019)
This document is the report of the public inquiry into the safety of Ontario’s long-term care system, conducted after the discovery of Wettlaufer’s crimes. The inquiry’s goal was to determine how the long-term care system needs to change to prevent these types of crimes in the future. The inquiry found that changes need to be made to the long-term care system because these crimes currently go undetected. There are systemic problems in long-term care, and the system is currently strained. The report makes 91 recommendations to address prevention, awareness, deterrence, and detection. These recommendations touch on medication management, incident analysis, staffing, death investigations, and the Ministry’s role in ensuring regulations are followed. The report stresses the importance of systemic changes.
Canadian Centre for Elder Law
This report examines the law, policy, and practice of consent to health care in the context of aging and dementia. This report includes a summary of health care consent rights, supportive and substitute decision-making, and chemical restraints, both inside and outside of long-term care. Additionally, this report discusses admission to long-term care, including committal through the Mental Health Act. This report suggests area for law reform, some of which are applicable to long-term care.
Long-term Care Resources for Family
Alzheimer Society of B.C. (2020)
This website lists information on how caregivers can care for relatives or friends living in long-term care while there are restrictions on visitors. This website also includes resources for caregivers including help lines and webinars.
This tool outlines tips for caregivers of people who are living in long-term care where visitors are allowed. These tips outline how to keep relatives safe by reducing virus transmission while still maintaining social support. This tool also gives tips on visiting a person living with dementia.
National Initiative for the Care of the Elderly and CanAge (2020)
This tool helps a person decide whether to remove a family member from a long-term care facility. This tool gives information on long-term care policy in Ontario. The tool outlines what factors a person should consider when making this decision, including the impact of COVID-19, the older adult’s physical needs, the accessibility of the caregiver’s home, and the caregiver’s ability to provide care.
D Stacey, C Ludwig, J Lavoie, S Sinha (University of Ottawa, April 15, 2020)
This tool helps a person decide whether themselves or a relative should remain in long-term care or leave to live with a family member. This tool gives questions a person should consider, including what care the older adult would need, whether the family member’s home is accessible, whether there is a family member who can provide care, and what reasons for staying or leaving are most important. The tool gives information on discharge and re-admission during the pandemic.
D Stacey, C Ludwig, J Lavoie, S Sinha (University of Ottawa, April 14, 2020)
This tool helps a person living in assisted living or a retirement community decide whether they should remain there or leave to live with a family member. This tool gives questions a person should consider, including how much assistance they need with daily activities, whether a family member is available to help, and what reasons for staying or leaving are most important.
Seniors First BC (formerly BC Centre for Elder Advocacy and Support)
This manual outlines some of the legal issues in long-term care, intended to help people working in law or health care. These issues include admission to long-term care, consent to health care, substitute decision-making, abuse and neglect, restrictions on visitors, staffing, and quality of care. This manual also outlines avenues for helping a client with legal or other issues in long-term care.
Health Care Decision-Making Tools (British Columbia)
Canadian Centre for Elder Law
CCEL has developed a booklet and series of videos explaining a person’s health care decision-making rights. These tools are targeted for people living with dementia, but are applicable to anyone, including a person living in long-term care. The tools outline rights to consent to health care, the impact of dementia on decision-making capacity, and the right to supported decision-making.