What Will Canada Do to Fix Its Senior Care Fail?

Last April as the pandemic hit hardest those in senior care homes, Prime Minister Justin Trudeau expressed shock. “We need to do better,” he declared. “Because we are failing our parents, our grandparents, our elders — the greatest generation who built this country.”

But the toll kept mounting until last week when COVID-19 deaths in facilities reached 14,420 — two out of every three lives claimed by the virus in Canada.

Last week, too, the executive director of Little Mountain Place in Vancouver resigned after 41 elderly residents died from COVID-19, the deadliest outbreak in the province.

Add these wake-up calls to many others Canada has received since the pandemic threw open the doors on horrors many nursing home residents endure. In May, for example, a report saying Canadian Armed Forces members deployed to long-term care homes in Ontario found expired medication; the presence of ants, flies and cockroaches; aggressive behaviour by staff to residents; patients left in soiled diapers; staff “not assisting residents during meals”; and an aversion to caring for deceased patients, leaving the task to military personnel.

What will it take politically to fix so broken a long-term care system? The Tyee conducted interviews with the government minister responsible and two national party leaders to fill in the picture.

Trudeau has called for national standards and talks are underway with the provinces.

Opposition leader Erin O’Toole says it’s not a federal matter to raise standards.

But the leaders of the New Democrat and Green parties explained why they are calling for even more sweeping changes at the national level to the long-term care system, including an end to for-profit models.

And experts say Canada must do far more to keep people out of long-term care facilities in the first place by supporting care at home.

The NDP’s plan

All of the sad stories emerging from long-term care homes are “appalling” for federal NDP Leader Jagmeet Singh.

Earlier this month, the New Democrats unveiled a plan “to fix Canada’s broken long-term care system” that would aim to shift “all for-profit care to not-for-profit hands by 2030.”

“Not a cent of public money should go toward a company trying to make a profit,” Singh told The Tyee.

The NDP’s strategy takes aim at three major for-profit operators — Extendicare, Sienna Senior Living and Chartwell Retirement Residences — which, according to a Toronto Star analysis, collectively paid out nearly $171 million to shareholders in the first three quarters of 2020 while receiving $138.5 million in provincial and federal wage subsidies tied to the pandemic.

At the time the story ran in late December, more than 480 residents and staff members had died of COVID-19 at facilities owned by Extendicare and Sienna in Ontario alone. The death toll at Chartwell was 281 residents across the country.

Singh said that ending for-profit-run homes would not be unlike the discontinuation of for-profit hospitals following the introduction of universal medicare in 1966. His first target would be to make public long-term care facilities owned by Revera Inc., a wholly owned subsidiary of a Canadian Crown corporation. “That can happen overnight,” said Singh, noting Trudeau managed to nationalize the Trans Mountain pipeline “with the snap of a finger.” (The change-in-ownership process took three months.)

Singh explained that a national task force would create a plan to phase out other for-profit care homes across the country and establish national regulations based on the five pillars of the Canada Health Act: public administration, comprehensiveness, universality, portability and accessibility.

The task force would also work with the provinces and territories to set national standards for staffing, pay and working conditions. This “would inherently push out for-profit, because you can’t make a profit if you’re actually caring for people the way they should be cared for,” said Singh. “Cutting corners with staffing has been shown to be the leading cause in the horrible conditions.”

Greens: ‘A humanitarian crisis’

Canada’s Green party has held virtual roundtables and town-hall meetings on long-term care involving experts on aging and infectious diseases, and Leader Annamie Paul told The Tyee there has been “unanimous consensus on what needs to be done and how quickly” in reforming the “fatally flawed and fundamentally broken” system — from requiring four hours of daily care per resident to providing a living wage to, and proper training for, workers in the homes.

“When you have to call in the military or the Canadian Red Cross, that’s a humanitarian crisis — and some have gone even further and called it senicide,” said Paul. “Every level of government in Canada should be engaged in addressing this.”

On Jan. 5, the Green party called on Trudeau to convene an emergency first ministers’ meeting to address the COVID crisis in long-term care. Two days later, Trudeau and the premiers discussed the issue “and agreed on the importance of sharing best practices and applying innovation solutions to minimize the risk to long-term care residents.”

Trudeau wants national standards for long-term care homes and committed to achieving them in last year’s throne speech. His challenge will be getting buy-in from his provincial counterparts in Quebec, Ontario, Saskatchewan and Alberta, where there has been pushback against Ottawa encroaching on their turf.

At the federal level, Official Opposition Conservative Leader Erin O’Toole favours allowing the provinces and territories to set their priorities for long-term care. His office did not respond to an interview request.

But the Greens join the NDP in wanting countrywide regulation of long-term care homes reflecting the principles of the Canada Health Act.

“We want universal long-term care. Long-term care is health care,” said Paul. “There is also no place for profit in long-term care.”

Paul’s father, Luther Peter Paul, who lived in a for-profit nursing home, died last May at the age of 80 after being rushed to hospital to treat what she explained was an avoidable case of sepsis.

“When there is a profit motive in health care, corners are cut,” Paul said.

A study last year of all 623 long-term care homes in Ontario conducted between March and May, and published in the Canadian Medical Association Journal, found “evidence that for-profit LTC homes have larger COVID-19 outbreaks and more deaths of residents from COVID-19 than non-profit and municipal homes.” Factors included “the higher number of for-profit homes with outdated design standards and chain ownership,” said the researchers. 

Paul said the Green party would also like to see more emphasis placed on community care, noting Canada invests less than comparably wealthy countries “in allowing people to stay at home and age in place.”

Liberal government: working with provinces

Deb Schulte, the federal minister of seniors, told The Tyee, “COVID has certainly laid bare significant systemic issues with long-term care that have been there a long time and which has generated a national conversation on what we should be doing.”

Schulte’s office provided The Tyee with a list of related initiatives by the federal government, such as a $1-billion safe long-term care fund announced in the fall to help provinces and territories prevent and control infection in facilities. That fund, added Schulte, includes money to boost workers’ wages.

The Liberal government last fall also committed $38.5 million over two years for training and placement of up to 4,000 personal support worker interns to address “acute” labour shortages in long-term care and home care.

On the matter of for-profit long-term care, Schulte said that “all providers need to be accountable for protecting those in their care,” noting that the nursing-home landscape is different across the country.

For instance, all long-term care facilities in the Northwest Territories are publicly owned, while in New Brunswick, all of them are in private hands. In British Columbia, publicly subsidized and private-pay beds are allowed within the same facility. “Our focus has really been on making sure that seniors, no matter what facility they’re living in, get the care that they need and that those facilities get the support that they need,” said Schulte.

However, if there was unanimity among the provinces and territories to remove for-profit homes, the federal government would support such a move, said Schulte.

For now, her focus is on national standards. Schulte said that discussions have begun with the provinces and territories to establish a national framework and an update is coming in the “near term.”

Also pledged in last year’s throne speech is a change to the Criminal Code “to explicitly penalize those who neglect seniors under their care, putting them in danger.”

Schulte said that while the federal government is taking “the leadership role,” it does so “in co-operation” and “respectful of our provincial and territorial partners who have the jurisdiction over this sector.”

In an online roundtable with health-care professionals earlier this month, however, Trudeau said he would not await agreement from the provinces and territories before drafting a national framework.

Canada rates low on spending

There is no time to waste, say experts. A group called Doctors for Justice in LTC has called on the Ontario government to take immediate action to address the “grave humanitarian crisis” involving nursing homes in the province. Among the recommendations are to end for-profit long-term care homes; set a minimum pay standard for frontline staff; and ensure that 70 per cent of workers are full time.

York University sociologist Pat Armstrong, who has studied Canada’s long-term care system since the 1990s, is among the more than 1,000 signatories to the open letter.

A paper Armstrong co-authored for the Canadian Centre for Policy Alternatives last year recommends national standards, with federal funding for nursing homes dependent on several criteria, such as the “establishment and enforcement of minimum staffing levels” and “that all public money goes to public or non-profit organizations, including any sub-contracted services.”

Armstrong told The Tyee national standards should include not just fewer people to a room but better food, cleaning and laundry. A lot of “critical components of long-term care” she said, “are contracted out, creating problems.”

Armstrong said standards should have teeth through “inspections and enforcement” and the goals should be eliminating for-profit homes and for-profit outsourcing.

Dr. Samir Sinha, director of geriatrics at Sinai Health and the University Health Network in Toronto, said that the amount Canada spends on publicly funded long-term care is one-third less than the average by the 37 member countries of the Organization of Economic Co-operation and Development.

He said more money, too, should go to supporting frail people at home. “We also spend a disproportionate amount of our dollars — 87 cents of every dollar — to warehouse people in care homes as opposed to supporting them in their homes. In the average OECD country, a third of their spending goes toward the provision of home and community care — or about three times more than what we spend,” he explained.

Sinha, who led Ontario’s seniors strategy, has written extensively on the need for reform. He told The Tyee Canada’s long-term care system is “disjointed” and “grossly underfunded” with “regulation and enforcement that’s largely toothless.” Eight out of 10 facilities across Canada had trouble keeping staff before the pandemic and too many facilities are old and built for four patients to a room.

Sinha says careful thought needs to be placed on ending for-profit facilities. “Are we going to do a federal buy-back strategy? If we buy a for-profit home, we have to buy out its licenses, its property — that’s billions and billions of dollars. Most of the homes in Ontario are for-profit.”

“We should focus on funding better hours of care and funding for the creation of better facilities, and making sure you have a level of accountability and enforcement around whatever standards and regulations exist.”

“Long-term care homes should be a positive option,” said Armstrong, “not the last and worst resort.”

As Trudeau’s point person on making changes, minister Schulte says she has personal incentive to see them through. “I feel very, very emotional about what our seniors have gone through in the last year and that’s what motivates me to be more focused in getting support to them with our partners, which are the provinces and territories,” said 61-year-old Schulte, whose mother-in-law died last June and was living in a nursing home, and whose father-in-law lives in a retirement residence.

For Jagmeet Singh, progress towards reform can’t happen soon enough. In November, he attended an event called “Broken Hearts, Empty Shoes,” organized by a group called Canadians 4 LTC.

Thousands of empty shoes were laid across the lawn of Parliament Hill to honour the lives of nursing home residents lost during the pandemic.

“Seniors in long-term care are some of the most vulnerable people in our society — who often have complex health issues and many times, dementia or other cognitive impairments through aging,” said Singh. “For our elders, who sacrificed so much for us to have what we have, to be treated this way is just appalling, and it has to end.”