The COVID-19 crisis has revealed deadly structural flaws in how we care for our elderly. As of May 7th, 82% of COVID-19 related deaths were amongst Long-term Care (LTC) residents and staff and Canada had the highest proportion of deaths from COVID-19 in LTC settings among 14 countries. Lack of surge capacity, allowing patients with COVID-19 to wander, and understaffing no doubt led to more loss of life. The recently released military report detailing “horrific” conditions in for-profit LTC facilities in Ontario exposed shocking failures in LTC. However, the truth is that LTC was in dire straits ahead of this pandemic, and COVID-19 has simply underscored how close to the breaking point we have been.
When our universal healthcare system was first established in the 1960s, the average Canadian had a life expectancy of less than 70, and a higher proportion of seniors lived at home with their family. With advances in healthcare, many Canadians can expect to live to the age of 85 or older, approximately 1 in 3 Canadians over 85 now live in some form of LTC facility, and the long-term care population has surged to the hundreds of thousands.
LTC in Canada is provided by a patchwork of systems, with a mix of public, private for-profit, and private not-for-profit institutions. Where there is a profit motive in health care, corners are cut. And when corners are cut, people die. For-profit LTC facilities have cut corners when in care through inadequate staffing, and underfeeding. Recent data from our current crisis suggests LTC residents in for-profit facilities are more likely to die from COVID-19.
The provincial and federal governments have been aware of the inadequacies of LTC for decades. As far back as 1984, the Canadian Medical Association (CMA) reported that the standard of care provided in many LTC facilities was “grossly inadequate," and that they failed to provide “any guarantee of adequate basic care." Even then, the CMA recommended "the implementation of strict regulations enforcing meaningful standards" and a transition away from the use of for-profit institutions. The recommendations were sidelined, LTC was not prioritised or included in the Canada Health Act, and seniors have been paying the price ever since.
In recent years, there have been increasing calls from experts for universal public funding of LTC and recognition of its clear role as an essential medical service. Research indicates that such universal coverage is effective in countries where it has been implemented, such as The Netherlands and Norway.
The Green Party of Canada has been very outspoken on the failures of our LTC system. In July 2019, we raised concerns around foreign ownership of these facilities in a letter to Ministers Bains and Goodale. In January and early March, the Green Party of Canada repeated calls for major changes in how seniors’ care residences are operated, and advocated for home-sharing plans and other strategic programs in order to support the wishes of Canadians who prefer living at home. We are now calling for a national inquiry into long-term care facilities.
Long-term care must be included under the Canada Health Act so that we can ensure every Canadian residing in LTC lives safely, and with dignity. Specifically, we must amend the Canada Health Act to include LTC and establish national standards of care.
We need to shift policy towards investing in innovative community-care in recognition of the fact an overwhelming majority of Canadians prefer to live at home for as long as possible. Canada only spends 13% of LTC funding on community and home-based care, lagging behind the OECD average of about 35%. Naturally occurring retirement communities, co-housing models, and enhanced home support programs should be supported. These programs not only respect the autonomy of our seniors, but they are also cost effective as they utilise existing infrastructure.
We must value LTC staff as essential and skilled workers by paying fair wages and increasing staffing to prepare for future pandemics and improve day-to-day function. At present 79% of LTC workers report unhappiness with their profession, evidence that our current system is not only failing residents but also their caregivers. A recent report by the National Institute on Ageing notes that staff in long-term care facilities are underpaid and overworked. Proper expansion passes a cost-benefit analysis as many costs will be covered in new taxable income and savings from reduced hospital care.
Guaranteed Liveable Income (GLI) will work hand-in-hand with our recommendations for LTC reform. We recognize that ~8 million Canadians provided unpaid caregiving for elderly family members each year, and GLI will afford more Canadians the financial flexibility necessary to care for their family at home.
We must expand LTC services. At present, approximately 40,000 Canadians are awaiting LTC beds in expensive hospital rooms. This amounts to $2.3 billion in excess cost that would be saved if we had the requisite beds. Furthermore, it is estimated that we will need ~200,000 new LTC beds by 2035 to accommodate the aging population.
Universal health care is a right and must be guaranteed at every stage of life. Our long-term care system has failed residents and staff members. We will move towards a universal funding model that will increase capacity and recognise the difficult task of caregiving by paying fair wages to workers. We will enact policy that focuses on giving more Canadians the option of living in the community or at home with family. Ultimately, our policy is focussed on maintaining dignity for seniors, whether they are in a LTC facility, in community care, or living in their family home.