As hundreds of long-term care homes across the country grapple with new outbreaks of COVID-19, highly-anticipated draft national standards for these facilities are being released today.
The pandemic exposed fatal weaknesses in Canada’s long-term care sector. In the first few months of the pandemic, more than 80 per cent of Canada’s known COVID-19 deaths happened in long-term care and retirement homes — the highest such rate among nations in the Organisation for Economic Co-operation and Development (OECD).
“I’m hoping. My God, I’m hoping that this will be a clear blueprint that really can enable provincial and territorial and federal action to move long-term care to where all Canadians are demanding it to go,” said Dr. Samir Sinha, director of geriatrics at Sinai Health and the University Health Network in Toronto.
Sinha chaired the Health Standards Organization technical committee that drafted the proposed standards. The HSO is an independent, not-for-profit organization that develops standards and assessment programs for the health and social services sectors.
The federal government launched the project to draft new national standards last spring. Today’s report from the HSO revises standards affecting the quality of direct care — but not standards related to infection control.
Infection control standards are being rewritten by the Canadian Standards Association (CSA), which is also looking at ventilation, plumbing and medical gas systems in long-term care facilities. The CSA’s draft standards are expected sometime in February.
The HSO’s proposed national standards go well beyond the current ones, which were last updated in 2020. The draft regulations focus on resident-centred care and run to eight new sections, 17 new clauses and 148 new criteria.
“We didn’t want to leave anything out. We want to really outline everything that we think needs to be properly assessed … properly coordinated,” said Dr. Sinha.
Giving residents more autonomy
The draft standards are intended to give long-term care residents more control over their lives by giving them a greater say in daily care decisions and visitor policies. They would direct long-term homes to plan meaningful daily activities and facilitate social connections between residents, both inside and outside of facilities.
The HSO document includes a section on defining and protecting the right of residents to “live at risk” — to, for example, balance facilities’ need to protect their residents with the right of individual residents to receive visitors.
While the document doesn’t state clearly where that balance should be struck, it’s clearly intended to address the isolation and loneliness suffered by many long-term care residents who were cut off from in-person visits early in the pandemic.
“I was actually very disheartened to see that we did not get the balance right between keeping residents safe from a virus and separating them from their families. The outcome, in many cases, was detrimental to residents,” said B.C.’s former health minister Terry Lake, now CEO of the B.C. Care Providers Association. Lake had not yet seen the draft standards when he spoke to CBC News.
Susan Mills’ mother Barbara, who is 86 and has dementia, is a resident at The Grove Nursing Home in Arnprior, Ont. Mills said the forced isolation her mother experienced for almost seven months in 2020 — when she could only see her family through a window — accelerated her decline.
“I feel guilty (she was there) but … I didn’t really have a choice,” said Mills.
‘We have to find that balance’
Barbara’s floor is in lockdown again because of another COVID outbreak. Both Mills and her mother are fully vaccinated and, as an essential caregiver, Mills is allowed to visit her. But the outbreak means more isolation within the facility.
“She is confined to her room 24-7,” said Mills.
Dr. Sinha said the HSO committee heard many similar stories.
“We have to find that balance in terms of allowing residents to live with risk … but also balancing the safety of everybody who’s living in a home,” he said.
The HSO’s proposed new standards also would compel long-term care facilities to prove that they have enough staff to cover required hours of care in each province, and to continuously monitor the safety and effectiveness of the care provided.
The draft standards cover planning for emergencies, such as new disease outbreaks or natural disasters.
Convincing the provinces
Ensuring the new standards are adopted and enforced will take government money, said Lake — “a lot of money.”
He acknowledged that provinces will be reluctant to let Ottawa set standards in their jurisdictions.
“However, if there is a national standard that is funded,” he added, “then I’m sure that provincial and territorial governments would want to ensure that the outcomes that are outlined with that new investment would be met.”
The Liberals promised $9 billion for long-term care during the last election, in addition to the $3 billion over five years already committed in the last budget.
In the mandate letter Health Minister Jean-Yves Duclos received when he took over the portfolio, Prime Minister Justin Trudeau tasked him with bringing in new legislation to improve the state of long-term care.
CBC News asked Duclos’ department when the legislation will be tabled and whether it will include national standards.
‘If it’s not done now, it will never be done’
“As long-term care falls under provincial and territorial jurisdiction, any legislation will be designed in a manner that reflects jurisdictional responsibilities,” said a department spokesperson in an email to CBC News. “The federal government will work collaboratively with provinces and territories, while respecting their jurisdiction over health care, including long-term care.”
Many hope the pandemic’s silver lining will be tangible improvements to long term care. Mills said she fears the window of opportunity for change is closing.
“In my view, if it’s not done now, it will never be done,” she said. “The pandemic has shown the flaws that were obviously there before and not addressed.
“So if there is no legislation in the coming few years, I would say then there will be no changes to long-term care.”
The HSO’s draft standards will be open to public review for 60 days. The CSA’s proposed standards, expected in February, also will be subject to public input for 60 days. The final standards are expected this fall.