Demands grow for national, universal long-term care in response to pandemic

The COVID-19 crisis has exposed critical vulnerabilities in Canada's network of long-term care facilities. Now, momentum is building in support of major reforms to improve care for the country's elderly by making long-term care a publicly funded, universal system.

Painting a grim picture of the situation in seniors' homes across the country, Amanda Vyce, representing CUPE members who work as care aides, said residents are often left unbathed in soiled diapers or clothing by overworked and underpaid staff.

"COVID-19 didn't create the deadly crisis we're facing in long term care. The systemic issues that facilitated this heartbreaking situation existed long before this moment. What the pandemic is doing is shining a spotlight on those problems and making them worse," she told the House of Commons health committee today.

Vyce urged the federal government to work with provinces and territories to bring long-term care under the Canada Health Act, making it a publicly insured core health care service that is accessible and universal.

She also called on the federal government to provide adequate, targeted funding for long-term care through the Canada Health Transfer.

Vyce said the federal government should work to enforce a national standard of 4.1 hours of hands-on care per resident every day — and eventually eliminate private, for-profit ownership of nursing homes.

The COVID-19 crisis and its disproportionate impact on long-term care facilities has ignited a debate over long-term care in Canada. Nearly 80 per cent of COVID-19-related deaths in this country have happened in seniors' homes — a statistic Vyce called "horrifying."

A Conference Board of Canada study in 2017 projected that another 199,000 long-term care beds would be needed by 2035 — a vast increase over the 255,000 beds available in 2016.

Vyce said the largely profit-driven private care system is characterized by low wages, precarious employment and high levels of workplace violence and injury that make it difficult to recruit and retain workers. That, she added, has left long-term care homes dangerously short-staffed for more than a decade.

When a staff member calls in sick, she said, often they're not replaced — adding to an already heavy workload.

"When this occurs, staff rush from resident to resident to perform care. For residents, it means they may not receive their bath, their call bell may go unanswered, or they may sit or lay in a soiled diaper for hours," she said. "When workers don't have adequate time to perform necessary tasks, the quality of resident care suffers."

Situation is 'appalling and unacceptable': NDP MP

Tamara Jansen, the Conservative MP representing the B.C. riding of Cloverdale–Langley City, told CBC News in an email that the crisis in Canada's long-term care facilities was made worse by a lack of access to personal protective equipment (PPE). 

"We have discovered that lack of access to personal protective gear for health care workers has contributed to the spread of infection in senior care facilities," said Jansen. "From previous pandemics we already know the importance of having a well-maintained stockpile of PPE. The Liberal government has no excuse for the situation we find ourselves in."

NDP health critic Don Davies called the current situation in Canada "appalling and unacceptable." He said the country must move to bring long-term care under the Canada Health Act.

"When seniors are in hospital, they are cared for in our public system. When they are transferred to long-term care, there is no reason this should change," he told CBC.

"I think bringing long-term care under our public health system is key to addressing the deplorable conditions our seniors in care face. It would also result in more effective and efficient care."

Erin Strumpf, a health economics expert at McGill University, said the arguments in favour of publicly funded long-term care would be similar to those in support of a national pharmacare program.

"It would not necessarily be more expensive overall, but it would be more expensive for provincial and territorial governments. The extent of this shift toward the public sector would depend on current programs and mix of financing," Strumpf told CBC.

With increased public coverage likely would come a greater demand for long-term care (LTC) services, Stumpf said — and without an increase in the supply, that could mean longer wait times and increased in-hospital costs.

Greater government involvement also could improve the quality of care in long-term settings through regulation and workplace incentives, she said.

In a media statement, Canadian Nurses Association CEO Mike Villeneuve said that Canadians should have access to long-term care based on their needs, not on their ability to pay.

"We will be advocating for a dramatic overhaul of the LTC system from the ground up. Whether that means LTC falling under medicare or some parallel agreement remains to be determined and we do not want to presume those policy decisions," he said.

During today's health committee meeting, Liberal MP Marcus Powlowski, a medical doctor from Thunder Bay, Ont., said he sees widespread agreement that long-term care in this country needs significant improvements. But he wondered aloud how society would pay for it.

Where to find the money?

"Can we as a society afford to put that much more money into looking after elderly people? How are we going to find the money?" he asked.

Vyce said questions of funding social policy programs are usually complex and difficult.

"Where there is a political will, there is a way to find the money and to provide it to the services where it is most needed to support Canadians," she replied.

The Canadian Institute for Health Information (CIHI) projected in 2017 that Canada's population of people aged 65 and older would jump by 68 per cent in 20 years. It predicted the number of people aged 75 and older would double over the same time period.

Last month, as deadly COVID-19 outbreaks erupted in long-term care facilities, Health Minister Patty Hajdu said it's time to re-evaluate the tendency to "devalue" the work of caring for people, including children and the elderly. She said the devastating impacts of the pandemic on seniors' homes offer an opportunity to move toward a better system for caring for the elderly.

"That is a large project for Canada, but it's one that I'm excited about, actually, because I think in every crisis there's a silver lining," she said.

"And the silver lining for us is I think collectively, with the provinces and territories, to think about how we will move forward from this time and really refocus our efforts to make sure everybody has an opportunity to age in dignity with the care that they deserve at the end of their life."