Standards group calls for sweeping post-pandemic changes to how long-term care homes operate

A national standards association is calling for profound changes to the way Canada's long-term care facilities are run after the pandemic exposed serious weaknesses that contributed to thousands of deaths.

The package released today by the Canadian Standards Association runs to 338 draft recommendations for new long-term care standards.

Among other things, the CSA is calling for single rooms with private bathrooms for long-term care residents, dedicated hand-hygiene sinks and better contingency plans for staffing shortages when "catastrophic" events occur.

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).

According to the National Institute on Ageing's latest numbers, more than 16,000 residents of long-term care homes in Canada have died because of COVID-19. Thousands of staff members in long-term care facilities have been infected as well, and more than two dozen of them have died as a result.

"We really took a different approach in the development of these standards," said Alex Mihailidis, chair of the CSA Group technical subcommittee that developed the draft standards. He said the advisory group that came up with the standards included long-term care residents and family members.

"The hope here is that they all now have skin in the game … The hope is that they will lead the charge to see change from within," he said.

The CSA draft standards released today are part of a larger package of standards requested by the federal government last spring. The first part of that package, released at the end of January by the Health Standards Organization (HSO), proposed standards for the quality of direct care that covered things like staffing and residents' rights.

Infection control, private bathrooms

The CSA draft standards are comprehensive and include detailed infection control measures covering such things as PPE supplies, laundry and waste management and rules for cleaning a room after an outbreak or death.

They also cover aspects of day-to-day functions — such as helping residents eat, bathe and go outside — and visitation policies. They include a section on staff training and education as well.

The CSA document proposes new standards for the design of long-term care facilities themselves. It calls for single-occupancy rooms with private bathrooms and improvements to ventilation and medical gas systems.

Mihailidis said CSA drafted the standards with the goal of keeping residents safe while giving them more control over their lives.

"We kept in mind throughout … even though it's quite technical in some places, that these are people's homes," he said.

"We are not developing a standard for a hospital or medical facility. These are most likely the last homes that many individuals would be living in."

A right to privacy

Which is why the CSA document includes a section on respecting the rights of residents with the capacity to "consent to sexual and intimate acts" and to "engage in such activity as long as it is not illegal." The CSA also calls on long-term care facilities to offer residents privacy for "intimate acts" and "conversation."

But these standards won't automatically become binding when they're finally published in the fall because they're not in legislation yet.

The federal government has promised a new long-term care act that it insists will respect provincial jurisdiction over the long-term care sector. It's not clear whether provinces would be compelled to adopt and enforce the standards in that law, or whether they'd have the option of drafting their own revised standards.

And adopting and enforcing the CSA's recommended standards — especially the ones dealing with physical infrastructure and staffing — would be expensive.

"You can't meet a standard if you don't have the money," Michele Lowe, executive director for the Nursing Homes of Nova Scotia Association, told CBC News before the draft standards were made public.

"There's been this narrative that long-term care facilities and operators should have done better and they chose not to do better. But the reality in many of these cases is they didn't receive the funding from the department of health in those provinces."

The pandemic and the profit model

Larry Baillie's father Glenn Baillie died during a particularly dire long-term care home outbreak in Winnipeg in 2020. He said he agrees that funding is a big problem — but so is the industry's for-profit model.

"One year before (the pandemic), the physical therapist told me, 'We don't have enough money to provide care, but they had enough money to pay the shareholders,'" he said, adding he strongly supports the idea of national standards.

"Do not be fooled. For-profit means for-profit."

The Liberals promised $9 billion for long-term care during the last election, in addition to the $3 billion over five years already provided in the last budget.

"What price do we put on folks living in long-term care? These are our parents, our grandparents, as well as the workers that … are exposed as a result of going to work in the morning," said Mark Hancock, national president of CUPE, a union representing about 90,000 long-term care workers across the country.

New standards will be costly

The CSA is proposing different standards depending on whether a facility is an existing structure or a new build. For example, it calls on existing long-term care homes with rooms housing multiple residents to convert them into rooms for a maximum of two residents.

It says existing facilities should ensure they have a single room available to manage communicable infections or palliative care, and should provide private roll-in showers if resident washrooms don't have individual shower enclosures.

Mihailidis concedes that not all long-term care homes will have the resources to do everything the CSA recommends.

"We tried to provide as many different options and clauses and approaches so that if a home needs to pick and choose, they can do so," he said.

Hancock said he hopes to see the promised funds in the upcoming federal budget. He said he wants to see that funding linked to improved standards in the sector, even though health care is a provincial responsibility.

"We've seen in many cases that provinces are paying lip service to the federal government," he said. "So I think there's some real need to have teeth in these standards."

In the mandate letter Health Minister Jean-Yves Duclos received when he took over the portfolio, Prime Minister Justin Trudeau tasked him with introducing new legislation to improve the state of long-term care. The government has said such legislation would respect provincial and territorial jurisdiction but has not said when it will be tabled.

Larry Baillie said that what happened to his father and others in long-term care could have been prevented if Canada's health care policy valued seniors.

"We should … not look at them as an older person laying in a bed, but look at him as Glenn Baillie, owner of Spoke & Edge (ski shop) and president of Rotary," said Baillie. "We need to cherish them."

The proposed standards are subject to public input for the next 60 days.