At this point, we are all too familiar with the devastating impact of COVID-19 on long-term care residents. At the time of writing, more than 100,000 Canadians have been infected and 8,700 have died, with deaths in long-term care accounting for slightly more than 80 per cent of Canada’s total COVID-19 deaths.
While these numbers are alarming, the infection and death rates don’t capture the unacceptable conditions in many long-term care facilities and Canada’s generally apathetic approach to older adult care. This was the case before and during the pandemic, and, if we do not make a change, it will continue to be the case once COVID-19 is well behind us.
What went wrong in long-term care
The issues with long-term care are long-standing and well-known. Chronic underfunding, outdated infrastructure, inadequate staffing levels, poor pay and benefits for mostly part-time work and a patchwork system made up of public, private, non-profit and for-profit providers are just some of the most cited concerns.
Add to this a new strain of coronavirus; governments and health experts that were caught off guard and focused on shoring up hospitals to deal with the influx of patients; and, in many cases, governments and long-term care providers reacting slowly in implementing safety protocols and sourcing personal protective equipment, and you end up with the tragic circumstances that transpired in many long-term care homes.
Many other factors likely contributed to the conditions in long-term care during the pandemic. There are also governments and facilities that managed to curb the impact of the virus and remain relatively unaffected — in Canada and around the world. It will be essential to examine what went right as well as what went wrong, and leverage these findings to protect residents of these facilities in the future.
COVID-19’s impact on home and community care and informal caregivers
While long-term care has been in the spotlight, home and community care services were also affected by the virus. Many providers cut back on “non-essential” services to limit the spread of the virus. A survey conducted with the three largest providers of these services in Canada found that in the weeks after the lockdown, home nursing care fell by 22 per cent; personal support workers’ services were reduced by 31 per cent; and home-based treatments, such as physiotherapy and occupational therapy, dropped by 65 per cent.
In addition, respite care and other services for informal caregivers were also cut due to the virus. At a time when many informal caregivers faced increased stress and additional caregiving duties, supports for these people were essentially non-existent.
Moving forward, increasing the availability of home and community care services as well as improving direct supports and services for caregivers will help ensure more care is provided at home, where the spread of infections and viruses is reduced.
The aftermath of COVID-19 and older adult care
Over the coming months and years, conditions in long-term care facilities during the pandemic will be investigated, studied and hopefully, rectified. Many governments, public bodies and agencies have already announced their intention to conduct reviews.
While these reviews are necessary, and their findings important, long-term care is only one aspect of older adult care. In thinking about reforms, it is essential to consider improvements to home and community care and supports for informal caregivers.
A shift to more home and community care
If Canada learns anything from this pandemic, it should be that we rely too heavily on institutional care to meet the needs of older adults, ignoring evidence from global counterparts and the wishes of those who need care. Instead, we should expand home and community care services, which are less costly, align with older adults’ wishes to age at home and in their communities and lead to better health outcomes and quality of life.
This requires a national shift from a reliance on institutional care to providing care in homes and communities. It also involves implementing national standards for long-term care, home care and other older adult care, to ensure a baseline level of quality care across the country.
National standards for older adult care
This shift has to come from the top down. Government — and likely the federal government — will need to enact laws that support this new direction.
This is because the Canada Health Act, which outlines Canada’s public health-care framework, focuses heavily on establishing criteria, conditions and funding for hospitals and physicians — perhaps because its drafters borrowed much of the language from the Medical Care Act of 1966. In 1966, Canada had a young population and people aged 75 and over accounted for just three per cent of the population. Consequently, health services to support them, such as those in long-term care and home care, were not on the agenda.
Today, Canada’s population is older, and people aged 75 and over make up 7.4 per cent of the population — a demographic that is growing rapidly. The Association, for example, counts 27.6 per cent of its membership at 75-plus. People are living longer and developing chronic conditions and degenerative diseases such as dementia. Care for these people isn’t delivered by physicians and hospitals, but by personal support workers, nurses, informal caregivers, long-term care and home and community care. Canada’s health-care framework must adapt to our changing demographic and needs.
The benefits of national standards for older adult care are apparent when looking at the global pandemic experience. A report released in May 2020 by the Canadian Institute for Health Information compared Canada’s COVID-19 experience to 16 other OECD (Organization for Economic Co-operation and Development) countries, and found that while no clear differences in outcomes were observed across funding models — public, private or mixed — countries with centralized regulation and organization of long-term care, such as Australia, Austria, Hungary and Slovenia, generally had lower numbers of COVID-19 cases and deaths.
Canada has one of the highest rates of institutional care and one of the lowest rates of home care among developed countries. This likely contributed to the high proportion of COVID-19 deaths in long-term care. It also highlights misalignment between Canada’s approach and that of its global counterparts, many of which already rely heavily on home and community care.
In Denmark, regular monitoring of an older adult’s needs starts at age 75. Home-care services coupled with routine house calls by health professionals empower older adults to remain at home and part of their community for as long as possible, and to live independently while receiving support for activities with which they need help. Denmark has long-term care homes, but they more closely resemble living in a house with roommates than in a medical facility. This approach has led to a happy, active and engaged older adult population and Denmark being recognized as one of the best countries in which to grow old.
In considering reforms to older adult care, we can’t forget informal caregivers, who provide an estimated 80 per cent of community care and 30 per cent of institutional care. We need to better recognize the contributions of these individuals and provide them with the support they need — financially, psychologically and emotionally — so they are better equipped to carry out their caregiving responsibilities and their role as crucial partners in care.
It is for all these reasons that implementing a national seniors strategy — a key advocacy priority of Federal Retirees — is so vital. This strategy will allow for a comprehensive and co-ordinated approach to older adult care and help address many of the issues currently plaguing our system.
As part of such a strategy, Federal Retirees is calling for all levels of government to collaborate on a national review of long-term care and implement national standards for long-term care and home and community care. To learn more about our position, visit federalretirees.ca/ltc. Join our Reach 338 network and support our campaigns for a national seniors strategy and a more comprehensive and co-ordinated approach to older adult care. Visit federalretirees.ca/joinreach338 or email advocacy.