New long-term care standards will fall flat without money or enforcement, experts warn

Critics argue the $3 billion offered by Ottawa is nowhere near enough

Minister of Health Patty Hajdu listens during a news conference on the COVID-19 pandemic in Ottawa, on Friday, Dec. 4, 2020. (Justin Tang/The Canadian Press)

Karina Roman · CBC News · Posted: May 22, 2021

[Excerpts] The federal government is spending $3 billion over five years to establish new standards to improve long-term care in Canada. Advocates say the money alone is not enough — that they want measures to ensure new standards actually lead to better care for seniors.

Expectations are high for the new standards, now being developed by the Health Standards Organization (HSO) and the Canadian Standards Association (CSA). The work will take at least another 20 months but those involved say they hope new standards can help prevent the dire conditions that contributed to high pandemic death rates in the long-term care sector.

In the first wave of the pandemic, long-term care facilities saw 80 per cent of Canada’s total COVID-19 deaths. Outside of Quebec and Nova Scotia, deaths in long-term care actually increased in the second wave.

But experts warn that new standards alone won’t solve the many problems in the sector exposed by the pandemic. They say they fear that, after decades of government indifference to long-term care, public pressure to fix those problems might fade as the pandemic wanes.

“I do not want these standards to sit on a shelf and not be used,” said Alex Mihailidis, technical subcommittee chair for the CSA.

“If we can take anything positive out of this pandemic and everything we’ve seen happen … I think we are at the tipping point and that is going to really drive the political will and social will forward and ensure that these standards are really taken seriously.”

What would new standards look like?

Experts say the long-term care sector needs to improve both the delivery of care and the operation of its facilities. That extends to everything from the number of hours of direct personal care residents should expect to staff-resident ratios and infection prevention and control practices.

It also includes ventilation systems, plumbing, medical gas systems and facilities’ use of technology. All of those things could depend on possible new infrastructure standards, which could dictate how new long-term care homes should be built, how many residents can be put in a single room and how common and isolation areas should be constructed.

The HSO and CSA also will have to work out how infrastructure standards would apply to existing buildings.

“We’re pushing to basically say with everything that we’ve learned so far, with everything we’re learning about the state of long-term care in Canada, how do we actually make these new standards pandemic-proof?” said Dr. Samir Sinha, the director of geriatrics at Sinai Health and the University Health Network in Toronto. He’s heading up the technical committee for the HSO.

The HSO already has standards for long-term care homes; the pandemic proved they’re clearly insufficient. Across Canada, almost 70 per cent of long term care homes are accredited based on either those HSO standards or a U.S.-based equivalent.

In Quebec, 100 per cent of homes require accreditation. But Quebec’s long-term care homes were among those hardest-hit by the pandemic.

Dr. Sinha acknowledges that 20 months is a long time to wait for new standards, but the work takes time.

“This is actually how you end up developing good quality standards. Or do you want to just be politically expedient and get more of the same of what?” he said.

“Because whatever we’ve been doing so far, frankly, hasn’t worked well. Now that everybody’s attention is on this, I’m determined to make sure that we do this right.”

Will new standards make a difference?

The answer to that question depends on what the provinces do. Provinces — which are primarily responsible for long-term care — will be called on to spend the money needed to meet those standards and to fill massive staffing shortages.

Experts also say the effect of new standards will depend a lot on whether they’re mandatory, and whether those facilities caught violating them can expect penalties.

“Unless they’re mandatory, then they are a wish list of what we think is important and that’s not going to really make substantive change,” said Laura Tamblyn Watts, CEO of CanAge — a national seniors advocacy organization — and an adjunct professor at the University of Toronto.

“So it’s important that those standards have some type of force of law and that breaking them [has] some type of profound penalty against them.”

Tamblyn-Watts said long-term care homes almost never lose their licenses to operate for violating standards and the fines they face are “almost laughable.”

Technically, the federal government could create its own legislation and regulations to make the standards mandatory. Experts say that’s unlikely.

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