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Restoring Trust: COVID-19 and The Future of Long-Term Care
The federal government must immediately commission and act on a comprehensive, pan-Canadian, data-based assessment of national standards for necessary staffing and staffing mix in nursing homes. National standards must encompass the care team that is needed to deliver quality care and should be achieved by tying new federal dollars to those national standards.
The federal government must establish and implement national standards for nursing homes that ensure (a) training and resources for infectious disease control, including optimal use of personal protective equipment and (b) protocols for expanding staff and restricting visitors during outbreaks.
The provincial and territorial governments, with the support of new funding from the federal government, must immediately implement appropriate pay and benefits, including sick leave, for the large and critical unregulated workforce of direct care aides and personal support workers. Appropriate pay and benefits must be permanent and not limited to the timespan of COVID-19. Pay and benefits must be equitable across the country and equitable both across the LTC sector and between the LTC and acute care sectors for regulated and unregulated staff.
Provincial and territorial governments must make available full-time employment with benefits to all unregulated staff and regulated nursing staff. They should also evaluate the impact on nursing homes of “one workplace” policies now in effect in many nursing homes and the further impact on adequate care in other LTC setting such as retirement homes, hospitals and home care. Provincial and territorial governments must assess the mechanisms of infection spread from multi-site work practices and implement a robust tracking system.
Provincial and territorial governments must establish and implement (a) minimum education standards for the unregulated direct care workforce in nursing homes, (b) continuing education for both the unregulated and regulated direct care workforce in nursing homes and (c) proper training and orientation for anyone assigned to work at nursing homes through external, private staffing agencies.
To achieve these education and training objectives, provincial and territorial governments must support educational reforms for specializations in LTC for all providers of direct care in nursing homes, care aides, health and social care professionals, managers and directors of care.
Provincial and territorial governments, with the support of federal funds, must provide mental health supports for all nursing home staff. In addition to extraordinarily stressfulpandemic working conditions, these staff are experiencing significant deaths among theolder adults they have known for months and years, and among colleagues. They are grieving now, and this will continue.
Federal support of the LTC sector must be tied to requirements for data collection in all appropriate spheres that are needed to effectively manage and support nursing homes and their staff. Data collected must include resident quality of care, resident quality of life, resident and family experiences, and quality of work life for staff. Data must be collected using validated, appropriate tools, such as tools suitable for residents with moderate to severe dementia. Captured data must address disparities and compounding vulnerabilities among both residents and staff, such as race, ethnicity, language, gender identity, guardianship status, socioeconomic status, religion, physical or intellectual disability status, and trauma history screening.
Data collection must be transparent and at arm’s length from the LTC sector and governments. Provincial and territorial governments must evaluate and use data to appropriately revisit regulation and accreditation in nursing homes. They must take an evidence-based and balanced approach to mandatory accreditation, as well as to regulation and inspection of nursing homes. They must engage the LTC sector in this process, particularly the people receiving care, their families, managers and care providers.
Canada’s choice Canadian nursing homes have generally been able to “just manage.” However, just managing is not adequate. Then came COVID-19, a shock wave that cracked wide all the fractures in our nursing home system. It precipitated, in the worst circumstances, high levels of physical, mental and emotional suffering for our older adults. Those lives lost unnecessarily had value. Those older adults deserved a good closing phase of their lives and a good death. We failed them. We have a duty to care and to fix this—not just to fix the current communicable disease crisis, but to fix the sector that enabled that crisis to wreak such avoidable and tragic havoc. We have the capacity, the knowledge and the resources to take immediate steps toward restoring the trust we have broken.