Canada must radically reform disastrous long-term care system
Posted: April 8, 2021
(April 01, 2021)
By: Karl Nerenberg
Long-term care for the elderly is the weak sibling of Canada’s health system. If we did not know that previously, the COVID-19 pandemic has proven it conclusively.
During the first wave of the pandemic last spring, the Canadian Institute for Health Information (CIHI) reported that among a group of OECD countries, including the U.S., Australia, the U.K., Italy, Spain and France, Canada had the highest death rate from COVID-19 in long-term care homes.
Among CIHI’s other disturbing findings: long-term care residents received less medical care during the first wave of COVID-19 than in normal years.
Given there was a new and grave health threat, one might have expected seniors to receive more, not less, medical attention. That was not the case. The elderly in long-term care facilities, CIHI tells us, had “fewer physician visits and were less often transferred to hospital for the treatment of chronic conditions and infections.”
CIHI also affirms what most of us already knew, to wit, that during the pandemic the elderly “had fewer contacts with friends and family, which was associated with higher rates of depression.”
CIHI compares the carnage in long-term care facilities during the first wave, from March 1, to August 31, 2020, to what happened during the second, from September 1, 2020 to February 15, 2021, and finds no significant improvement.
In fact, the number of outbreaks in long-term care homes increased from the first to the second wave, from a bit fewer than 1,200 to almost 1,400. The number of individual cases — elderly residents who contracted COVID-19 — increased by more than 50 per cent, from a bit more than 21,000 to more than 34,000.
The only slightly good news is that the death rate relative to total cases went down from the first wave to the second, from 34 per cent, to a still frightfully high 22 per cent.
Put differently, during the first wave more than one in three elderly residents who contracted the disease died from it — a disastrous and gargantuan death toll. During the second wave, more than one in five afflicted with COVID-19 ultimately died. That would merely be a huge death toll. There were well over 7,000 deaths in each of the waves.
Systemic discrimination against old people
By now, we Canadians should all be well aware of this shameful record. But we might not fully appreciate the extent to which political choices, over decades, have contributed to much of this death and disease.
Some in Ontario have characterized the treatment of the elderly during the pandemic as a clear case of systemic age discrimination, and they are doing something about it.
Three groups, the Canadian Union of Public Employees (CUPE), the Advocacy Centre for the Elderly (ACE), and the Ontario Health Coalition, are asking the Ontario Human Rights Commission to take on the case of the elderly in long-term care and COVID-19.
They contend the suffering of elderly residents in long-term care during the pandemic period is a flagrant case of age-based bias.
In their letter to the Human Rights Commission, the three groups identify a number of issues, but focus mostly on cuts, over a long period of time, to Ontario’s hospital capacity.
From 1990 to 2014, the group points out, as Ontario’s population grew by a third, the province eliminated more than half of its chronic-care hospital-bed capacity — a cut of 6,100 beds.
This resulted in what the group calls the “de-hospitalization” of frail and sick elderly Ontarians. To make matters worse, Ontario has, for many years, “under-resourced” long-term care homes. That has meant too much crowding, and too few nurses, therapists, social workers, and personal support workers.
The pandemic revealed the disastrous cost of de-hospitalization.
When elderly residents became ill, often seriously ill, long-term care homes were extremely reluctant to transfer them to hospitals, even when the residents’ health conditions clearly warranted such transfers.
Elderly residents’ families relate “instances where long-term care homes could not provide safe and adequate care” for their loved ones. Yet they refused to transfer those residents to hospitals — or only did so after residents experienced an unacceptable degree of “grave suffering.”
Lawyers for the Advocacy Centre for the Elderly report “they received numerous calls from families who had to compel long-term care homes to call an ambulance to transfer their loved ones to hospital during the first wave of the pandemic.”
The group’s letter to the Human Rights Commission lays this scandal squarely at the feet of the provincial government. They say policies of the Ford government created a “culture of hospital avoidance” — a culture which left far too many elderly Ontarians with “minimal care while they were dying.”
The group explains the longstanding drive to de-hospitalize as a function of an effort to offload treatment of conditions that are not acute from hospitals to other facilities.
If people arrive at hospitals suffering heart attacks or as accident victims or requiring cancer surgery, there’s a place for them. If, on the other hand, they have conditions which require “complex continuing care, rehabilitative care or palliative care,” they are, for the most part, supposed to seek care outside the hospital system.
“Patients with these care needs,” the group alleges, “have been offloaded from hospitals to an array of facilities outside of the Public Hospitals Act.”
The effect of this offloading is to remove “patients from the protections of public insurance without user fees and extra billing,” as guaranteed by the federal Canada Health Act.
“These patients, who are predominantly and disproportionately elderly, have been sent to their own homes, retirement homes, transitional care units and hotels, sidestepping the protections provincial and federal legislation is supposed to afford them.”
NDP suggests feds and provinces together can fix long-term care
And there is the heart of the problem.
In Canada, long-term care for the elderly sits in an uncomfortable place between our largely public-sector health-care system, which guarantees equal treatment to all, and a patchwork system, which is partly based on a social welfare model and partly controlled by the private sector, subject to the imperatives of profit.
Like the health-care system in general, fixing long-term care will require a high degree of cooperation between the federal and provincial governments. The current federal Liberal government has pledged to tackle this challenge. For now, however, the Trudeau government is keeping its cards close to its chest.
In Parliament, New Democrats are playing their habitual role on the long-term care issue. They are trying to flush the government out of the bushes, and get it to commit to something specific, by making a comprehensive proposal of their own.
On Monday, March 22, NDP Leader Jagmeet Singh put a motion on long-term care before the House, enjoining the government to “ensure that national standards for long-term care, which are currently being developed, fully remove profit from the sector.”
More tangibly, Singh’s motion proposes the government offer the provinces $5 billion for long-term care over the next four years — with an important proviso, namely that funding be “tied to respect for the principles of the Canada Health Act.”
As well, the NDP wants the government to commit to “transitioning all for-profit care to not-for-profit hands by 2030.” Toward this end, federal authorities should work “with provinces and territories to stop licensing any new for-profit care facilities,” while “making sure measures are in place to keep all existing beds open during the transition.”
Speaking to his motion the New Democratic leader referred to the Canada Health Act of 1984, which put a stop to such practices as extra billing:
“Those same principles helped us achieve what Canadians now are most proud of: universal health care. We can use those same principles to lift up our vulnerable seniors in long-term care homes.”
The experience of the pandemic shows “we cannot go back to a health-care system where making money and profit was more important than the care of our vulnerable seniors. We cannot go back to a time when, if a pandemic or an outbreak happened, our loved ones in long-term care would bear the brunt of it.”
Now is the time for action, not “moments of silence” and “tributes to lives lost,” Singh says. “It is not enough to talk about being sorry or to wring our hands. Here is the moment to do something about it.”
As for the other parties in the House, the Bloc Québécois is clear. It opposes national standards, full stop. That would be a clear intrusion into provincial jurisdiction, the Quebec-based party says.
Liberals and Conservatives are less emphatic on that score, although both rhetorically asked Singh and other New Democrats if they had consulted any provincial governments before drafting their motion.
Otherwise, when Conservatives and Liberals spoke to the NDP motion, they mostly sounded as though they were on the same wavelength as the New Democrats.
For the Conservatives, MP Rosemarie Falk said:
“We need to work toward a comprehensive plan that will deliver substantial solutions for our seniors in care … There is no time to delay. We have seen throughout the pandemic the real human costs of neglecting this sector.”
Liberal Health Minister Patty Hajdu was more emphatic.
The minister declared:
“The government has committed to establishing national standards for long-term care as a means to address critical gaps in long-term care facilities, including the working conditions of lower-wage essential workers in senior care, particularly personal support workers, who have persevered in the face of adversity … Our government is taking action to support residents of long-term care homes, but we do know there is more to do.”
Former Green party leader Elizabeth May was the most supportive of Singh’s proposal. In fact, she pointed out that her party has been advocating for similar measures to those in the NDP motion.
May recognizes there is a thorny question of federal and provincial jurisdiction at play here. To resolve that, and get action on long-term care, the Green MP suggests to the Liberals they convene an “emergency summit of federal-provincial leadership to think about whether we can do better and overcome the jurisdictional barriers.”
In the end, as with the NDP’s earlier motion on pharmacare, only the three Green MPs joined the New Democrats in voting for this motion. Despite their rhetorical expressions of support, Liberals and Conservatives joined Bloc MPs in voting nay.
Now we have to await the coming federal budget. It will give the Trudeau government a chance to show what role, if any, it believes the federal government can play in reforming a long-term care system that has miserably failed the elderly during the COVID-19 pandemic.
Keep an eye on the Trudeau government’s first budget in two years, coming on April 19, in less than three weeks’ time.