A medical technician with the Canadian Armed Forces speaks with a resident at Ste. Anne’s Hospital in Montreal, as part of Operation LASER in 2020, when COVID hit and exacerbated a crisis in long-term care. Photo: Cpl. Geneviève Beaulieu
Across the country, long-term care falls outside the scope of the Canada Health Act and is therefore the primary responsibility of the provinces and territories. As such, long-term care (LTC) varies according to where you live in this country.
The federal government has tried to get the provincial and territorial governments to the table to discuss adopting national LTC standards, a suggestion by the Canadian Standards Association (CSA) Group and the Health Standards Organization. The federal government has also been working on its long-promised Safe Long-Term Care Act, with a view to creating facilities that are person-centred, a workforce that can respond to diverse needs, choice within the health continuum and nationally collected data that can be shared to highlight best practices. That goal may, however, outlast this Liberal government.
Meanwhile, the provinces operate independently. In 2021 in Ontario, the Fixing Long-Term Care Act was introduced, promising to provide an average of four daily direct-care hours per day for residents. Then, in a December 2024 staffing report, the provincial government admitted it had missed its targets. The first- and second-year interim targets were met, but the target of three hours and 42 minutes by March 31 was not hit. The document also said that, due to staffing shortages, there was a need for a further 13,200 nurses and 37,700 personal support workers in Ontario.
Lhamo Dolkar is a nurse practitioner (NP) who specializes in geriatrics and is president of the 54,000 member Registered Nurses’ Association of Ontario.
“I think the state of long-term care was dicey even before the pandemic. The pandemic just brought forth the health-care system gaps that were present and became more evident,“ Dolkar says. “Just in terms of human resources, just in terms of the care delivery that is provided and how far away we were becoming from being patient-centered. It was more task-oriented and residents were being seen more as tasks.“
In 2022, the Ontario government passed Bill 7, the More Beds, Better Care Act, without public consultation. This legislation allowed hospitals to discharge patients to LTC facilities not of their choosing, and in some cases at significant distance from their home communities, or face financial penalties. The intent was to free up hospital beds, but the bill is currently facing a Charter challenge.
To combat its nurse shortage, Ontario has turned to private agencies to fill staffing needs, a solution the auditor-general called “costly and unsustainable.“ Yet in 2019, the government had introduced Bill 124, which capped wage increases for nurses and other public-sector workers at one per cent a year for three years. In November 2023, that bill was struck down as unconstitutional and nurses were awarded retroactive wage adjustments.
The financial flogging was morale-killing for the already overburdened health-care workers, who’d been on the front lines during the pandemic.
Dolkar thinks Ontario allows too many for-profit residences and nursing homes, businesses that are prone to pinching pennies on supplies and staffing. That said, she gives the government credit for pushing colleges to expedite the registration of thousands of international nurses already in Ontario and allowing nurse practitioners (NP) to be employed as clinical directors in long-term care homes. This allows NPs to prescribe medicines for simple problems such as constipation or urinary tract infections. The doctor shortage meant that before this change, patients could end up in hospital because no doctor was available to treat these relatively common problems.
“That meant that you are increasing the number of patients in emergency rooms, creating hallway medicine,“ Dolkar says. “Nurse practitioners [serving] as clinical directors is an answer because they will oversee clinical supervision and be able to look at regulatory requirements that are needed for long-term care. And they would also be able to look at policies that need to be reviewed, revamped, brought in for a long-term care home.“
In recent years, Quebec’s major action on LTC has been to commit to nationalizing the remainder of its private LTC homes by 2025. This commitment came after the Quebec coroner’s report on LTC home deaths during the COVID-19 pandemic, in which one of the recommendations was to convert all private long-term care facilities to state-run long-term care facilities.
British Columbia has made some key improvements in LTC standards since 2020, including wage-levelling for workers and upgrading facilities to include better infection control, more single rooms and better ventilation. The province also committed to continuing to improve in key areas, such as raising the hours of direct resident care from the current 3.36 hours to the recommended four.
Dr. Roger Wong is a clinical professor of geriatric medicine and vice-dean of education in the University of British Columbia’s Faculty of Medicine. Wong does a lot of work with Alzheimer’s disease and dementia patients.
“There’s always conversations about accessing care, including long-term care, the right type of care at the right time,“ Wong says.
He cites common medical illnesses and issues such as a pneumonia, bleeding in the bowels, a stroke, or an accidental fall that leads to a fracture, as things that move seniors from community care to hospital. If the patient is already presenting mental decline, this may push caregivers to consider LTC for their loved ones.
Wong praises the idea of national LTC standards, but says the question is what implementation looks like. Wong suggests a cross-sectoral approach, improving labour practices through better policies and legislations, and finding equitable solutions to meeting the diverse needs of different communities.
He also points out that there is stigma associated with putting your loved ones into long-term care, especially in the Asian and South Asian communities that traditionally live in multi-generational homes.
Soldiers from the Royal 22nd Regiment say goodbye to a patient at Henri-Bradet Accommodation Centre during Operation LASER in Montreal. Photo: Cpl. Marc-André Leclerc
“It’s not just about increasing the number of beds or a number of homes,“ he adds noting the World Health Organization has designated this the decade of healthy aging. “It is very much about rethinking the whole paradigm of providing long-term care. Aging in place doesn’t necessarily mean that you keep the same person at the same geographic location throughout the entire aging journey.“
Janice M. Keefe, professor and chair in the Department of Family Studies and Gerontology at Mount Saint Vincent University and director of the Nova Scotia Centre on Aging, says in Atlantic Canada, which has the oldest population in the country at 20 per cent seniors, human resources are a big issue in long-term care.
“I would say in comparison to B.C. and Ontario, what we’re experiencing for the first time is an increasing proportion of staff, especially the care aides — the frontline staff — who are newcomers to Canada,“ she says. “They’re coming from lots of different places — the Philippines, India, even Africa.“
That shift in demographics among LTC workers is evidenced particularly in Alberta. Keefe says while about 20 per cent of LTC staff in Nova Scotia are new Canadians, in Alberta it is closer to 85 or 90 per cent.
In 2022, the Nova Scotia government invested $65 million in health authorities, long-term care and home care to increase pay by 23 per cent for continuing care assistants, making them the highest paid in Atlantic Canada.
“Quality of care is really important and it gets you to quality of life,“ Keefe says. “But at the end of the day, [in] your last days, you want to have some type of joy or happiness.“
Long-term care plans by party
NDP
The Safe Long-term Care Act, a key plank of the supply and confidence agreement the NDP had with the Liberals, may be in jeopardy if an election is called. Further, the NDP is calling for the abolishment of for-profit LTC and wants to introduce national long-term care standards. The party has also called for the creation of a national seniors strategy.
Liberals
A spokesperson for Health Canada and the Public Health Agency of Canada touted the investment ($7.1 billion over five years) through bilateral agreements with the provinces as a vehicle to allow people to “age with dignity close to home, with access to home care or care in a safe long-term care facility.” The organizations pointed to the January 2023 adoption of the long-term care standards from both the Canadians Standards Association Group and the Health Standards Organization and to consultations on the Safe Long-Term Care Act. The Liberals promised to introduce the act by the end of 2024, but didn’t. The Liberals signed agreements with two provincial and one territorial governments for personal support workers’ wage increases and training. In the fall of 2024 they talked about introducing a new refundable tax credit for personal support workers as soon as possible, but that was before Prime Minister Justin Trudeau announced he was resigning.
Conservatives
The Conservative Party of Canada’s national convention policy declaration in September 2023 mentions long-term care once under its senior care strategy and states, “provinces and territories should be encouraged to collaborate and agree on minimum service standards for home, community and long-term care, to determine and share best age-friendly initiatives and practices.”
Bloc Québécois
In its 2021 platform, the Bloc Québécois calls on Ottawa to ensure that people have access to quality care and health-care workers have good support and working conditions. It calls on the federal government to increase health transfers, without conditions, to cover 35 per cent of health-care costs.
— Mick Gzowski
Time to fix long-term care
In early 2023, national long-term care standards were announced. These standards were developed under the leadership of Dr. Samir Sinha, director of geriatrics at Sinai Health System, who acted as chair of the technical committee that developed the standards with collaboration between the Health Standards Organization (HSO) and the Canadian Standards Association (CSA).
The standards were developed with a rigorous, evidence-based process, led by experts and with the full participation of people with lived experience, with multiple public and focused consultations. The resulting standards provide a minimum standard of care and service delivery along with infection prevention and control. However, there is still work to be done. The standards are voluntary, and this is a problem. Enforceability and regulation, while difficult in a federal system, are needed to make a real, measurable difference.
As such, Federal Retirees is continuing to campaign for national long-term care standards to be implemented, with funding and accountability. More than 18,000 of our members have joined our call for better long-term care.
A federal election is imminent. Fixing long-term care is a priority of Federal Retirees and must be a priority in this election. Keep an eye out for our election materials and join our campaign to fix long-term care. See bit.ly/4aCq51f for more information.
— Jessica Searson