Correction: This story had previously stated that the process to develop the new national long-term care standards started in March 2020. The story has now been updated with the correct start date, which was in fact March 2021.
A draft of the recommendations was unveiled for public review by the Health Standards Organization (HSO) on Thursday.
The revised guidelines are part of a 21 month-long process including town halls and consultation workbooks involving over 18,000 Canadians and stakeholders that started back in March 2021 — a year after the COVID-19 pandemic hit Canada.
Dr. Samir Sinha, HSO’s long-term care services technical committee chair, said he is hopeful this will provide a “clear blueprint” to enable the federal government, provinces and territories to move long-term care “to where all Canadians are demanding it to go.”
“We know that the COVID-19 pandemic has significantly impacted long-term care homes across Canada and currently of over 30,000 deaths that have occurred, over 51 per cent of them have actually occurred in our long-term care and retirement homes — and that represents nearly 16,000 deaths to date,” Sinha said during a virtual news briefing Tuesday ahead of the launch.
Long-term care homes across the country are experiencing outbreaks and staffing shortages amid the spread of the highly transmissible Omicron variant of COVID-19.
Provinces have prioritized vaccine boosters for residents and tightened visitor restrictions to blunt the impact of this variant of concern.
What is new?
HSO developed its first long-term care services standards between 2012 and 2014, which were then revised between 2018 and 2020.
Under the new proposed guidelines that build on the previous standards from 2020, the criteria for resident-centred care, safe practices and a healthy and competent workforce have been added.
“What we see here … is a shift away from an institutional model and more to a resident-focused model. And that means everything from having a greater choice in the flow of your day as well to having more dignity and privacy. So this is a good step forward,” said Laura Tamblyn Watts, founder and CEO of CanAge, Canada’s national seniors’ advocacy organization.
Watts said she can see the impact of the pandemic playing out in these standards.
The recommendations stress that external services that are not part of the long-term care home’s workforce must also be available — either on-site or off-site — to residents when needed.
“We see more about the importance of social interaction and the importance of dignity on the residents’ lives, and that certainly does come from the pandemic. What we really see in these new standards is a balancing out of risk and choice,” said Tamblyn Watts. “So a more institutional model would be taking all of the risk away and that keeps people in a bubble, but not in a bubble, really, that no one wants to live in.”
There are also new sections that focus on governance and collecting data for quality improvement as well as a section on diversity, equity, inclusion and cultural safety.
Among other revisions, the 42-page document clearly defines what a designated support person, caregiver or essential caregiver is.
“A person or persons chosen by a resident to participate in the resident’s ongoing care,” the newly-included definition states. They are not members of the LTC home’s workforce, it adds.
“Residents have the right to include or not include any of their designated support persons in any aspect of their personal and other care, and to change who they wish to identify as a designated support person,” according to the draft document.
Despite what’s outlined in the document, a professor at Ontario Tech University, Vivian Stamatopoulos, said what she sees as the problem is the document’s vague language.
“I was hoping to see clear standards that are actually enforceable,” said Stamatopoulos.
She was hoping to see the mandating of a 70 per cent full-time to 30 per cent permanent workforce across the board to help provide proper continuity of care.
Another part that stood out for Stamatopoulos is that to people like her who have been fighting to end for-profit, long-term care there was no discussion of the role of ownership.
“At the end of the day, until you address the issues with funding and ownership, I don’t think we can actually ever create meaningful standards that will be followed through at the individual home level,” said Stamatopoulos.
“Like it or not, the evidence is there. The evidence has been there for decades. There is just simply far superior outcomes in terms of staffing, in terms of the resident experience, in terms of injuries, quality of care when you are in a non-profit home.”
The latest standards will now undergo a 60-day public review, in which Canadians are invited to give their input and feedback before the final version is published later this year.
In Canada, health comes under the jurisdiction of provinces and territories, so it is ultimately up to them to implement the standards as they see fit.
In response to the document’s launch, the Ontario Long Term Care Association (OLTCA) released a statement saying it supports the recommendations.
“While there are many homes in Ontario that are already have approaches to resident care and operations that are recommended in the draft standards, transforming the long-term care system on a large scale will require more government investment,” the statement reads.
In Ontario, the OLTCA stated that the government has made significant investments to increase resident care, and has funded tuition and other supports for new nurses and personal support workers.
“These are important commitments, but it will be years before these new staff, particularly nurses, will be qualified to work. OLTCA is asking the Ontario government to allow the thousands of internationally trained nurses to earn the Ontario credentials they need by working as nurses in long-term care,” the OLTCA said.
Sinha said there is a possibility that the standards could be implemented as legislation at the federal, provincial and territorial level.
As part of its 2021 election platform, the Liberal government under Prime Minister Justin Trudeau has pledged to develop a Safe Long-Term Care Act, train up to 50,000 new personal support workers and raise wages.
The feds are looking to invest $9 billion over five years to meet those targets for long-term care, with $3 billion specifically to support the implementation of new national standards.
“I think certainly Ottawa’s significant commitment to improving long-term care with hard dollars pledged … gives a stronger level of interest in these standards and the work that we’ve done to date,” Sinha said.