What should be done to fix Canada's long-term care system?

A recent — and scathing — report placed a lot of blame on Canada’s long-term care home operators in how they handled the COVID pandemic.

According to the British Medical Journal (BMJ), the country’s overall response to the outbreak was less than stellar.

In an editorial, entitled “The world expected more of Canada,” the authors from BMJ, the University of Toronto and the University of Ottawa pointed the finger at governments as well as employers.

“Beneath the surface of a general sense of satisfaction lie major pandemic failures,” wrote the authors.

While the editorial also talked about issues with vaccination hoarding and a widely dispersed response from various provinces and the federal governments, it had derision for the long-term care system itself.

“A particular disgrace is Canada being at the top of wealthy nations for COVID-related deaths in care homes for older people, despite more than 100 reports foreshadowing a nursing home crisis. In much of the world, COVID-19 exacerbated existing inequalities. But it is no less an indictment that an abundantly wealthy country’s response to a public health emergency failed to protect its most vulnerable citizens,” says the editorial.

Long-term issue for LTC industry

For one researcher, the BMJ article came as no surprise.

“Canada’s had unacceptable levels of infectious disease, death and respiratory infections in long-term care for decades and we had — after the first SARS pandemic — a number of recommendations about how to protect long-term care as a potential hotspot, none of which have been implemented,” says Dawn Bowdish (left), associate professor and Canada research chair in aging and immunity at McMaster University in Hamilton.

This once again points to a failure in the response and a missed opportunity, she says.

“There was a very brief period where the public’s interest was really high in protecting long-term care but so many of the changes or lessons learned haven’t been implemented, and there doesn’t seem to be much of an appetite to protect vulnerable older adults.”

“I’m deeply disappointed but I’m not surprised,” says Bowdish. “Canada was the top country in the world for deaths in long-term care in the world and that should be part of our deep, deep, collective shame.”

The BMJ concurred, citing “missed opportunities and fragmented and unclear leadership. Were lives lost as a result of the broken systems? Were decisions by governments taken appropriately and equitably? Will Canada be better prepared for the next public health emergency?”

Ontario nurses are also suffering from increased workloads and short-staffing, according to recent survey.

Staffing issues on the front line of long-term care

In the vanguard of the health-care system are personal support workers (PSW) and the head of a worker’s group says the problem isn’t a lack of knowledge, it’s been in what governments should have done while armed with information.

“I find that Canada does their due diligence when it comes to research but there is such a thing as too much research. Sometimes you have to act upon the research that’s already been done and move forward with action,” says Miranda Ferrier (right), CEO and provincial president of the Ontario Personal Support Worker Association (OPSWA) in Cambridge, Ont.

“Prior to COVID, the association was very vocal about there not being enough personal support workers on the ground in long-term care facilities and that we were losing PSWs because of all the reasons that are very apparent now today.

“They just refused to address that issue. They addressed everything around it, except that issue was one of them,” she says.

Some changes have been made in Ontario, according to Ferrier, but only in certain areas.

“They have ramped up IPAC [infection prevention and control] training for their frontline staff. They’ve offered them full-time lines, so that they don’t need to have two jobs in order to make one pay cheque and they treat them better.”

However, this represents, “unfortunately, a very small number. The majority still seem to almost be stuck in the pre-COVID years,” says Ferrier.

The lack of full-time careers being available is personally galling for Bowdish.

“I remember 20 years ago, when I was young and coming home and staying with my family over the Christmas holidays, and we all got what was probably influenza and we were so sick.”

Her father was a PSW, “but he was a part-time worker who worked in three different homes and couldn’t afford to take the time off, both for losing his seniority and shifts and just economically, so he took a bunch of Tylenol and worked in three long-term care homes.”

“I mean, that is appalling,” says Bowdish.

More employers should invest in caregiver support, considering 25% of employees currently are acting as caregivers for loved ones, according to an expert.

HR ‘needs to figure out hiring practices’ with PSWs

For Ferrier and the OPSWA, employers and HR departments are largely in charge of solving this particular issue.

“They need to figure out their hiring practices: who they can and can’t hire in long-term care facilities. That is the first thing that needs to happen because we’re seeing a huge staffing shortage — but we had this staffing shortage prior to COVID. It’s been an issue for 20 plus years,” said Ferrier.

“I’d like to see full-time lines in long-term care homes because that’s one way to make it into a career and it’s one way to make the person have a stake in these places.”

Besides this staffing concern, levels of care per person are unacceptable, according to Ferrier. She pointed to the New Brunswick model of care homes, with only 12 to 15 residents.

“The level of care is so much higher because PSWs only have to care for seven individuals, or six individuals as opposed to the numbers that we see here in Ontario which are 15, 25, 30 per PSW, which is just unrealistic numbers, let’s be honest.”

The current conditions in Ontario are not going to prevent further outbreaks, says Bowdish.

“The fact that we have too many people per room, that’s just an infection nightmare, and so we need to have better rules about how many people we can have sharing room.”

Transparency needed for long-term care

The BMJ advocated for a public inquiry to be held, so Canadians can know where we went wrong. However, this might be overkill, says Ferrier.

“At the end of the day, it’s about transparency. It’s like the premier [Doug Ford] said to me here in Ontario: ‘It’s all hands on deck.’ Everybody needs to help each other and that’s what we’re trying to do. It’s about teamwork.

“That’s the only way we’re going to fix the issue is by being transparent about the issues, addressing the issues, admitting to where we all went wrong and then fixing it.”