Seeking Solutions for Canada’s Care Home Crisis

Seeking Solutions for Canada’s Care Home Crisis
Two people hold protest signs outside Maison Herron, a long-term care home in the Montreal suburb of Dorval, Que., on April 11, 2020. (The Canadian Press/Graham Hughes)
Lee Harding

A military report highlighting deplorable conditions in care homes has left politicians searching for solutions. The Canadian Medical Association and Ontario Premier Doug Ford are both looking to the federal government to set guidelines and provide funds.

“We need the federal government at the table as a funding partner. Support us as we move forward. Help us fix this problem. We can’t fix it alone, no province can fix it alone,” Ford told reporters on June 1.

Ford said what’s needed is a standard operating procedure for the long-term care system across the country. “No matter if it’s in Quebec or Ontario or B.C., we need a system that everyone goes by,” he said.

Herb Emery, chair of economics at the University of New Brunswick, says poor policies in the care home sector have “allowed low-wage work with high patient-to-staff ratios to create basically a tinderbox of problems.”

“The long-term care sector’s problems are not new. It’s just now they’ve been hit with a crisis that has [made things] worse,” Emery, who formerly taught health economics at the University of Calgary, said in an interview.

The Canadian Armed Forces were sent to five struggling care homes in Ontario to provide humanitarian relief and medical support due to the COVID-19 pandemic. On May 26, the Ontario government released a report by the military which documented grave problems with substandard care.

Reported problems include rooms with feces and cockroaches, residents poorly fed and unbathed for weeks, wounds and bleeding left untreated, expired medications administered, catheters shared between residents, the delayed changing of soiled diapers which led to “skin breakdown,” and fallen and wounded residents ignored.

Pandemic protocols were not being followed in the five facilities, which have seen at least 225 deaths due to COVID-19. Over 1,600 virus deaths have occurred at Ontario care homes—roughly three-quarters of the provincial total. Statistics are similar across Canada.

The Ontario government is investigating the incidents detailed in the report and plans to launch an independent commission in September to examine its long-term care system.

Prime Minister Justin Trudeau, while noting that seniors’ homes are under provincial jurisdiction, has said the government “stands ready to support the provinces” on the issue with “more resources, more money.”

“We will be there depending on what the provinces need, what their situation is, to make sure all seniors are protected,” he told reporters on May 29.

Meanwhile, five Ontario Liberal MPs whose ridings are home to some of the care facilities hit by COVID-19 have written to Trudeau and Health Minister Patty Hajdu urging them to call on the Ontario government to launch a full public inquiry into the failings of the province’s long-term care system and recommend solutions.

They also want Ottawa to work with the provinces to establish enforceable national standards for long-term care homes across the country.

During question period in the House on May 27, federal NDP Leader Jagmeet Singh called for an end to for-profit private care homes, saying they “have been the site of some of the most deplorable conditions.”

Emery says that would be “a mistake,” however, because “the provinces have no capacity to build and operate them. And there's no reason other than ideological ground to get rid of a private operator, unless you failed to regulate correctly.”

Ultimately, Emery finds the discussion hard to take given that the problems in the long-term care system have been evident for a long time.

“I can't even watch the politicians that have been around for decades saying that they are outraged at the situation. They’re the same people who ignored all of the arguments that this is where we need to focus effort [and] resources,” he says.

“Anyone who claims that this has come as a surprise or they didn't see it as a risk is just disingenuous.”

The Canadian Medical Association has called on the federal government to “commit to a comprehensive pan-Canadian plan to improve seniors' care, including new federal funding.” The CMA wants staff levels to increase, with safer working conditions and publicly available reporting on the condition of care homes.

This call rings hollow to Emery. “The CMA is a bit disingenuous when they say they want to fix this because they are one of the interest groups that has prevented resources from shifting from medical treatment to the long-term care sector,” he says.

He believes the answer is to “move care away from the physician and the hospital as a focus to multi-based, team-based care.”

“Get out in the community, keep people living in their homes longer, [and] promote health. Then we would have less money spent on medical treatment by as much as 25 to 30 percent and we would not have the same need for institutionalized care,” he said.