Blueprint for fixing our disastrous long-term care system

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The Canadian Centre for Policy Alternatives (CCPA) has just issued a report detailing how the federal government could provide leadership "in developing a coordinated approach to long-term care." 

The COVID-19 crisis has exposed catastrophic weaknesses in Canada's patchwork system for housing and caring for the elderly and disabled. 

In this country, a huge proportion of the destruction the pandemic has wrought -- the disease and death -- has occurred in long-term care facilities. Canada's record in this regard is one of the worst in the world. A recent Canadian Institute for Health Information (CIHI) study showed that the death rate in Canadian long-term care facilities was double the average for OECD countries.

In response to that shameful record, the Justin Trudeau government promised federal standards for long-term care facilities in this past September's throne speech. 

The CCPA report's authors, York University professor Pat Armstrong and research associate Marcy Cohen, provide some helpful guideposts for the government as it goes about fulfilling that commitment.

Thumbs down to for-profit care

For starters, Armstrong and Cohen point to one of the conclusions of the CIHI study: Countries with "centralized regulation and organization" for long-term care, such as Australia, have done better than other countries, such as Canada, where responsibility for long-term care is more diffuse. 

Armstrong and Cohen's report then provides some basic principles for long-term care, and a set of concrete standards the federal government could demand of the provinces as conditions for federal funding. Ottawa does precisely that with regard to its contributions to the provinces for health care. It insists its provincial partners abide by the requirements of the Canada Health Act of 1984. 

Among the "foundational principles" the CCPA recommends for long-term care are: it should be connected to communities and neighbourhoods; it should be accessed on the basis of need, not ability to pay; and it should be operated on a not-for-profit basis. 

On the last point, the authors cite research that shows "a pattern of lower quality care in for-profit services." 

Armstrong and Cohen argue that "there is no evidence that for-profit services… lower cost, or improve quality, access or choice." More important, for-profit care makes it "more difficult to ensure health-focused governance, given the responsibility of for-profit firms to their shareholders." 

The not-for-profit principle could be an awkward one for the current federal government. 

One of the largest private sector corporations in the long-term care business, Revera Corporation, is a wholly-owned subsidiary of the federal government's Public Sector Pension Investment Board (PSPIB). You can go to Revera's corporate profile on its website and see for yourself, although they bury that little nugget of information in the small print at the bottom of the page.

Long-term care is a profitable business, even when it tragically fails to assure the health and lives of its clients. The prospect of big profits, largely immune from the ups and downs of the economy, is why this sector attracts major investors, including the PSPIB. 

The federal government's involvement in for-profit care is indirect, because the PSPIB operates at arm's length. That involvement is, nonetheless, a source of significant embarrassment. There has a been a troublesomely high COVID-19 death toll in two Revera-operated facilities.

If the government were to adopt the CCPA's recommendation, it would have to transform Revera into a not-for-profit entity. 

The bad news is that Revera's long-term care businesses could no longer be a cash cow for the pensioners' investment fund. The good news is that health care for the vulnerable residents might significantly improve.

Key standards provinces should meet include treating workers properly

Among the standards the CCPA report recommends the federal government should establish for long-term care -- and on which federal funding should be contingent -- the most significant ones concern staffing. 

The authors suggest there should be minimum staffing levels for long-term care institutions, which governments could set using "verified data and an assessment of social, emotional, and clinical needs."

As well, they propose that a minimum of 70 per cent of staff work in a single site, and that the remaining 30 per cent should be engaged on a permanent, part-time basis.

When it comes to remuneration, the report states that all staff should have "benefits and pay based on equity principles". And as for staff training and education standards, the report proposes that the long-term care sector should develop those in conjunction with public, post-secondary institutions. 

The treatment and training of the workforce in long-term care is a key issue, because meeting the needs of elderly and disabled is a face-to-face, human enterprise. It cannot be accomplished virtually. 

Inadequate pay, lack of necessary training, and, overall, lack of respect plagued the long-term care sector, here in Canada and around the world, since long before the pandemic. No plan for the sector will work without a clear focus on the multiple issues related to staffing.

"This is skilled labour. The skills required are both clinical and social, informed by an understanding of aging, culture, gender, and other intersections of identity." The report states, "The skills require continual renewal to address new developments and populations. They also require learning to work collaboratively in, and through, teams."

That is why the report puts such great emphasis on the need for long-term care staff to have "decent and equitable pay, benefits, sick leave, job security, breaks, the right to union protection, access to appropriate supplies (including PPE), safe physical and social environments, and appropriate staffing levels." 

Over to you, federal government. 

Karl Nerenberg has been a journalist and filmmaker for more than 25 years. He is rabble's politics reporter.

 

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