Question Period Note: Long-Term Care and new national standard

The Standards Council of Canada, Health Standards Organization and CSA Group announced the completion and public release of new national long-term care standards.

Throughout the COVID-19 pandemic, the federal government has been working collaboratively with provinces and territories to protect vulnerable Canadians in long-term care. The federal government has responded in a number of ways, including through key investments made to support residents and staff.

The Government is committed to improving the quality and availability of long-term care homes and beds.

On January 31, 2023, the Government welcomed the publication of the independent long-term care standards developed by the Health Standards Organization and CSA Group.

The standards development process is complementary to, but independent from, the Government of Canada’s collaborative work with provinces and territories to help support improvements in long-term care.

While the Government is committed to improve the quality and availability of long-term care, it is important to recognize that seniors want to live at home and in their communities as long as possible.

That is why the Minister of Health and I have asked the National Seniors Council to serve as an expert panel to examine measures, including a potential aging at home benefit, to further support Canadians who wish to age with the comfort of their own homes.

Long-term Care in Canada

Healthcare is a shared responsibility between the Government of Canada and provincial and territorial governments.

While the federal government provides financial support to the provinces and territories for health care services, the responsibility for matters related to the administration and delivery of these services, including long-term care, falls within provincial and territorial jurisdiction.

LTC is referenced in the Canada Health Act (CHA) as “extended health care services.” Extended services are not covered by the five criteria of the Act or its extra billing and user charges provisions, and therefore are not subject to the Act’s penalty provisions, but are subject to two general conditions in section 13 a and b of the CHA:

Information: PT governments are required to provide information to the federal Minister of Health as prescribed by regulation under the Act. The only information regulations in force under the CHA are the Extra-billing and User Charges Information Regulations, which outline the process and timelines associated with the annual reporting of extra-billing and user charges by the provinces and territories to Health Canada.

Recognition: PT governments are required to give appropriate recognition to the federal financial contributions in support of both insured and extended health care.

While not mandatory, every PT has LTC legislation, regulations, policies and/or standards, but variations and gaps exist in oversight, infection prevention and control, quality of care and workforce.

Third-party standards development process and Safe Long-Term Care Act

The new National Standards of Canada for long-term care being developed by the HSO and CSA Group will take into account lessons learned from the COVID-19 pandemic and incorporate the latest evidence-informed, people-centred requirements of quality care and services. The standards will address both the delivery of safe, reliable and high-quality care (HSO), and the health infrastructure and environmental design of long-term care facilities (CSA Group). The process is being undertaken by expert standards development organizations with broad engagement, and is taking place at arms-length from the Government of Canada.

While Health Canada did not fund the development of standards, the department did provide funding to both HSO and CSA Group to support enhanced engagement and consultations with Canadians and stakeholders (e.g., persons with lived experience, Indigenous peoples, official language minority groups, etc.) to ensure diverse perspectives were captured.

The CSA Group published their national standard on December 1, 2022, while the Health Standards Organization released their national standard on January 31, 2023.

The Government has reiterated the commitment to national LTC standards in the Minister of Health’s most recent mandate letter: “This includes working with provinces and territories to improve infection prevention and control measures, identify shared principles, and develop national standards and a Safe Long-Term Care Act to ensure seniors get the care they deserve”. We will continue to work with provinces and territories to monitor progress on improvements in LTC, including using federal funding, and consider how these new standards might inform federal legislation.

Situation in LTC homes throughout the COVID-19 pandemic

A number of long-standing issues in long-term care have been starkly revealed by the COVID-19 pandemic. This includes issues related to infection prevention and control; HHR; compliance with standards and regulations; infrastructure; and PPE. Many LTC facilities in Canada suffered major COVID-19 outbreaks and numerous deaths occurred. At the peak of the first wave, outbreaks in LTC and seniors’ homes accounted for 81% of deaths in Canada. Many stakeholders have released reports and recommendations on addressing issues faced in LTC facilities.

Many COVID-19 restrictions in LTC have been relaxed in provinces and territories. This includes the ability for residents to have additional visitors, greater social interaction between visitors, as well as the ability to leave facilities with family or friends.

Reports and recommendations

On March 30, 2021, CIHI released a report titled: Long-term care and COVID-19: The first 6 months. This report examines the pandemic experience in LTC facilities across all provinces and territories. This report highlighted that:

COVID-19 cases among residents of LTC and retirement homes increased by more than two-thirds during Wave 2 compared with Wave 1.

Compared with pre-pandemic years, in Wave 1, LTC residents had fewer physician visits; fewer hospital transfers; and less contact with friends and family, which is associated with higher rates of depression.

In all provinces where it could be measured, the total number of resident deaths was higher than normal during this period, even in places with fewer COVID-19 deaths.

Provincial and national inquiries (to date) on COVID-19 in LTC have made similar recommendations and speak to long-standing concerns in the sector.

Since the onset of COVID-19, a number of organizations such as the Royal Society of Canada, Ontario Long-Term Care Association and the Registered Nurses Association of Ontario, have released reports calling for action from the Government of Canada to improve the quality of care for seniors living in LTC facilities. Recommendations for improving LTC include:

increasing procurement of personal protective equipment

addressing workforce issues (e.g. increased staffing, national human resources strategy, improved pay/benefits)

providing capital investment to build and redevelop existing LTC homes

developing national standards

enhancing data collection

planning for management of resurgence of COVID-19

improving access to rapid testing

Several provinces launched inquiry processes related to long-term care facilities, including Alberta, Manitoba, Ontario, Quebec, Nova Scotia, and Prince Edward Island. Some reports have been released and provinces have already announced initiatives to address gaps in LTC, including:

Ontario Long-Term Care COVID-19 Commission report: This report focused on the actions and inactions that significantly contributed to the devastation experienced in long-term care during the covid-19 pandemic. The report overviews the state of the long-term care sector and pandemic preparedness before covid-19, addresses the response to the pandemic, and then looks at promising developments in long-term care in Ontario. The report ends with the Commission’s recommendations.

Alberta Facility-Based Continuing Care Review: The report focuses on the development of recommendations for improvement to address long-lasting systemic issues that existed prior to the COVID-19 pandemic, which were subsequently magnified by the pandemic. The Review also captured feedback from Albertans regarding their experiences with the Facility-Based Continuing Care Review during the pandemic as well.

Manitoba- Maples Parkview Place Review: The report highlighted the key drivers that contributed to the outbreak in the Maple’s LTC facility. The report also has 17 recommendations, broken down at the facility level, regional level, provincial level, and additional considerations.

Québec- Performance of Care and Services for Older Adults: In January 2022, the Quebec Health and Welfare Commissioner released her final report into the care and service offered to seniors in the pandemic's early months. The report recommended transforming the health system from one that focuses primarily on providing medical and hospital services to one that gives priority to the patients' needs amid an increasingly aging population. In July 2022, the Commissioner released an additional report which presented an analysis of the performance of LTC facilities in Quebec.

Government of Canada initiatives to support PT actions in Long-term Care

The Government of Canada has worked collaboratively with provinces and territories throughout the COVID-19 pandemic to protect vulnerable Canadians in long-term care. The federal government has responded to COVID-19 through a number of initiatives.

Budget 2021

Budget 2021 builds upon previous COVID measures taken by the Government of Canada to support seniors and vulnerable populations across the country. Commitments included:

$3 billion over five years to Health Canada to support provinces and territories in ensuring that standards for long-term care are applied and permanent changes are made.

$41.3 million over six years, and $7.7 million ongoing, starting in 2021-22, for Statistics Canada to improve data infrastructure and data collection on supportive care, primary care, and pharmaceuticals.

$90 million over three years, starting in 2021-22, to Employment and Social Development Canada (ESDC) to launch the Age Well at Home initiative. This would assist community-based organizations in providing practical support that helps low-income and otherwise vulnerable seniors age in place.

Increasing Old Age Security for seniors 75 and over, beginning in 2022.

$27.6 million over three years for a Group Tax-Free Savings Account to support retirement saving for personal support workers.

$960 million over three years for a new Sectoral Workforce Solutions Program, led by ESDC. The purpose of the program is to help sectors design and deliver relevant training, and connect Canadians with the training they need to access good jobs. For the health sector, this would include the need for more skilled personal support workers.

Fall Economic Statement 2020

To address significant challenges revealed during COVID-19, in the 2020 Fall Economic Statement, the federal government announced the creation of a new Safe Long-Term Care Fund. This fund transferred $1 billion to the provinces and territories to protect people living and working in long-term care. Provinces and territories can use this money to improve infection prevention and control in facilities, including to assess infection prevention and control readiness, improve infrastructure such as ventilation, and address workforce gaps, including hiring more staff or raising wages. As of March 31, 2022, we had reached agreements with all provinces and territories. In addition to the $1 billion in funding for the Safe LTC Fund, the Fall Economic Statement committed:

$6.4 million to Healthcare Excellence Canada’s LTC+ initiative to expand to support up to 1,000 facilities across Canada. The goal is to better position participating facilities to prevent and manage any future outbreaks. Participating teams receive seed funding to support needed improvements, access to training sessions and materials, and coaching on the implementation of the program’s key components.

$38.5 million over two years to Employment and Social Development Canada to support training up to 4,000 personal support worker interns through an accelerated 6-week online training program combined with a 4-month work placement, to address acute labour shortages in long-term care and home care.

In addition, the Government of Canada:

Invested billions of dollars to procure personal protective equipment (PPE) and continued to work with the provinces and territories to ensure LTC facilities have access to the protection they need.

Proactively purchased and deployed high dose flu vaccine for all LTC residents in Canada, to prevent twin illnesses of seasonal influenza and COVID-19 in LTC homes.

Prioritized LTC and congregate living settings for vaccination, with most residents and staff having already received at least two doses.

Created volunteer inventories to support public health response, including in the LTC sector.

Developed infection prevention and control guidance specific to LTC and congregate living settings.

Deployed the Canadian Armed Forces and the Canadian Red Cross to LTC homes to respond to urgent needs.

Provided up to $3 billion in federal funding to support provinces and territories to increase the wages of low-income essential workers, which included front line workers in hospitals and LTC facilities.

Invested $740 million in the Safe Restart Agreements to support provinces and territories, including to address the immediate needs in LTC.

Created a new temporary COVID Resilience stream under the Investing in Canada Infrastructure Program for quick-start, short-term projects, including in LTC.

Accelerated training for up to 4000 personal support worker interns to address critical labour shortages in LTC facilities and home care.

Private Member’s Motion M-47, Improvements to Long-Term Care

Private Member’s Motion M-47 was placed on notice by the Liberal Member for Avalon, Ken McDonald, on February 7, 2022. It called upon the House to recognize the long-standing issues affecting LTC that have been exposed by the COVID-19 pandemic, the need to ensure conditions of work reflect care standards seniors deserve, and for the government to work with PTs to improve LTC. These improvements are as follows:

“[...] the government should work with PTs to (i) improve the quality and availability of LTC homes and beds; (ii) implement strict infection prevention and control measures, including through more provincial and territorial facility inspections for LTC homes; and (iii) develop a safe LTC act collaboratively to ensure that seniors are guaranteed the care they deserve, no matter where they live.”

The motion repeated the commitments made in the Liberal Party of Canada’s 2021 electoral platform and aligned with the Minister of Health’s 2021 Mandate Letter and the Liberal Party of Canada’s and New Democratic Party’s new Supply and Confidence Agreement. The motion passed on September 21, 2022.

Federal government ownership of long-term care facilities

The federal government does not own any long-term care facilities, including federal departments responsible for the delivery of long-term care (i.e., Veterans Affairs Canada (VAC), Indigenous Services Canada).

Aging at Home Benefit Panel

Canadians have a preference to remain at home as they age, rather than in a facility. According to a National Institute on Ageing and Telus Health survey, 91 per cent of respondents, and almost 100 per cent of those 65 years of age and older, report that they plan on supporting themselves to live safely and independently in their own home as long as possible.

The Minister of Seniors and the Minister of Health have recently announced that the National Seniors Council (NSC) would serve as an expert panel to examine measures, including a potential aging at home benefit, to further support Canadians who wish to age within the comfort of their own homes. In developing its advice, the National Seniors Council undertakes a range of activities, including commissioning research, consulting with seniors and stakeholders across the country, and convening expert panels and roundtables.

The development of a panel aligns with the Minister of Health’s five key priority areas for health care, including the need to build on “efforts to help Canadians age with dignity closer to home and improve LTC facilities”. Any measures undertaken would also complement the $6 billion over 10 years (started in 2017-18) being provided to provinces and territories to improve access to home and community care.

Staffing, including training 50,000 Personal Support Workers

As announced in the 2020 Fall Economic Statement, the Government of Canada is funding a $38.5 million pilot project to address acute labour shortages in long-term and home care. This funding is being used to recruit and train up to 2,600 new Supportive Care Assistants through an accelerated online training and hands-on work placement. It is anticipated that the pilot will also support up to 1,300 of these Supportive Care Assistants to pursue full Personal Support Worker certification.

The shortage of PSWs in the long-term and home care sector has been a growing issue for several years and was exacerbated by the COVID-19 pandemic. In fact, during the early part of the pandemic, there was such an acute shortage of PSWs that the Canadian Armed Forces were deployed in long-term care facilities in Quebec and Ontario. An aging population and the rising need for long-term care is projected to put further pressure on the demand for PSWs. While pay is an important issue for PSWs, the pandemic has highlighted broad issues within the PSW field, including chronic understaffing, stress, burnout, and challenging working conditions.

The Government has been working collaboratively with provinces and territories as well as other federal departments. As part of its engagement with stakeholders, Health Canada has heard about the need for solutions that:

Improve working conditions, including higher client-staff ratios and staffing models that support a safer work environment

Enhanced job security and compensation

Protection from mental health risks

The Government is also engaged on a number of fronts to increase the supply of PSWs, including through:

Sectoral Workforce Solutions Program: project underway to assist up to 300 persons with disabilities to train for and secure employment in the health sector, a portion being PSWs.

Future Skills: three projects underway that will support 150 PSWs.

The Budget 2021 announcement of $27.6 million to allow my65+ to provide savings incentives for personal support workers in the elder care sector.

The COVID-19 pandemic has disproportionately affected Canadians receiving long-term care in community settings, specifically long-term care facilities, assisted living facilities, and seniors’ residences. Even residents of facilities not affected directly by the virus have faced social isolation and reduced services.

Minister of Seniors’ Mandate Letter

Specific commitments include:

“Support the Minister of Health in their work to improve the quality and availability of long-term care homes and beds. This includes working with provinces and territories to improve infection prevention and control measures, identify shared principles, and develop national standards to ensure seniors get the care they deserve.”

“Establish an expert panel to provide recommendations for establishing an Aging at Home Benefit. You will be supported by the Minister of Health in this work