Question Period Note: LONG-TERM CARE HOMES

• What is the federal government doing to support provinces and territories in addressing major issues in long-term care facilities and avoiding the results seen in the spring in long-term care facilities?

• The federal government is taking a number of steps to respond to the significant challenges faced by long-term care facilities across the country.

• In the Fall Economic Statement, we committed to fund of up to $1 billion for a Safe Long-term Care Fund, to help provinces and territories protect people from COVID-19 in long-term care.

• Provinces and territories will be able to use this funding to undertake a range of activities, including carrying out infection prevention and control readiness assessments, making improvements to ventilation and hiring additional staff or topping up wages.

• We are also committing $6.4 million over two years, starting in 2020-21, to the Canadian Foundation for Health Improvement to expand its LTC+ initiative, which supports pandemic preparedness in long-term care facilities and seniors residences with seed funding to help address gaps.

• Earlier this year, the Government of Canada and provincial/territorial governments reached a Safe Restart Agreement, supported by over $19 billion in federal investments, to help provinces and territories restart the economy, while making Canada more resilient to waves of the virus.

• This included $740 million in funding to support our most vulnerable populations, including incremental infection prevention and control measures to protect those in long-term care, and those receiving home care and palliative care.

• The government also continues to work with the Canadian Red Cross to support provinces and territories facing outbreaks in long-term care. The Red Cross is already working closely with local authorities in order to provide assistance in outbreak situations in long-term care homes.

• We will continue taking any action we can to address challenges in long-term care institutions and support seniors while working alongside the provinces and territories.

Reports and recommendations

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 the improvement for 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

As well, the Health Canada-funded Canadian Foundation for Healthcare Improvement (CFHI) and Canadian Patient Safety Institute (CPSI) released a report in summer 2020 outlining promising practices in six key areas that have the potential to help long-term care and retirement homes prepare for possible future COVID-19 outbreaks, or mitigate their effects:
• Preparation;
• Prevention;
• People in the workforce;
• Pandemic response and surge capacity;
• Planning for COVID-19 and non-COVID-19 care; and
• Presence of family.

Current situation and investigations in long-term care facilities

Several provinces and territories have launched inquiry processes related to long-term care facilities, including Alberta, Manitoba, Ontario, Quebec, Nova Scotia, and Prince Edward Island. The majority of the ongoing investigations do not have set timelines for reporting results.

Investigation reports completed to date have identified of key factors that contributed to the outbreaks including staffing issues (e.g. shortages, lack of training/orientation, working ill/asymptomatic), lack of proper PPE, insufficient equipment, poor communication between management/staff/families, poor infrastructure and lack of managerial oversight. Key recommendations for quality improvement include addressing staff challenges (e.g. increase full-time positions, staffing ratios, training), improve infection prevention and control measures and improved pandemic planning.

Families of residents in long-term care facilities have publicly reported their frustration and concern regarding how their loved ones are cared for, as well as the poor conditions in the residences. Families are calling for increased accountability and systematic changes in how long-term care facilities are operated. A number are bringing legal action against facilities over their COVID-19 response.

Government of Canada Actions

While long-term care is primarily a provincial and territorial responsibility, including the oversight of publicly and privately operated long-term care homes, the federal government is taking a number of steps to respond to the significant challenges faced by long-term care facilities across the country in the context of the COVID-19 pandemic. These actions are laid out in the Key Messages and If pressed sections.

LTC+: Acting on Pandemic Learning Together” initiative: To help the long-term care sector share learnings and strengthen pandemic preparedness, the Canadian Foundation for Healthcare Improvement CFHI partnered with the Canadian Patient Safety Institute to launch the LTC+: Acting on Pandemic Learning Together initiative. It is based on the findings captured in their report “Reimagining Care for Older Adults: Next Steps in COVID-19 Response in Long-Term Care and Retirement Homes”, and focuses on promising practices in six key areas that have shown potential to help organizations prepare for possible future outbreaks or mitigate their effects. The six areas are preparation; prevention; people in the workforce; pandemic response and surge capacity; planning for COVID-19 and non-COVID-19 care; and, presence of family. Participating teams receive seed funding from CFHI to support needed improvements, access to training sessions and materials, and coaching on the implementation of the program’s key components. As of November 10, there are about 300 long-term care and retirement homes participating in the initiative or are in the process of registering. It is this initiative that received an additional $6.4M in funding through the Fall Economic Statement.
The Fall Economic Statement also provides $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.

Long-Term Care Facility Ownership Breakdown

On September 24, CIHI released a breakdown of the type of ownership of publicly funded LTC homes offering 24-hour nursing care across the country. Ownership of these facilities can be public or private. Privately owned LTC homes can be subdivided into for-profit and not-for-profit organizations.

The proportion of private and publicly owned LTC homes varies by province/territory. Overall, 54% of LTC homes in Canada are privately owned (28% for-profit, 23% not-for-profit and 3% no breakdown) and 46% are publicly owned.

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 (ie, Veterans Affairs Canada (VAC), Indigenous Services Canada).

The last facility/hospital run by VAC was Ste Anne's Hospital in Quebec. It was transferred to the province in April 2016. VAC now supports about 4000 Veterans in over 1150 provincially and privately owned and operated long-term care facilities across the country. This can include subsidized accommodation or meal costs or funding for facilities on an annual basis to support an enhanced level of services and specialized programs for veterans.

Since 2007, Revera Inc. is a wholly-owned operating subsidiary of the Public Sector Pension Investment Board (PSPIB), an independent Crown corporation established under the Public Sector Pension Investment Board Act in 1999 and is registered under the Canada Business Corporations Act.

The PSPIB operates at arm's length from the federal government – i.e., it is not part of the federal public administration. Its business affairs are managed by an 11-member Board of Directors, and investment decisions are informed by a governance model outlined in the PSPIB Act.

SYNOPSIS

Long-standing issues in supportive care, particularly long-term care, have been starkly revealed by the COVID pandemic. Tragically, in the first 7 months of the pandemic, long-term care and retirement home residents and staff represented 25% of all COVID-19 cases. Approximately 80% of all COVID-19 deaths in the country were connected to long-term care and seniors’ residences.

Outbreaks in long-term care facilities are on the rise. The proportion of long-term care homes with outbreaks in Ontario has tripled since early September. In Quebec, according to Montreal's regional director of public health, seniors 65 and older accounted for 6% of COVID-19 cases in mid-September, but that proportion had increased to 15% of all positive tests in October. Some long-term care facilities are currently experiencing major outbreaks (e.g., over 60% of residents being infected with COVID-19, multiple staff infected, and a rising number of deaths). An increased number of outbreaks are also occurring in long-term care facilities in provinces that had few/no outbreaks in the summer.

As of November 29th, Québec and Ontario remain the most affected provinces and territories, with at least 182 known active outbreaks in LTC/assisted living facilities in Québec and 173 in Ontario, followed by Alberta (110), Manitoba (75), British Columbia (53), Saskatchewan (18), New Brunswick (1), and Newfoundland & Labrador (1). Additional outbreaks may be active across provinces and territories.
IF PRESSED ON ADDITIONAL SUPPORT PROVIDED BY THE FEDERAL GOVERNMENT…

• The Public Health Agency of Canada has provided guidance on the care of residents in long-term care, as well as infection prevention and control guidance to help prevent COVID-19 infections among residents and workers in long-term care and assisted-living facilities, as well as in home care. This guidance was developed with the National Advisory Committee on Infection Prevention and Control and endorsed by the Pan-Canadian Special Advisory Committee.

• Up to $3 billion in federal funding has been provided to support provinces and territories to increase the wages of low-income essential workers, which could include front line workers in hospitals and long-term care facilities.

• The Government of Canada adapted the Investing in Canada Infrastructure program to respond to the impacts of COVID-19. A new temporary COVID-19 Resilience stream has been created to provide provinces and territories with added flexibility to use existing resources to fund quick-start, short-term projects, including health infrastructure such as long-term care homes.

• In collaboration with partners, the Health Canada-funded Canadian Foundation for Healthcare Improvement and Canadian Patient Safety Institute have launched an initiative to spread promising practices in preventing and mitigating the impact of COVID-19 on long-term care and retirement homes. The goal of the initiative is to better position participating facilities to prevent and manage any future outbreaks.
IF PRESSED ON THE SAFE RESTART AGREEMENTS…

• The Government of Canada is working to ensure that Canada has the resources it needs to restart the economy safely, while protecting the health of Canadians.

• Canadians receiving long-term care, home care and palliative care are at an increased risk of more severe cases of COVID-19. It is important to have continued protections and supports in place for these vulnerable populations.

• In partnership with the provinces and territories, federal efforts are focussing on priorities to address Canadians’ immediate needs within the next six to eight months, including vulnerable populations.

• For example, provinces and territories can use the funding to address staffing issues and provide personal protective equipment in long-term care, home care, and palliative care facilities and services. Funding can also be used to support other vulnerable populations.To support the economy, the Government of Canada also continues to work with provinces and territories to support procurement of personal protective equipment.
IF PRESSED ON THE SPEECH FROM THE THRONE…

• The Government announced its intention to work with the provinces and territories to set new national standards for long-term care so that seniors get the best support possible.

• The Government will also look at further targeted measures for personal support workers, who do an essential service helping the most vulnerable in our communities. Canada must better value their work and their contributions to our society.

• The Government of Canada will work with Parliament on Criminal Code amendments to explicitly penalize those who neglect seniors under their care, putting them in danger.
IF PRESSED ON THE FALL ECONOMIC STATEMENT…

• Through the 2020 Fall Economic Statement, the Government of Canada is committing up to $1 billion for a Safe Long-term Care Fund, to help provinces and territories protect people in long-term care and support infection prevention and control.

• Further, the government is committing $6.4 million over two years, starting in 2020-21, to the Canadian Foundation for Health Improvement to expand its LTC+ initiative, which allows long-term care facilities and seniors residences to register via an online portal and submit a self-assessment, making them eligible for coaching and seed funding to help address gaps.

• The government is also committing $1 million to engage with third parties to help identify resources to conduct readiness assessments in long-term care facilities and facilitate training on infection prevention and control.

• The government also reiterated its commitment to establishing national standards for long-term care as a means to address critical gaps in long-term care facilities, including raising the working conditions of lower-wage essential workers in senior care, particularly personal support workers, who have persevered in the face of adversity.