Question Period Note: Long-Term Care Homes

• What is the federal government doing about working with provinces and territories to develop national standards in LTC?

KEY MESSAGES
• The COVID-19 pandemic has tragically highlighted long-standing and systemic challenges in Canada’s LTC system.
• The federal government has committed to working collaboratively with the provinces and territories to take any action it can to support seniors.
• Budget 2021 includes a $3B investment over five years ($600M per year), starting in 2022-23, to ensure that provinces and territories provide a high standard of care in their long-term care facilities.
• This is in addition to the 2020 Fall Economic Statement’s commitment of up to $1B through the Safe LTC Fund to support infection prevention and control through making improvements to ventilation, hiring additional, and topping up wages.
• The federal government will continue to work collaboratively with provinces and territories, while respecting their jurisdiction over health care, including long-term care. This work would ensure seniors and those in care live in safe and dignified conditions.

IF PRESSED ON ADDITIONAL SUPPORT PROVIDED BY THE FEDERAL GOVERNMENT…
• Throughout the pandemic, the Government of Canada has prioritized protecting vulnerable Canadians, including those in LTC and supported provinces and territories extensively. The Government of Canada has:
• Invested billions of dollars to procure personal protective equipment (PPE) and continued to work with the provinces and territories to ensure LTC has 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 one dose.
• 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 could include front line workers in hospitals and LTC facilities.
• Invested $740 million in the Safe Restart Agreements to support provinces and territories 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.
• Committed to working with Parliament on Criminal Code amendments to explicitly penalize those who neglect seniors under their care, putting them in danger.
• To help the LTC sector share learnings and strengthen pandemic preparedness, we provided $8.6 million to Healthcare Excellence Canada to support LTC facilities across the country through the LTC+ initiative. Over 1,000 facilities are participating in the program.
• Accelerated training for up to 4000 personal support worker interns to address critical labour shortages in LTC facilities and home care.
• Budget 2021 proposes to provide $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.
• Additional federal measures to support seniors and those receiving care from Budget 2021:
• provide $90M 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.
• increase Old Age Security for seniors 75 and over, beginning in 2022.
• provide funding of $27.6 million over three years for a Group Tax-Free Savings Account to support retirement saving for personal support workers.
• establish a new Sectoral Workforce Solutions Program, led by ESDC, and funded by $960M over three years. 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.
IF PRESSED ON WORK ON STANDARDS FOR LONG-TERM CARE…
• The pandemic has shone a light on systemic issues affecting long-term care facilities across the country. The government welcomes the news that the Heath Standards Organization and Canadian Standards Association are launching a process to help address those issues in Canada.
• The Health Standards Organization’s and Canadian Standards Association’s work with governments, stakeholders, and Canadians to develop national standards will help inform our ongoing discussions with provinces and territories on improving the quality of life of seniors in long-term care.

BACKGROUND
Third-party standards development process
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, and the health infrastructure and environmental design of long-term care facilities.
Speech from the Throne
In the September 2020 Speech from the Throne, the Government of Canada committed to taking any action it could to support seniors. These commitments included:
• Working with the provinces and territories to set new national standards for long-term care so that seniors get the best support possible.
• looking at further targeted measures for personal support workers, who do an essential service helping the most vulnerable in our communities; and
• Working with Parliament on Criminal Code amendments to explicitly penalize those who neglect seniors under their care, putting them in danger.

Fall Economic Statement
In addition to the $1B in funding for the Safe LTC Fund, the Fall Economic Statement committed:
• $6.4 million to the 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.

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

As well, the Health Canada-funded Healthcare Excellence Canada (formerly the Canadian Foundation for Healthcare Improvement (CFHI) and the 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
Vaccination campaigns in long-term care facilities and seniors’ residences have significantly reduced the number of outbreaks in congregate living settings. While there have been some concerns about a low uptake of COVID-19 vaccines among LTC employees, overall, the vast majority of residents and LTC workers have been fully vaccinated. As of June 4, 2021, the number of outbreaks and cases in all PTs, including the most affected provinces, ON and QC, has sharply decreased since its peak in January 2021. The majority of PTs are not reporting any active outbreaks 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.

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 (i.e., 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 4,000 Veterans in over 1,150 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.

None