Question Period Note: LONG-TERM CARE HOMES

• 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.

KEY MESSAGES

• The COVID-19 pandemic continues to highlight longstanding challenges in long-term care, including gaps in infection prevention and control, staffing, infrastructure, and visitation policies.

• Our Government has made significant investments in long-term care since the pandemic began, including up to $4B to help provinces and territories improve the standard of care in those facilities.

• In the Speech from the Throne, we have reiterated our commitment to strengthen health care for everyone including seniors and persons with disabilities; we know there is work to be done to better meet long-term care needs.

• We look forward to working with provinces and territories to improve access to quality long-term care and to support training and better wages for 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.

• Our Government welcomed the news that the Health Standards Organization and Canadian Standards Association have launched a process to help address those issues.

• 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.

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.
• While the Canada Health Act (CHA) covers physician and hospital services, long-term care is not publicly insured under the CHA.
• 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.

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.

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. As of October 5th, 2021, there are still some outbreaks in long-term care facilities due to the fourth wave of COVID-19.

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.

Several provinces have already announced initiatives to address gaps in LTC, including:
• ON:
o Commitment to build 30,000 new LTC beds over 20 years
o Commitment to add 27,000 LTC staff by 2024/25
o Commitment to 4 hours/day of direct care by 2024/25
o Mandated vaccination for all LTC home staff by November 15, 2021
• QC:
o Mandated vaccination for all health care staff (including LTC staff) by November 15, 2021
o Transforming more than 2,500 LTC spaces into seniors’ homes by 2022, which are aimed at providing living environments that are better adapted to seniors’ needs
o Created an accelerated training program to integrate up to 10,000 new personal support workers in LTC facilities
o Committed to increasing wages of personal support workers in LTC facilities and hospitals above $25/hour

Provinces are also experiencing staff shortages in a number of health care settings, including LTC. This may be exacerbated as provinces bring in requirements for all health care staff to be vaccinated, or be put on unpaid leave.

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:

• $3B 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.
• $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.
• 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.
• $960M 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
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.

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.

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. The process is being undertaken by expert standards development organizations, and is taking place at arms-length from the Government of Canada with broad engagement.

Long-Term Care Facility Ownership Breakdown
On September 24, 2020, 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. Public Service Pensions are the responsibility of the Treasury Board Secretariat.

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.

KEY FACTS
• 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. According to the Public Health Agency of Canada, more than 55% of COVID-19 deaths in Canada have occurred in long-term care facilities (with a proportion varying from 0% in smaller provinces and territories, to 43% in Ontario, 61% in Nova Scotia, and 72% in Québec. Eighty-one percent of the deaths in long-term care facilities occurred in Quebec (54%) and Ontario (27%). Even residents of facilities not affected directly by the disease are facing social isolation and reduced services.