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.

• 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 $4 billion dollars 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 past two years have been devastating for Canadians in long-term care, their families, and for the hardworking people who care for them. Canadians deserve to feel confident in the care seniors receive.
• We welcome the news that the Health Standards Organization and the CSA Group have conducted extensive public consultations, completed the 60-day public review of their draft LTC standards, and expect to release the final LTC standards by December 2022.
• This is an important step to improving care for seniors that will set the bar higher for safe and respectful care in these facilities.
• We look forward to working with provinces and territories to use the standards to drive lasting change.

IF PRESSED ON WORK ON THE SAFE LONG-TERM CARE ACT…
• As long-term care falls under provincial and territorial jurisdiction, any legislation will be designed in a manner that reflects jurisdictional responsibilities.
• The federal government will work collaboratively with provinces and territories, while respecting their jurisdiction over health care, including long-term care.

IF PRESSED ON MOTION M-47…
• I would like to thank my colleague, the honourable Member for Avalon, for raising this motion about a critical part of our health care system.
• The federal government has made significant investments to support vulnerable Canadians and the workforce that supports them.
• We will continue to work in partnership with provinces and territories to strengthen our long-term care system so that all Canadians can get the high quality care they need, no matter where they live.

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

Current situation and investigations in long-term care facilities
Several provinces 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.

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 2022
Budget 2022 proposes the creation of an expert panel to study the idea of an Aging at Home Benefit. The panel will report to the Minister of Seniors and the Minister of Health.

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 will transfer $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 $1billion 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 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.

The Health Standards Organization and the CSA Group have completed the 60-day public review period of their draft LTC standards. Both organizations expect to release their final LTC standards by December 2022.

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.

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 calls 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 repeats the commitments made in the Liberal Party of Canada’s 2021 electoral platform and aligns 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 first hour of debate on this motion took place on April 25, 2022 and the second hour of debate is expected to take place in mid-June.

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).

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, 41% of COVID-19 deaths in Canada have occurred in long-term care facilities and seniors’ residences (with a proportion varying from 0% in the territories, to 38% in Ontario, 53% in Québec, and 70% in Prince Edward Island. Nearly eighty percent of the deaths in long-term care facilities occurred in Quebec (49%) and Ontario (29%). Even residents of facilities not affected directly by the disease have faced social isolation and reduced services.
• Health Minister Mandate Letter
The Government of Canada has committed to work in partnership with provinces and territories to strengthen our universal public health care system and public health supports, so all Canadians can get the care they need no matter where they live. Collaboration with provinces and territories will be key to ensuring the primary care system is positioned for the future, including accessible health system data, as well as working to improve the quality and availability of long-term care. Specific commitments include:
o Negotiating agreements with provinces and territories to support efforts 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 and a Safe Long-Term Care Act to ensure seniors get the care they deserve.
o Work with the Minister of Employment, Workforce Development and Disability Inclusion and provinces and territories to train up to 50,000 new personal support workers and raise wages
o In this, the UN Decade of Healthy Ageing (2021-2030), promoting seniors’ physical and mental health to enable them to live longer at home, including by supporting the Minister of Seniors in their work to establish an expert panel to provide recommendations for establishing an Aging at Home Benefit.