Question Period Note: Long-Term Care and New National Standards

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• The COVID-19 pandemic has disproportionately affected Canadians living in long-term care homes. Canadians are concerned about the availability of safe, high-quality long-term care services.
KEY MESSAGES
• Every senior in Canada deserves to live in dignity, safety, and comfort, regardless of where they live.
• The COVID-19 pandemic has highlighted long-standing and systemic challenges in long-term care homes across Canada.
• We welcome the release of complementary, independent LTC standards from CSA Group and the Health Standards Organization (HSO).
• In the coming weeks, we will move forward with consultations and engagement with stakeholders and Canadians on a principles-based Safe Long-Term Care Act.
• We have announced an investment of close to $200 billion to provinces and territories, which includes $3 billion over five years for long-term care and $1.7 billion over five years to support hourly wage increases for personal support workers and related professions.
IF PRESSED ON HEALTH CARE SYSTEM FUNDING …
• We announced that we will increase health funding to provinces and territories by close to $200 billion over 10 years, including $46.2 billion to provinces and territories in new funding.
• This includes $7.8 billion over five years for long-term care, home and community care, and mental health and substance use.
• New funding includes $1.7 billion over five years to support wage increases for personal support workers and related professions.
• These investments will provide access to safe long-term care and home care so Canadians can age safely.
IF PRESSED ON WORK ON STANDARDS FOR LONG-TERM CARE …
• The Government is appreciative of the work of CSA Group and HSO and welcomes these new long-term care standards as it reflects the importance of long-term care to all Canadians.
• Together, the standards focus on the delivery of safe, reliable, and high-quality long-term care services, safe operating practices and infection prevention, and control measures in long-term care homes.
• Federal funding to provinces and territories to improve long term care is focused on two main priorities: supporting compliance and enforcement of standards in LTC facilities and supporting the LTC workforce.
IF PRESSED ON FEDERAL GOVERNMENT ENFORCING STANDARDS …
• Delivery of long-term care services is a provincial and territorial responsibility. Given the Constitutional division of powers, the federal government cannot impose national standards on provinces and territories, or directly on long-term care facilities, but the funding agreements allow us to work together to prioritize the uptake and adherence to the standards.
IF PRESSED ON WORK ON THE SAFE LONG-TERM CARE ACT …
• The Government of Canada is also committed to doing more to support seniors across the country. We know Canadians want to age closer to home and family, but also expect long-term care to be safe, when needed.
• As such, our government is looking at developing a Safe Long-Term Care Act to help ensure seniors get the care they deserve, while respecting provincial and territorial jurisdiction.
• In the coming weeks, we will move forward with consultations and engagement with stakeholders and Canadians on a principles-based Safe Long-Term Care Act.
IF PRESSED ON WHAT IS THE FEDERAL GOVERNMENT DOING TO SUPPORT PERSONAL SUPPORT WORKERS …
• Budget 2023 confirmed the Government’s commitment to an increase in health care funding of close to $200 billion over 10 years, including $46.2 billion in new funding for provinces and territories. One of the priority areas of this funding is to further support the health workforce.
• This new funding also includes a federal investment of $1.7 billion over five years to support hourly wage increases for personal support workers and related professions.
• Budget 2023 also committed to provide $50 million over five years to strengthen the retirement savings of personal support workers.
• We continue to work with provincial and territorial governments on how best to support recruitment and retention of personal support workers.

Long-term Care (LTC) in Canada
• 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 LTC falls within provincial and territorial (PT) 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.
• 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.

Mandate Letters
Minister of Health 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. Specific commitments include:
• 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.
• Train up to 50,000 new personal support workers and raise wages.

Third-party standards development process and Safe Long-Term Care Act
On January 31, 2023, the Government of Canada welcomed the release of complementary, independent LTC standards from the Health Standards Organization (HSO) and CSA Group and thanked them for their dedicated work to complete the development of LTC standards. The national standards development process was complementary to, but independent from, the Government of Canada’s collaborative work with PTs to help support improvements in LTC. While Health Canada did not fund the recently released LTC standards, it did provide funding to CSA Group and HSO to support enhanced engagement and consultations with Canadians and stakeholders to ensure the diverse perspectives were considered during the development of both standards.

The Government of Canada is also looking at developing a new principles-based Safe Long-Term Care Act to help ensure seniors get the care they deserve, while respecting provincial and territorial jurisdiction. In the coming weeks, the Government of Canada will move forward with consultations and engagement with provinces and territories, stakeholders and Canadians on safe long-term care legislation that will be designed to reflect jurisdictional responsibilities.

Health Care System Funding
On February 7, 2023, the Prime Minister and his PT counterparts met to work together on improving Canada’s health care system. First Ministers discussed shared health priorities to deliver real results for Canadians as well as the importance to uphold the Canada Health Act to protect Canada’s publicly funded health care system.

At the meeting with premiers, the federal government announced it will increase health funding to PTs by close to $200 over 10 years, including $46.2 billion in new funding. This amount includes $25 billion to advance shared health priorities through tailored bilateral agreements, building on the $7.8 billion over five years that has yet to flow to provinces and territories for mental health and substance use, home and community care, and long-term care.

In addition, new funding announced includes $1.7 billion over five years to support hourly wage increases for personal support workers and related professions, as federal, provincial, and territorial governments work together on how best to support recruitment and retention.

Budget 2023 proposes to provide up to $50 million over five years, starting in 2023-24, to Employment and Social Development Canada to develop and test innovative solutions to strengthen the retirement savings of personal support workers without workplace retirement
security coverage.

Situation in LTC homes throughout the COVID-19 pandemic
A number of long-standing issues in LTC were starkly revealed by the COVID-19 pandemic, including: infection prevention and control; health human resources; compliance with standards and regulations; infrastructure; and personal protective equipment. 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 PTs and stakeholders have released reports and recommendations on addressing issues faced in LTC facilities.

Government of Canada initiatives to support PT actions in LTC
The Government of Canada has worked collaboratively with PTs 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:

• The Safe Restart Agreement provided provincial and territorial governments with over $19 billion, including $740 million in funding to support our most vulnerable populations through infection prevention and control measures to protect those in LTC and those receiving home care and palliative care.
• 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.
• Since 2020, the Government of Canada has provided $10.7 million to Health care Excellence Canada, who have enabled more than 1,500 long-term care facilities and retirement homes across Canada to implement best practices for preventing and addressing COVID-19 infection. In their next phase of work, participating teams will be supported to address gaps in the safety and quality of care received in long-term care.
• Budget 2021 provided:
o $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.
o $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.
o $90 million over three years, starting in 2021-22, to Employment and Social Development Canada (ESDC) to launch the Age Well at Home initiative.
o $27.6 million over three years for a Group Tax-Free Savings Account to support retirement saving for personal support workers.

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).

• On January 31, 2023, the Standards Council of Canada, Health Standards Organization and CSA Group announced the completion and public release of new national long-term care standards.
• Budget 2023 confirmed the Government’s commitment to close to $200 billion over 10 years to improve health care services for Canadians.
• Funding includes $7.8 billion over five years that has yet to flow to provinces and territories for mental health and substance use, home and community care, and long-term care.
• In addition, new funding announced includes $1.7 billion over five years to support hourly wage increases for personal support workers and related professions, as federal, provincial, and territorial governments work together on how best to support recruitment and retention.