New long-term care standards will fall flat without money or enforcement, experts warn

The federal government is spending $3 billion over five years to establish new standards to improve long-term care in Canada. Advocates say the money alone is not enough that they want measures to ensure new standards actually lead to better care for seniors.

Expectations are high for the new standards, now being developed by theHealth Standards Organization (HSO) and the Canadian Standards Association (CSA). The work will take at least another20 monthsbut those involved say they hope new standards can help prevent the dire conditionsthat contributed to high pandemicdeath rates in thelong-term care sector.

In the first wave of the pandemic, long-term care facilitiessaw 80 per cent of Canada's total COVID-19deaths. Outside ofQuebec and Nova Scotia, deaths in long-term care actually increased in the second wave.

But experts warn that new standards alone won't solve the many problems in the sector exposedby the pandemic. They say they fear that,after decades of government indifference to long-term care, public pressure to fix those problems might fadeas the pandemic wanes.

"I do not want these standards to sit on a shelf and not be used," said Alex Mihailidis, technical subcommittee chair for the CSA.

"If we can take anything positive out of this pandemic and everything we've seen happen I think we are at the tipping point and that is going to really drive the political will and social will forward and ensure that these standards are really taken seriously."

What would new standards look like?

Experts say the long-term care sector needs to improve both thedelivery of care and the operation of itsfacilities. That extends to everything from the number ofhours of direct personal care residents should expectto staff-resident ratios andinfection prevention and control practices.

It also includesventilation systems, plumbing, medical gas systems and facilities'use of technology. All of those things coulddepend on possible new infrastructure standards, which could dictatehow new long-term care homes should be built, how many residents can be put in a singleroom and how common and isolation areas should be constructed.

The HSO and CSA alsowill have to work out howinfrastructurestandardswould apply to existingbuildings.

"We're pushing to basically say with everything that we've learned so far, with everything we're learning about the state of long-term care in Canada, how do we actually make these new standards pandemic-proof?" said Dr. Samir Sinha, the director of geriatrics at Sinai Health and the University Health Network in Toronto. He's heading up the technical committee for the HSO.

The HSO already has standards for long-term care homes;the pandemic proved they're clearly insufficient. Across Canada, almost 70 per cent of long term care homes are accredited based on either those HSO standardsor a U.S.-based equivalent.

In Quebec, 100 percent of homes require accreditation. ButQuebec's long-term care homes were among thosehardest-hit by the pandemic.

Dr. Sinha acknowledges that 20 months is a long time to wait for new standards, but the work takes time.

"This is actually how you end up developing good quality standards. Or do you want to just be politically expedient and get more of the same of what?" he said.

"Because whatever we've been doing so far, frankly, hasn't worked well. Now that everybody's attention is on this, I'm determined to make sure that we do this right."

Public input

Normally, in standards development processes, technical committees made up of stakeholders and experts work ondraft standards that are then presented to the public for input and review towardthe end of the process.

But the death toll inthelong-term care sector during the pandemic has generated a massive amount of public interest in this process especially among those who've lost loved ones in long-term care.

The HSO and CSAare expected to take into account the results of public surveys on long-term care standards and are holdingtown halls to solicit input starting this summer.And the HSO technical committee was assembled in part througha public application process.

Will new standards make a difference?

The answer to that questiondepends on what the provinces do. Provinces which are primarily responsible for long-term care will be called on to spendthe money needed to meet those standards and to fillmassive staffing shortages.

Experts also say the effect of new standards will depend a lot on whether they're mandatory, and whether those facilities caught violating them can expect penalties.

"Unless they're mandatory, then they are a wish list of what we think is important and that's not going to really make substantive change," said Laura Tamblyn Watts, CEO of CanAge anational seniors advocacy organization and an adjunct professor at the University of Toronto.

"So it's important that those standards have some type of force of law and that breaking them [has] some type of profound penalty against them."

Tamblyn-Watts said long-term care homes almost neverlose theirlicenses to operate for violating standardsand the fines they face are "almost laughable."

Technically, the federal government could create its own legislation andregulations to makethe standardsmandatory. Experts say that's unlikely.

Still, in a March interview with CBC, Health Minister Patty Hajdu argued enforcement is key.

"It's not just a question, for me, of having standards. It's about also a commitment and a path forward to enforcing those standards, or to upholding those standards," she said.

"Because, of course, some provinces and territories did have standards and it didn't necessarily lessen the tragedy in those provinces and territories. So it's about figuring out what the standards need to be. And then the separate process is how you ensure that those standards are applied consistently, so folks that are dependent on care are indeed safe in those places."

How much wouldit cost?

The Standards Council of Canada says it plansto contribute up to $340,000 to fund the work on long-term care standards.

The real price tag, of course, is whatultimately getsspent byfederal and provincial governments to ensure the standards mean something. Critics say the $3 billion over fiveyears Ottawa is offering the provincesis simply not enough.

"That's about six or seven dollars per resident per day," said Terry Lake, CEO of the B.C. Care Providers Association, which represents 400 long-term care and assisted living homes. Lake is a former provincial health minister.

"You have to have the provinces on board to make them mandatory because health care is provincial jurisdiction. There are carrots and sticks and the carrot, of course, from the federal government is funding. I think some provinces may be reluctant to have a standard that's enforced without more funding going in to incentivize those standards."

Already, someprovincial governments have bristled at the idea oftaking any direction from Ottawa, money or no money.

"I think those premiers are reading their populations wrong. These jurisdictions have had extremely bad outcomes in long-term care and much of it was preventable," said Tamblyn-Watts. "The pushback is out of step with how furious and distraught the voters are about it."

But a number of recent provincial budgets that committed money to building new homes or increasing staffing in existing ones have been criticized for not setting aside anything close towhat is required even at atime of intense public pressure for change.

Advocates say they fear that's not a signthepolitical will is there to ensurethe thousands of people who died in long-term care homes during the pandemic did not do so entirely in vain.