COVID crisis exposes enormous shortfalls in long-term care system

Residents in the chapel at St. Michael’s Long-Term Care Centre

Marco Levytsky, Editorial Writer.

As the COVID infection curve appears to be flattening, several provinces, including Quebec, which, with only 24% of Canada’s population, accounts for over 50% of the cases and almost 55% of the deaths, have adopted plans to phase in the lifting up of restrictions as to business closures. Whether or not it is too early to do so is a matter for debate, but all jurisdictions that have done so are including strict guidelines – for example, limiting restaurants to 50% capacity, maintaining physical distancing, including the ban on gatherings of more than 15 people, and so on. As well, the data will be very closely monitored before any additional steps are taken and should the number of daily cases increase, restrictions may well have to be put back in place.

The rationale behind the lifting of restrictions, particularly in Quebec, is that COVID-19 cases and deaths are localized both in terms of geography and certain sectors or institutions – long-term care facilities in particular. In fact, a very glaring and disturbing statistic is that 80% of COVID-19 deaths in Canada have occurred in long-term care facilities.

One such institution that has maintained an exemplary record in this regard – no cases, let alone deaths – is the Ivan Franko Home in Toronto, a residence that is ethno-specific and caters to seniors of Ukrainian heritage. There, the staff took quick action, even before the provincial government issued its own guidelines. The Ivan Franko Home was recently singled out by CBC News as an example for others to follow. (For more on this see the CBC story). Another such institution is run by St. Michael’s Health Group in Edmonton – a faith-based organization, also founded by members of the Ukrainian community, but open to seniors of all ethnocultural backgrounds.

“We believe that this is due to some of the early, additional screening measures and the pro-active approach we took even prior to some of the required changes that were implemented by Alberta Health Services and the Chief Medical Officer of Health,” St. Michael’s CEO John Kopeck told New Pathway – Ukrainian News. “We believe that taking this pro-active approach served our organization, residents, staff and families well to keep everyone safe during this COVID-19 pandemic.”

Nevertheless, he adds that once this pandemic is finished it is time to take a serious look at the current long-term care system in Canada.

This issue was most recently addressed in a new background report released April 24 by the Canadian Centre for Policy Alternatives (CCPA).

“With long-term care facilities on the frontlines of the COVID-19 crisis, the importance of universal, publicly funded, accessible health services has never been clearer,” said report co-author Pat Armstrong, distinguished research professor in sociology at York University and CCPA research associate.

“That the largest proportion of COVID-19 deaths in Canada are in nursing homes attests not only to the vulnerability of residents, but also to residents’ high health care needs and our failure as a country to implement policy changes that have been supported by evidence for over a decade.”

This report, entitled “Re-imagining Long-term Residential Care in the COVID-19 Crisis” reviews existing research on solutions for reforming long-term residential care, which shows that care homes run on a for-profit basis tend to have lower staffing levels, more verified complaints, more transfers to hospitals and higher rates for both ulcers and morbidity.

“Managerial practices taken from the business sector are designed for making a profit, rather than for providing good care. These include paying the lowest wages possible and hiring part-time, casual and those defined as self-employed in order to avoid paying benefits or providing other protections. Contracting out services such as cleaning, laundry, food and security can also increase risk by bringing more people into homes on a daily basis,” states the report.

The report’s short-term recommendations include: making all staff permanent and limiting their work to one nursing home; raising staff wages and benefits, especially sick leave; rapidly providing testing for all those living, working or visiting in homes; ensuring access to protective equipment immediately; and severely limiting transfers from hospitals.

In the long term, the report suggests policymakers should “more effectively integrate long-term residential care into the public health care system, through federal legislation similar to the Canada Health Act, in order to develop a universal public long-term care plan that is accessible and adequately funded.” Among those recommendations: stop privatization and promote non-profit ownership; ensure protective equipment is stockpiled for the future; build surge capacity into labour force planning and the physical structure of facilities; and establish and enforce minimum staffing levels and regulations.

However, it is most important to distinguish between those private institutions that are run on a for-profit basis, and those, like Ivan Franko and St. Michael’s that are run as non-profit entities. Aside from that one recommendation to “stop privatization and promote non-profit ownership” the report makes no mention of the role played by non-government, non-profit institutions. And they play a vital role that needs much more attention than that accorded by the report. While it is important for both federal and provincial governments to establish some very necessary regulations to ensure proper care for the residents, and proper compensation for the staff, it is also necessary to recognize and enhance the private non-profit organizations like Ivan Franko Homes and St. Michael’s Health Group. Give them the proper financial support they need to maintain their high standards of care with love and dignity.

The COVID-19 crisis has exposed the shortcomings of our current long-term care system in a very stark manner. This is something that needs to be addressed in a very sweeping manner if we intend to consider ourselves a society that cares for its most vulnerable.