The time to fix long-term care in Canada is now

By: Isabelle Gagnon-Arpin, Monika Slovinec D’Angelo

The COVID-19 crisis has drawn attention to the inconsistent regulations, low standards of care, and poor working conditions in Canadian long-term care facilities. But the pandemic has also provided an opportunity to learn from the successful management of long-term care in some provinces versus others. With what works and what doesn’t in plain sight, now is the time to fix long-term care in Canada by building a road map to get there.

In British Columbia, a modern infrastructure with fewer multi-bed units, government-initiated staffing controls, pay increases, and the provision of personal protective equipment (PPE) kept long-term care infections relatively low. In contrast, Ontario and Quebec did not take the same approach to stopping the rate of transmission of the virus. Their approach was less efficient and likely more costly, relying on full-scale investigations and the deployment of the military.

By failing to quickly invest in protective equipment and staffing capacity, these provinces struggled to contain outbreaks and saw death rates that were 14 and 23 times higher, respectively (as of May), compared with British Columbia. Unless decisive actions are taken, the systemic weaknesses accentuated by COVID-19 will increase in severity and magnify the risks to which long-term care patients and staff are exposed.

A first step toward fixing Canada’s long-term care system would be to invest. Chronic underfunding, driven by a focus on cost containment due to the steep growth in healthcare costs associated with an aging population, is at the root of the crisis we face today. It is estimated that $200 billion would be required to simply address immediate challenges through 2035. However, with Canada’s population aging and the requirement for long-term care beds expected to double by 2035, more substantial investment is needed to add capacity, update or build new facilities, and raise the level of care. The impacts of not doing so have been laid bare over the last few months. That said, there is an upside to this approach, which we highlighted in some of our research. In addition to improved care for patients, adding 199,000 long-term care beds would boost real annual GDP by an average of $12 billion and support 123,000 jobs per year. Similarly, the demand for nurses to provide continuing care for seniors would create an increase of nearly 80,000 full-time jobs.

An important second step would be to support standard measurement, systematic data collection, and a performance management framework. Accessible to health professionals, administrators, researchers, and patients, these tools could promote benchmarking, along with sharing, assessing, and adopting of best practices. Transparency and open access to data could also foster healthy competition among providers and much-needed accountability across jurisdictions when they are falling short—all with an aim to improve patient care.

With long-term care now in the spotlight, we must seize the opportunity to do right by patients and the workers who provide their long-term care. This means moving away from the stagnancy wrought by underfunding and lack of oversite toward a system driven by continuous improvement, appropriate investment, and accountability.