Draft report on national long-term-care standards could shape Canadian legislation

The draft report on national long-term-care standards says residents must be free to engage in activities they enjoy and live in homes designed to feel quiet and safe.

The standards also recognize the key role front-line staff play in the philosophy behind “resident-centered care,” saying workers must be allowed to connect with people living in homes, to uphold “individual needs, abilities and preferences.”

Released on Thursday for public review, committee chair Dr. Samir Sinha said that while the final standards will be used to assess nursing homes, they could also provide the foundation for new regulations or laws, including the Liberals’ promised “Safe Long-Term Care Act.”

“These standards can be so much more than just the basis of accreditation programs,” said Sinha, director of geriatrics at Sinai Health and University Health Network.

The plan for national standards was born from public outrage as COVID-19 swept through Canadian nursing and retirement homes, killing more than 15,800 residents, mostly older adults, in both settings.

Created by a committee of residents, caregivers, staff, doctors and academics, the draft standards fall under the Health Standards Organization (HSO), which is Canada’s sole health-care standards development body. Accreditation Canada uses those standards in its work. It assesses 68 percent of Canada’s 2,202 nursing homes, according to information provided by HSO. In Ontario, where accreditation is voluntary, 84 percent of homes participate in an assessment program and of those, 41 percent use Accreditation Canada. In Quebec, the oversight is required and 96 per cent use Accreditation Canada.

The primary goal of the proposed standards, Sinha said, is to “reorient everyone’s thinking towards a resident-centered approach.” Equally important is the need to attract and retain long-term-care workers with jobs that pay well, provide training and time to connect with residents, he said.

“Without staff, you do not actually get resident-focused care.”

The new standards are expected to be finished by the end of the year. In a briefing with reporters, Sinha said there are previous cases of standards that became regulations or laws. The Standards Council of Canada told the Star those examples include regulations for hockey helmets and testing requirements for the respirators used as personal protective equipment.

Laura Tamblyn Watts, CEO of CanAge, a seniors advocacy group, said the report is a “significant improvement from the previous version and shines a light of hope on a sector which has long been shunted into the dark corners of policy.”

“It signals an important shift in culture that has long been needed.” But, Tamblyn Watts cautioned, without the funding or provincial legislation and regulations that include the standards, they “can only go so far.”

On Wednesday, Health Minister Jean-Yves Duclos and the Minister of Seniors Kamal Khera sent a joint statement to the Star saying the federal government will respect provinces’ “jurisdiction over health care to introduce the new long-term care act and ensure seniors live in a safe and respectful environment. ” The statement did not update the status of the legislation.

Health Canada said in an email that the 2021 budget “provided a $ 3 billion investment over five years, starting in 2022-23, to support provinces and territories in their efforts to ensure standards for long-term care are applied and permanent changes are made. ”

Demand for change to long-term-care homes has reached an all-time high. Most operate like institutions, requiring residents to awaken, eat and participate in group activities at specific times dictated by the home or provincial regulations. Nursing homes are funded and licensed by provinces, creating a patchwork system across the country.

Anthony Quinn, spokesperson for CARP, said politicians should be aware that the boomer generation has awakened.

“Prior to the pandemic this was a battle fought almost exclusively by the residents and their family members,” Quinn said. “Today, the entire generation of boomers, a massive voting block, are looking at the system and saying; “Fix it now… change the culture… make the investments now… for my aging parents, and for myself and my loved ones, we should ever be in need of long-term care.”

The national standards, said Jane Meadus, a committee member and lawyer with the Advocacy Center for the Elderly, are written broadly enough that individual provinces could use them to meet their local needs. “They could spur change in legislation across Canada,” Meadus said.

The resident-centered philosophies upheld in the new standards have attracted attention in recent years, although many have existed for decades. In the early 1990s, for example, American geriatrician Dr. Bill Thomas created the Eden Alternative. Now widespread, it began with a plan to eradicate what Thomas called the “three scourges” of nursing homes: loneliness, boredom and helplessness.

If the national standards are properly implemented, workers would listen to a resident’s wishes for medical care and social activities. That could mean singing with a caregiver to Broadway tunes. Gardening outdoors. Or cooking pancakes for fellow residents. The point is to enable people to feel a sense of purpose in life.

The focus on the well-being of front-line workers is timely. The pandemic sped up staffing shortages that have long plagued the industry. Since Dec. 1, roughly 4,000 long-term-care workers have isolated at home from the Omicron variant, while others work double shifts.

Critics say Premier Doug Ford’s Bill 124 is worsening the staffing crisis. It placed a one per cent annual wage cap, over three years, on public service workers – including staff in not-for-profit and charitable nursing homes. Many say they are leaving the sector, although workers in private and municipal homes are exempt.

“Bill 124 has been the final straw for so many,” said Cathryn Hoy, president of the Ontario Nurses’ Association. “Unprotected, unappreciated, not valued. Targeting them for wage and benefit suppression measures has broken them. ”

If the draft standards were in place now, CanAge’s Tamblyn Watts said, “they would not survive Ontario’s Bill 124.

“This is a perfect example of how governments can create destructive legislation.”