New national long-term care standards, which stress quality of life and safe building design, have received a cold initial reception from the Ontario government.
If the voluntary standards are implemented, funded and enforced, they have the potential to transform the way people live and work in nursing homes, advocates say.
But the degree to which they will be adopted remains unclear: the federal government has said it won’t require them across Canada, and it appears Ontario has no immediate plans to do so either.
Ontario long-term care minister Paul Calandra said Tuesday that while his ministry will review the standards, Ontario is already fixing long-term care through “leading standards across North America” for construction and remodeling of 58,000 beds and plans for four hours a day. care.
“I have no interest in diluting Ontario’s very high standards, and I am hopeful that the federal standards meet Ontario’s high standards,” Calandra said, just hours after the standards were officially released.
What Calandra called “federal” standards have been written by long-term care experts for two independent groups. The Health Standards Organization committee focused on quality of life for residents and staff, while a separate CSA Group committee looked at construction operations, design for small homes of approximately 10 residents, and prevention and infection control.
Calandra’s apparent rejection of the new approaches did not sit well with advocates, including those who have worked on the standards for the past two years.
“There’s a disturbing arrogance to that thinking that doesn’t help anyone, especially seniors in Ontario,” said Laura Tamblyn Watts, executive director of CanAge, a national senior advocacy group.
“The new national HSO and CSA standards are the most progressive, thoughtful, and pragmatic approaches to transforming long-term care. They are at the forefront of long-term care regulation and accreditation,” said Tamblyn Watts, who served on committees involved in developing the standards.
“Charitably, the minister can be very proud of Ontario’s highly prescriptive legislation for long-term care,” he said. “However, national accreditation standards provide guidance and details on how to ensure we never again experience the horrors in long-term care that we saw during COVID-19, and new (provincial) legislation is not enough. We need standards and the funding and political will behind them to make real change.”
There are many homes where the HSO standards will not apply.
The standards will be used by Accreditation Canada, which, based on 2020 figures, said it assesses 94 percent of publicly operated nursing homes in Canada (896 homes out of 953) and 36 percent of privately owned homes ( 586 homes out of 1,611) .
Accreditation Canada assesses all homes in Quebec and 41 percent of homes in Ontario, where about 15 percent, according to 2020 figures, do not use any accreditation, the HSO said.
France Gélinas, a health critic for the Ontario NDP and Nickel Belt MPP, said the provincial minister knows better than to suggest the new standards would lead to a “dilution” of Ontario’s rules.
“This is insulting,” Gélinas said. “What we have in Ontario doesn’t compare. We are decades back in Ontario. There is no required annual evaluation of our long-term care homes. Who are we kidding here?
He applauded the new standards for their coverage of the issues, though said he wished they had included a 4.1 hour daily hands-on requirement.
“They covered everything from fall prevention to socializing to what happens in the event of a disaster. I think they did a very good job,” he said.
“And then, I’m a politician, so why am I not happy? They are not required. There is no accountability. They are a wish list.”
Dr. Samir Sinha, chair of the HSO committee, said the standards were written with the “latest and best available evidence” and input from 19,000 Canadians. Many were from Ontario.
“I am sure the minister will see that these evidence-based standards are really a step up from what Ontario currently has. And there is a real opportunity for the minister to finally mandate accreditation and link Ontario’s enforcement and inspection measures to these standards as well,” Sinha said. He is the director of health policy research at the National Institute on Aging, which has partnered with the Toronto Star on The Third Act, an initiative focused on aging well.
Sinha said the four-hour care was not made a requirement because the evidence supporting that standard is now 20 years old, and the committee recognized that some residents need more care and others less. But by the standards, she said, each home would have to show that it was providing adequate care for each resident.
After Calandra appeared at a morning news conference at Humber River Hospital, highlighting “faster and easier” access to ultrasound or X-rays for long-term care residents, she cited her government’s funding for the construction of nursing homes in “big and small” communities. ”
“We are bringing them to smaller communities, because one of the things we heard, especially during the pandemic, was that people wanted to be in homes that were closer to their family. It makes a world of difference when someone can have their family and friends close to them. So our regulations do that.”
But Sinha said the construction of the new homes is based on old design standards that allow for institutional models with 32-person units and shared rooms. CSA standards for nursing home design call for small homes of about 10 residents and single rooms with individual bathrooms, she said.
Not everyone criticized Calandra. The Ontario Registered Nurses Association said it is “disappointed that the federal government has not made these standards mandatory, leaving instead mosaic approaches between and within provinces and territories.”
He also said the standards “fall short of addressing the critical issues of current staffing shortages” and the mix of skilled health workers.
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