New voluntary standards released for long-term care homes devastated by the pandemic
Promised new national standards for long-term care homes in Canada have now been released — part of Ottawa’s attempt to avoid a repeat of the alarming death tolls in long-term care homes that marked the early stages of the pandemic.
The Health Standards Organization (HSO) released 60 pages of comprehensive standards on Tuesday to complement the Canadian Standards Association Group’s (CSA) release of 115 pages of standards in December. The federal government started the standards project in spring 2021.
Both organizations have been tasked with developing standards to improve the quality of care in long-term care homes (LTC) across the country. The HSO focused on the care itself and the CSA on the physical infrastructure.
CLOCK | Federal government welcomes new voluntary standards: Minister: Federal agencies welcome new voluntary “resident-centred standards” for long-term care “The aim is to ensure that all facilities across the country are accredited with these national standards,” Senior Minister Kamal Khera told Power & Politics on Tuesday.
Though the new standards are voluntary, health experts say they won’t do their job unless LTC homes adopt them all without exception.
“This is kind of an all-or-nothing thing. This is basically the standard of care,” said Dr. Samir Sinha, director of geriatrics at Sinai Health and the University Health Network in Toronto and chair of the HSO’s technical committee that drafted the standards.
“My biggest fear is that if we don’t take these standards to heart and make sure they are the basis for inspections, enforcement, quality improvement and accountability… I fear these standards will just sit on the shelf.” “
The pandemic has exposed fatal weaknesses in the LTC sector. In the first few months of the pandemic, more than 80 percent of Canada’s known COVID-19 deaths occurred in long-term care and retirement homes — the highest such rate among Organization for Economic Co-operation and Development (OECD) nations.
As of July 2022, more than 17,000 long-term care home residents in Canada had died from COVID-19, according to the National Institute on Aging.
Thousands of employees at LTC facilities have also been infected; more than 30 died as a result. In some provinces, the Canadian Armed Forces had to be called in to assist in LTC homes.
Members of the Canadian Armed Forces at the Yvon-Brunet Residence, a long-term care home in Montreal, May 16, 2020. (Graham Hughes/The Canadian Press)
dr Sinha said the standards put in place today would have saved many lives if they had been in place at the time of the COVID-19 outbreak.
“If these standards were in place earlier, I don’t think we would be the world leader in long-term care. I honestly think we would have been one of the best,” he said.
The two sets of standards are intended to complement each other. They go beyond preparing for a pandemic, covering everything from preventing falls and maintaining flexible meal schedules (some LTC residents skipped meals during the pandemic during staff shortages) to end-of-life care and contingency plans for disaster events.
Friends and family visit incarcerated residents of Extendicare Guildwood in Toronto on June 12, 2020. (Evan Mitsui/CBC)
The new standards also address directly how COVID-19 has affected the quality of long-term care. As such, they include recommendations for flexible visitor policies, for rules that balance the rights of LTC residents with the health and safety of others, and for maintaining social interaction with family even during public health emergencies — along with Page for Page of Infection Prevention and Control Standards.
“These standards will primarily improve the quality of care for their residents, but they will also improve the care business if these homes show they are making those improvements,” said Alex Mihailidis, a professor in the University of California’s Institute of Biomedical Engineering Toronto and Chair of the CSA Group Technical Subcommittee that developed the infrastructure standards.
New standards for LTC buildings
The standards set new standards for LTC home construction and renovation. They state that single rooms in LTC homes should have dedicated three-piece bathrooms for residents, while shared rooms should have access to dedicated private rooms for “intimate acts.”
CSA standards require dedicated hand hygiene sinks and outdoor access for each level of a long-term care home. They offer guidance on waste management, video surveillance, signage and the design of staff rooms.
“Changing infrastructure and building infrastructure is costly,” Mihailidis said. “But… time is of the essence as there are plans across the country… to build new long-term homes. We hope they will look at our standard.”
CLOCK | New Long-Term Care Standards Voluntary: Canada Unveils National Standards for Long-Term CareOttawa has established new standards for Canada’s long-term care facilities in response to thousands of facility deaths during the COVID-19 pandemic. But advocates fear the voluntary guidelines will not have the teeth to protect vulnerable residents.
Much of the pressure on LTC homes due to the pandemic has been attributed to staff shortages and recruitment battles. The standards assume that a specific staff-to-resident ratio is required and do not prescribe a specific number of hours of care. However, they point out that evidence is strong that an average daily grooming of 4.1 hours is required.
“The biggest challenge facing many nursing homes right now is staff retention and recruitment, especially when hospitals are also facing significant staff shortages and paying much higher wages,” said Dr. sinha
For many of those still grieving the loss of a loved one in long-term care during the pandemic, the standards are a welcome step forward – but only a first step.
Eddie Calisto-Tavares celebrates her birthday with her father in 2017. (Submitted by Eddie Calisto-Tavares)
Eddie Calisto-Tavares’ father Manuel Calisto was one of 56 people who died during the second wave of COVID-19 at the Maples Long Term Care Home in Winnipeg in the fall of 2020. It was the worst affected house in that province.
“How do families like mine get these standards (to be implemented)? They are beautifully written, but how do we get them enforced? Then how do we make these houses accountable?” asked Calisto-Tavares.
Calisto-Tavares was struggling to gain access to her father when he contracted COVID-19 in late October 2020. She arranged to self-isolate in a hotel so she could continue to visit and care for him. She said what she saw at his LTC home still haunts her.
“I heard people screaming. They were hungry… they were so cold. They screamed that they were thirsty,” she said. “I could only say, ‘Help is coming, help is coming,’ because I knew very little help was coming.”
While the standards are mandated by the federal government, health care falls under the jurisdiction of the provinces. Some critics and family members of LTC residents have called for Ottawa to enshrine the standards in law to make them mandatory.
A $13.7 billion problem
Senior Citizens Minister Kamal Khera said the government is still in the very early stages of developing the Safe Long Term Care Act promised by the Liberals during the last election campaign. She argued that the introduction of the standards themselves is an important milestone.
“These standards will make a difference and it’s a step in the right direction to ensure we improve the lives of Canadians and seniors across Canada,” she said.
In the 2021 budget, Ottawa allocated US$3 billion to help provinces implement the standards. Experts say the work will cost much more.
Parliament’s Budget Officer estimated the cost of securing long-term care at $13.7 billion a year, in excess of what is currently being spent. Many advocates of long-term care patients are hoping that a much-anticipated new health deal between the federal government and the provinces could cover at least some of those costs.
“What kind of carrot and stick will be involved? Will it be the Canada Health Transfer and related money? Will it be each province that signs these standards and provides the funding needed to implement these standards?” asked Terry Lake, CEO of the BC Care Providers Association, an industry association representing long-term care and assisted living providers in BC
Lake, a former provincial health minister, said he worried the issue of long-term care had “gone off the political radar.”
CLOCK | Ontario Secretary of Long-Term Care Responds to New Voluntary Standards: ‘I have no interest in diluting what Ontario already has’: Paul Calandra on LTC Standards ‘We will take a look at what these new national standards are, Ontario Secretary of Long-Term Care Paul Calandra told Power & Politics on Tuesday. “I just have no interest in doing anything that would in any way dilute the very high standards that we have established here.”
“Obviously it was the number one issue during the pandemic … and now we’re seeing it kind of drop down the priority list. And we can’t let that happen,” he said.
Much of the debate about long-term care in Canada has revolved around whether for-profit facilities can operate. Lake said the results from for-profit and non-profit homes in BC are about the same.
The process of developing the standards has seen a very high level of public participation – suggesting that politicians need to heed the public’s desire for change, a union official said.
“If there’s any opposition from prime ministers across the country to any of these standards, or any kind of federal interference in this act, I think they’re seriously misinterpreting the will of the people they represent,” said Candace Rennick, National Secretary Treasurer of CUPE, a major union representing tens of thousands of long-term care workers across Canada. She has worked in various positions in nursing homes.
“People want enforceable standards. They want penalties and consequences for people who don’t follow the rules. They want to know that if they send their loved ones to these facilities, they will spend their final days with dignity and respect. And that’s not happening.”