The effort to develop national standards for long-term care (LTC) in Canada will take a big step forward next month.
Two organizations have been working on separate aspects of establishing standards. They will each publish their proposals in February, and an advisory committee will oversee the work of combining them into a comprehensive document.
When adopted, the standards will be tied to the accreditation process for LTC providers, and may affect their eligibility for government funding.
The Canadian Standards Association has been given the work of establishing standards for the operations side of LTC facitlities. Laura Tamblyn Watts, CEO of the seniors’ advocacy group CanAge, is part of the tactical working group for the project.
“The CSA’s work focuses on the operations—the buildings, the infection prevention and control. That's the ‘right hand,’ if you will,” Tamblyn Watts said.
“The ‘left hand’ is under the leadership of Health Standards Ontario. It's not that it's Ontario focused, it's just that they are focused on care standards,” she said. “The two different organizations each have their own work cut out for them. And then there is a coordinating committee between the two of them.”
The two groups will publish their work in February, and then a further round of consultations will take place. Tamblyn Watts said the final standards will be published in November.
Shocking revelations about inadequate facilities, poor care, and outright abuse outraged Canadians in 2020 and 2021 as the Covid-19 pandemic devastated LTC homes. Standards of care varied from province to province, and from one care provider to another.
Tamblyn Watts said it is important to have high minimum standards that are uniform across the country.
“Right now across the country, long-term care homes are languishing behind modernization that we've seen in other fields,” she said. “Of course Covid-19 threw a spotlight onto how outdated and how inadequate long-term care was and shocked people into realizing that we really didn't have agreed-upon standards for care or operations.
“We need as a country to make sure that the quality of care and the quality of life is consistent and not based on your postal code.”
The new standards will be a minimum, not a maximum, she said. Care providers will always be permitted and encouraged to do more.
There is plenty of room for improvement on both the operational and care standards sides, she said, but there are existing standards for the latter. The operational standards team started more or less from the ground level.
“It's being drafted kind of from scratch,” Tamblyn Watts said. “And that is because a lot of the standards were from hospitals originally, or other types of more institutional congregate housing.
“In some cases, we are really building for the first time a modern understanding of what the physical environment should look like for long-term care. Talking about technology for the first time.
“Some of them are well-established—windows and so on,” she said. “But the philosophy behind that has really changed. I would say there's going to be a significant jump in modernization and real guidance in operations for infection prevention and control and so on.”
The tragedies revealed in the early days of the pandemic unleashed a public outcry. There were expressions of grief for the people who suffered, and continue to suffer, in LTC facilities and anger at the institutions and governments that allowed the neglect and abuse to happen.
This was part of the urgency of establishing new standards for facilities and for care. Tamblyn Watts says it’s good that the work began more or less immediately, because public attention has since shifted.
“We have always seen that when seniors’ issues come into focus, that focus starts to blur fairly quickly after the crisis,” she said. “We have seen how poorly seniors made out during Covid-19, so we had that spotlight focus early on. But many people don't realize that we are in almost as bad a situation now, in terms of staffing, as we were at the beginning of wave one.
“When the spotlight slides away, the attention and focus and money slide away too.”
Long-term care, she said, shouldn’t be given its priority level based on its level of media attention.
“I think having instituted national standards will provide a backstop against that kind of slide,” Tamblyn Watts said. “You know, how people get care and the way that they live in terms of quality of life should not be based on media highlighting issues. It should be based on a robust and innovative policy framework and standards underpinning to ensure the well-being of all residents in long-term care.”
The public’s concern now is not whether seniors and other LTC residents can live a good life in a safe environment, she said. People are more concerned about disruptions and inconveniences in their own lives.
“People have turned their eyes away from the ongoing crisis in long-term care, and are now more focused on whether gyms and restaurants are opening than how seniors are being treated in long-term care homes,” she said.
It’s tempting to read a policy of “protecting the most vulnerable” as really meaning “lock away the old folks so the rest of us can get on with our lives.” Tamblyn Watts says proper care standards will focus on the role of care in supporting an appropriately high quality of life. This includes providing for as much independence and personal liberty as possible.
“We have residents, who may have had even their fourth dose, who are often still locked down and living by a very different and far stricter set of rules than the broader community, than somebody who may have only had two doses. So there are fundamental injustices, not just ongoing but escalating in long-term care,” she said.
“Attention has moved away from this issue. Our hope is that national standards will buttress that and start making clear that care and resident’ needs need to be put first, in a way that is focused on the importance of quality of life for residents.
“Somehow, our aging society doesn't seem to mind taking away the rights and liberty of seniors, particularly those in institutional care, when their [own] focus seems to be on whether or not they can go to the shopping mall.”
Tamblyn Watts will serve on the advisory committee that combines the two categories of standards into a single document. She said the process will receive input from LTC operators, professionals, and resident representatives before publishing their finished document in November.
Meeting or exceeding the final standards will be part of the accreditation process for LTC operators whether for-profit, non-profit, or publicly operated. Governments may decide on whether compliance affects operators’ eligibility for funding.
“We'll see if the government decides that it won't fund homes that don't meet the standards. That's something to look for, but we're not at that point just yet,” Tamblyn Watts said.
“When it comes to legislation, that will require some persuasion on behalf of the provinces to buy into that process. But first you have to create the standards and get everyone's input, and that's what they're doing right now.”