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What’s happening with national standards for long-term care?

If you found yourself outraged, devastated, and in grief at the loss of life in long-term care during the pandemic, you may be wondering what is happening with Prime Minister Trudeau’s promise to create national standards. The short answer is that the federal government’s actions to date are little more than superficial delay tactics.

A recent poll by Angus Reid confirms that a great majority is seeing through Trudeau’s empty promises, with three quarters of respondents saying they doubt any significant change will happen in long-term care in the next five to ten years. Yet 58% of respondents support the federal government getting directly involved in long-term care, and 75% believe a major system overhaul is needed. 60% want to see private for-profit care phased out.

Clearly, we want and need clear commitments to legislated and enforceable national standards that eliminate profit in long-term care. Read on to learn how you can take action to ensure Canada gets national LTC standards with some teeth.

The rise and fall of Trudeau’s commitments

Prime Minister Trudeau has repeatedly failed to fulfill his promises about national standards for long-term care. In the fall 2020 Throne Speech, he committed to working with the provinces and territories to set national long-term care standards. In December, the Prime Minister recommitted to setting the standards and intimated that provinces refusing to adopt the “highest standards” would not receive federal funding for long-term care.

But when the federal budget was revealed in March, the federal government inadequately committed $3 billion over 5 years, with funding to start only in 2022. That means only $600 million per year, split between 10 provinces and 3 territories. It is nowhere near to the $13.7 billion per year required to fund change. In addition, without strings attached to these public dollars, there is no guarantee that funding will go to improving care conditions rather than addressing other provincial priorities or profit-taking.

Indeed, the government has taken no steps to address for-profit care delivery in long-term care, which has been conclusively shown to result in inferior care and higher risk of COVID-19 outbreaks and deaths compared to public and non-profit delivery.

What can we expect of the new “national standard” for Canada?

Rather than beginning the political process to legislate and enforce national standards with teeth, the federal government has offloaded the responsibility of creating national standards to the Health Standards Organization and Canadian Standards Association. The HSO/CSA process is intended to revise a technical standard from 2020. This means we already have a “national standard”, but that this mechanism failed to prevent nearly 15,000 COVID-19 deaths in long-term care and retirement homes in the first two waves of the pandemic. Why?

As two players in the private accreditation industry, HSO/CSA have no power to establish clear roles for federal and provincial governments or to hold private for-profit operators to account. HSO’s standards are primarily used as a basis of assessment for optional accreditation by an industry that benefits financially from accrediting long-term care facilities. We know that almost 70 percent of long-term care homes in the country were accredited prior to the pandemic and have learned the hard way that accreditation fails to address neglect and preventable deaths.

By passing the work of creating standards to the private sector, Trudeau can claim that change is on its way. In reality, this process commits the federal and provincial governments to nothing – no ongoing funding, and no public accountability, and no enforcement. And importantly, it significantly delays action by initiating a nearly two-year long consultation process when no fewer than 12 major investigations have already made clear what action is required.

Call for legislated national standards

A recent survey conducted for the Canadian Medical Association found that 86 per cent of Canadians believe that long-term care should be considered an integrated part of our health system and funded and administered accordingly. Making that vision a reality will mean legislation that creates federal responsibility and enforcement mechanisms to hold provinces accountable.

Real national standards should be publicly governed and require minimum staffing requirements, accountability and enforcement of standards, and public reporting of verified data. Funding should be attached to those requirements.

And importantly, the federal government needs to make a commitment to take profit out of long-term care. A national standard that fails to hold for-profits to account is no standard at all.

Take Action

Make your voice heard in the HSO national standards consultation. We want to make sure the most common input HSO gets is supportive of legislated standards. Tell HSO that you want legislated and enforceable national standards. Tell them you do not want the national standards to be buried in a non-enforceable assessment tool within Accreditation Canada. For more suggestions on regulations to recommend, see this briefing note jointly prepared by provincial health coalitions. There are two ways to provide input to HSO:

Help make national standards an election issue. Don’t let Trudeau off the hook. Keep drawing attention to the lack of action accompanying his commitment. Demand that federal candidates make clear commitments to legislated national standards and eliminating profit in long-term care instead of optional accreditation. Here are some questions to ask your candidates:

  • What is your position on national standards for LTC? Can you commit to work towards a legislated national standard?
  • Do you support using the federal spending powers to create funding for LTC that is contingent on provincial governments meeting national standards?
  • Do you support eliminating private for-profit operators from our LTC system?

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