Consultations are ongoing to get public feedback on the proposed Safe Long-Term Care Act, which the federal government hopes will provide a framework and funding for the provinces to improve long-term care services. The consultation opened on July 21st and remains open until September 21st. Marc Serré, MP for Nickel Belt, explains that the goal is to get comments from residents, families, and institutions such as the Au Château on what a new set of federal standards should look like. “There are 200,000 residents across Canada living in long-term care facilities, and we owe this to our seniors, we owe this to our parents, and older folks that have dedicated their lives to Canada,” says Serré.
The MP has been working towards better services for Canadian seniors for several years. “I had a motion in the House of Commons, in 2017, to develop a national seniors’ strategy. This has been really important to me since I’ve been elected. As part of that strategy, we now have for the first time a dedicated federal Minister for Seniors,” he declares. Serré adds that he’s been hearing calls for more infrastructure support and staffing within long-term care facilities since he’s been elected. “Even prior to the pandemic this was an issue. The pandemic really highlighted it. We had to call in the army for crying out loud!”
After seeing the devastation in long-term care homes across the country during the pandemic, the federal government decided they had to act, despite long-term care falling under the purview of provinces. They hope that provinces will agree to certain standards in order to access new federal funds.
“We have $3 billion ready over the next 5 years. We want to do a Safe Long-Term Care Act that we want to negotiate with the provinces. We will not impose it, we cannot mandate it, because then you get into Constitutional and legal challenges,” describes Serré, adding that this funding will represent much-needed relief for long-term care homes who have seen the bulk of the federal health care funds go to hospitals. While he respects that healthcare is a provincial matter, he says “Our approach as a federal government has been ‘Here’s some money, but let’s negotiate,’.”
When it comes to Ontario, Serré is hoping to see an agreement but points out that the current government has shown hesitance in the past. “We’ve done this with provinces with child-care, and again Ontario is the last province or territory, across the country, that signed the child-care agreement with us,” he notes. However, when it comes to long-term care, Serré admits that the problem is not a new one. “We have to be fair too, this is not just a Ford government issue. Previous Liberal governments, in my opinion, have not done well for long-term care,” he says, adding that while the current government is dragging its feet, so have previous ones.
The province has had many issues with standards being low, and in some cases not being met within long-term care facilities. “The standards were not even met, and the provincial government cut their audits and inspections, so no one knew until we had to send in the army, and people died,” stresses Serré. He also asserts that “the vast majority [of issues], if not all of them, came from institutions that were privately run.”
In Ontario, approximately 57% of homes are privately owned. What Serré hopes is that an elevated standard of care outlined in the federal Act, and agreed upon by the province, will help eliminate the disparity between the care offered in publicly-funded and for-profit LTCs. Although the goal of the Safe Long-Term Care Act is not to eliminate or reduce privatized long-term care, Serré admits that could be a result of it. “In my opinion the standards have to be higher than they are today, that means it might discourage the private sector because they have to spend money on services and not to their shareholders,” he predicts. Ultimately, it is a simple question of everyone having a better, and equal standard of long-term care across the whole of Canada, regardless of who is providing that care, he stresses.
Sue Lebeau, CEO of the West Nipissing General Hospital and its Long-Term Care section, Le Pavillon, thinks that an increase in standards is still a good financial investment in the long-term. “If we have quality care, then it prevents costs, both human and financial, down the road,” she asserts, and adds that the cost-saving could benefit all facets of healthcare. That includes hospital care, as she explains: “Plausibly, if the standard of care is higher, we might have reduced incidents of falls, for instance, or reduced incidents of medication errors. All of which might lead to hospitalization, and adverse outcomes for that resident. Those are the kinds of cost-savings that I’m talking about.”
When it comes to enforcing the Act, Serré brings up the federal government’s recent healthcare funding claw-backs. “The federal government has already shown that we have clawed back, in recent years, to the provinces that have not adhered to the Canada Health Act and have been privatizing services. The same would apply here. […] If you don’t adhere, we have the claw-back mechanism, but it does get challenging because the provinces sometimes get very creative,” he explains. Once again, he brings up the Ontario government as an example. “The Ford government is balancing its budget. Meanwhile, there’s reports from the Auditor General that says there’s $4 or $5 billion of federal COVID money for health that had not been spent.”
That COVID funding had very few conditions attached to it due to being approved in an emergency. In contrast, the funding from the Safe Long-Term Care Act would require the provinces to “show the receipts” when it comes to spending it, which is something Serré says the provincial and federal governments have always fought about. “This is a 150-year constitutional battle between the provinces and the feds. The provinces want the money, but they want to have zero accountability,” he opines.
As it stands, it is not clear what the province is thinking. The Ford government’s Long-Term Care Minister, Paul Calandra, stated on July 18th that they will review the standards proposed by the federal government, but that they “have no interest in watering down what Ontario is already doing.” In 2021 the province did introduce new LTC legislation, but that change only came on the heels of over 3,800 deaths in long-term care during COVID, and critics argue it isn’t enough. “What we have in Ontario doesn’t compare. We are decades behind in Ontario. There is no mandatory yearly assessment of our long-term-care homes. Who are we kidding here?” said Ontario Health critic and Nickel Belt M.P.P. France Gélinas, in response to Calandra’s comment.
While a negotiation between the province and the federal government might seem like it would slow the process of enacting new standards, Sue Lebeau believes that some good might come out of the process. “I would anticipate that if all parties involved identify their shared goal, which is really high-quality care for seniors at the most appropriate place and the most appropriate ways, negotiation doesn’t necessarily need to be a hindrance, it can be positive. With discussion and diverse ideas come better solutions. I don’t think negotiation in-and-of-itself is necessarily a bad thing if we remember what it is we’re working towards, together,” she suggests.
How an agreement would affect services in West Nipissing is to be determined. The Au Château Home for the Aged administration has not provided a comment on the Safe Long-Term Care Act and the on-going consultations, saying their provincial association is working on a submission. However, Marc Serré did have some comments with regards to the facility. “People in West Nipissing should be proud of the Au Château. They should be proud of the dedicated staff that are providing services to residents. I know there’s always complaints, and it’s difficult, but it’s not the staff that are the issue. They just don’t have enough hours, and [support from] the provincial government, and that’s where I’m pushing for the federal government to get involved in negotiating to get better services and provide money to the provinces,” he explains.
He encourages West Nipissing residents to have their say by participating in the consultation.
Sue Lebeau had some input after looking at the questionnaire and noticing an emphasis on cultural safety. “We don’t see a lot of traditional practices or Indigenous-familiar practices in long-term care in general. There are some places that have them, but it’s not across the board by any means. That’s an important direction to consider as our Indigenous population is the fastest growing, and at some point, they will be a significant number of representatives in long-term care homes,” she predicts, adding that First Nations, Inuit, and Indigenous populations can make up roughly 20% to 25% of many Northern Ontario communities.
Lebeau also stresses that long-term care doesn’t only encompass care provided in a facility. “Most seniors wouldn’t necessarily choose to be in a long-term care home if they could be in a home or home-like setting and receiving the support for activities of daily living and so forth, in a way that supports them in being as autonomous or independent as possible. I think we need to make sure we don’t lose sight of that, because most Canadian seniors don’t end-up in long-term care, they age at home,” she points-out, adding that if she was “in the seniors’ shoes, I’d want to be at home as long as I can.”
For those interested in having their say, an online questionnaire can be completed, or people can send an email with their feedback. Information on how to take part is posted online at http://www.canada.ca/en/health-canada/programs/consultation-safe-long-term-care.html