Long-Term Care: A Lost Sibling of the Canadian Healthcare Family

Most Canadians do not pay attention to the operations supporting long-term care facilities. Indeed, the last thing most people wish to think about is the day they may have to live inside these homes. But, ever since COVID-19 claimed countless residents’ lives, the inner workings of these facilities are seen as increasingly consequential and the public is understandably curious about them. On March 14, Quebec ⁠— Canada’s worst-hit province ⁠— reported that a health-care worker employed in long-term care home contracted COVID-19 after returning from a spring break vacation. However, the severity of the outbreak that followed was not determined by the number of workers that returned sick. Rather, Quebec’s nursing home crisis traces back to ineffective responses to these initial outbreaks. 

By now, approximately 90 per cent of Canadians are aware of the deaths that occurred in long-term care homes since the start of the pandemic. Many also know that these homes are particularly vulnerable to COVID-19 for reasons besides their immuno-compromised occupants. Failure to address mismanagement and systemic shortcomings in long-term care facilities left one of Quebec’s most vulnerable demographics defenseless against the spread of the virus.

Debilitated workforce and best practice handicaps

Due to shortcomings in the current system, workers are unable to act in the best interest of senior residents. When faced with widespread staff shortages, some Quebec facilities employed recent college graduates to look after infected residents who struggled to breathe after contracting the virus. In one case, Sandrine Valence-Lanoue, a 22 year-old birthing nurse with only 10 months of experience, was transferred to a long-term care home, where she scrambled between 100 residents during a single night shift. Filling these staff shortages was delayed by hiring bureaucracies coupled with fractured communication between authorities and front line workers. Because high turnover rates overwhelmed the hiring process early on, nurses’ offers to help at senior’s institutions often went unheeded for weeks at a time.  

CTV Montreal tweets that the Legault government aims to fill long-term care staffing shortages by fall 2020. Via Twitter.

Another devastating reality of the current system is that many employees are underpaid. When the first COVID-19 cases were confirmed in Quebec, many workers earned around minimum wage, forcing them to work at multiple facilities to maximize their hours. Precarious employment in the long-term care sector likely contributed to the severity of the outbreak by accelerating community spread. Furthermore, in Quebec, there is considerable variation between starting wages in public and privately owned facilities. At the beginning of the outbreak, starting salaries in privately owned care homes hovered over minimum wage, whereas workers in publicly-run care homes received a starting salary of $20.55 per hour. In early April, the province of Quebec increased the wages of care workers and reduced existing wage gaps to address the contrasting issues of multiple employment and voluntary unemployment. Despite this change, there is still a long way to go in terms of maintaining a workforce that can support the current demands of running a safe care home. 

Heterogeneity in starting wages points to a possible relationship between privatization and preparedness in the onset of COVID-19. Approximately 37 per cent of long-term beds in Canada are situated in private care homes. Since private homes are profit-seeking, it is easy to see why they could be deemed greedier versions of public homes, making them more inclined to shave expenses and push the limits of what is considered reasonable care for residents. In theory, privatization increases efficiency by promoting competition, but this logic should not apply when individual safety is directly at stake. As the number of deaths continues to climb, statistics may confirm that private homes have visibly higher death tolls than public homes. According to one study in Ontario, for-profit homes recorded nearly double the number in deaths of non-profit homes. However, regardless of what statistics reveal, both forms of ownership left families grieving the deaths of their loved ones with no feeling of closure. This is not an issue for one party to solve.

A long-term care home is a house of cards

Although Canada regularly fails to address problems in the long-term care sector, the many pre-existing flaws in the system were not deadly until now. According to the NIA Long-Term Care COVID-19 Tracker, about 81 per cent of Canada’s recorded deaths have been connected to these facilities. The first flaw that contributed to preventable deaths comes from disproportionate attention — in terms of funding and traininggiven to hospitals at the expense of nursing home facilities. Ultimately, the lack of personal protective equipment deployed to Quebec’s nursing homes put nurses and residents at greater risk of getting sick. Likewise, tight budgets begot struggles with under-staffing and underdevelopment that were present in the industry before the pandemic. For instance, 40 per cent of long-term care homes in Canada require significant infrastructural and building renovations to avoid small common spaces and crowded rooms. 

Moreover, there is minimal guidance regarding the operation of these homes at the federal level because long-term care is not backed by the Canada Health Act. In addition, the country does not have a set of federal laws enforcing best practices in these facilities. Therefore, there are obvious differences in emergency readiness among long-term care facilities across Canada. Long-term care is not considered as medically necessary as other forms of health care, but the more upsetting issue is arguably the lack of centralized oversight, meaning individuals in this business are operating blindly, without careful consideration of their answers to critical questions. Since different facilities have different owners, there are divergent views regarding what it means to provide sufficient care. 

While the geriatric population is the main victim of Canada’s poorly constructed long-term care sector, they also suffer from a limited ability to stand up for themselves. Surely, if my grandparents are to use this service in Canada, I want to be reassured that health authorities have reached a consensus in the following gray areas: What resident-to-staff-member ratio should be justified in a long-term care home? How much supply and back-up supply should sit in inventory? And lastly, how much should be spent in preparation for black swan events? 

As COVID-19 cases ramp up, so are the number of cases waiting to be certified as class action lawsuits against long-term care homes. The arguments centered around these proposed lawsuits are a great benchmark for the type of the discussions that need to happen, regardless of the type of ownership guarding the homes. These lawsuits will test the boundary of negligence and conscientiousness, which are all ethical considerations that should have been discussed by health authorities long ago. 

A lingering question is how long-term care facilities can mobilize the necessary human and capital resources to be ready for future crises like hospitals were at the outset of COVID-19. According to the Canadian Association for Long-Term Care, the cost of keeping a senior patient in a hospital bed can reach up to $1,800 per day, whereas the cost of a bed in a long-term care facility is approximately $200 per day. This finding could be a starting point for implementing reforms and increasing federal involvement in the long-term care sector. 

These flaws in our system always existed, but public involvement was only set free amid the onslaught of a global pandemic and the loss of thousands of lives. The future is uncertain, but if we adopt a more long-term outlook, another catastrophe will not be needed to learn from our mistakes. 

Featured image “Elderly” by Kevin Dooley is licensed under CC BY 2.0. No changes made.

Edited by Emma Frattasio