Waves of the COVID-19 pandemic have revealed and created many competing public policy priorities. Perhaps no revelation has been more embarrassing than the state of elder care in Canada. A quote often attributed to Mahatma Gandhi goes, “The true measure of any society can be found in how it treats its most vulnerable members.”

As Canada recovers and rebuilds from the pandemic, addressing the health of our seniors should be among the country’s top policy priorities.

There has been much talk for decades about the need for a national seniors’ strategy. However, politicians follow public sentiment and lack of political will has stalled any meaningful reform.

Ageism smolders beneath the surface. The widespread indifference of many Canadians bout the impact of COVID-19 has illuminated indifference and cynicism. Statements that COVID impacts only the elderly and those with medical comorbidities have dehumanized them and minimized the devastating impact of the illness on our most vulnerable.

Canadians are proud of medicare and like to champion their commitment to a just society. Only when our most vulnerable are treated with the dignity and respect they deserve will we achieve both Gandhi’s measure and the just society to which Canadians aspire.

There are many ways to achieve this goal. Respect for, and the care of, our seniors should be supported across political ideology. Provincial and federal governments of all political stripes can work together to achieve this. As we emerge from this pandemic, we must not be complacent about what has come to light; but instead through sound public policy, work toward the betterment of seniors in Canada.

Taking care of the care workers

Long-term care reform in Canada will require a massive, multi-year effort

Although the provision of publicly funded health care has evolved since The Medical Care Act was adopted in 1966, medicare remains antiquated, focused on treating sickness rather than improving health. The system was built for the young, at a time when the average Canadian was 25 years old and life expectancy was 72 years. The care that seniors require most – such as prescription drugs, community health services or long-term care homes – was not envisioned as part of medicare.

Despite a recognition by both provincial and federal governments over the past few decades of the need for reform, little progress has been made to revitalize health care. As such, the care that we provide our seniors has not kept pace with advancements and has lacked innovation. The impact on elders – and more specifically those within communal care settings, both private and public – during the pandemic is a tragedy that must be used as a platform to bring about change.

The Doug Ford government established Ontario’s Long-Term Care COVID-19 Commission in July of 2020 and its final report was released April 30, 2021. Specific to long-term care homes in Ontario, its measures cover infection-control practices, staffing and hands-on care standards, leadership and accountability, and better integration with the broader health-care system, among other things. The recommendations have application for other provinces across Canada and should be the basis of reform.

Further work has transpired to develop new national long-term care services standards. The Standards Council of Canada, the Health Standards Organization and the Canadian Standards Association are collaborating to develop these benchmarks, shaped by the needs of residents, families and Canada’s long-term care workforce.

The development of national standards is needed; it is encouraging to know this work is underway and that a resident/family-directed approach that is evidence-based will be taken. Publication of the proposals is expected in December.

National standards are needed not only for care provision but also for enabling mechanisms. We should have guidance on the expectation for hands-on care, staffing complement, pay equity and the mix of skillsets needed in long-term care. We must also have common principles for a model of care that balances the social and medical needs of seniors. This would include agreement on infrastructure requirements, such as the creation of environments where residents are happy to make the place their home rather than feeling institutionalized, as well as the integration of long-term care homes into the broader community, and the involvement of residents and families to co-design services.

Further, it should be recognized that best practices do exist in models such as the Green House and Butterfly models where small houses of about 10 residents are cared for in a setting that feels like a home and not an institution. Governments much commit to such models when considering new long-term care infrastructure projects.

The federal government could play an important unifying role by implementing a dedicated federal elder-care transfer to alleviate regional disparity and inequity. Such a transfer would be predicated on the provincial fulfilment of criteria similar to those outlined in the Canada Health Act.

These conditions should be born out of the national standards to be released later this year. However, they must be broader than simply focusing on long-term care and must extend to home care and health-promotion initiatives for seniors. Public dialogue and provincial collaboration should inform the final criteria and conditions.

There are examples of excellence in the provision of elder care from which we can learn and adapt to the Canadian context. Denmark has focused on keeping seniors living in their homes, through strengthened assisted living and home-care services. Most seniors prefer to live in their own homes as long as possible. Health systems must enable them to do so not only through the expansion of home-care services but also through the use of new technology and an emphasis on prevention and early detection.

Home care spending data are a launching point for better policies

Moving long-term care from a vicious to a virtuous cycle

Robust home-care services are both the patient-centred way to deliver care for the elderly and a cost-effective model. When seniors are able to remain in their homes and the care is brought to them, infrastructure and associated costs are avoided. Needs can be met in the community and addressed earlier, rather than seeking costly, acute-care services through emergency departments and urgent-care centres.

Preventing illness is preferred to treating it, for the patient’s sake and the system. If we can better address the health needs of seniors in advance, they will remain healthier longer and avoid premature intensive, hands-on care.

Elder care policy must include a focus on wellness, education, adopting healthy lifestyles, literacy with new technologies that can support health, and fostering a sense of community. To achieve this, it will be necessary to look beyond a system’s health portfolio and engage organizations that have the ability to impact the social determinants of health, such as not-for-profit groups, seniors’ advocacy groups, community service organizations and other human services ministries within government.

COVID-19 has brought to light the untenable state of elder care in Canada. People of all ages and walks of life have felt shame and dismay at what the light has exposed. The widespread public reaction holds the promise action will occur. Politicians will respond if the public is loud enough in demanding change.

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Kevin Wasko
Kevin Wasko is a practising emergency physician and physician executive. He recently left his position as an executive leader with the Saskatchewan Health Authority and joined Trillium Health Partners in Mississauga, Ont.

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