The catastrophic impact of COVID-19 on the long-term care sector likely was made worse by the outdated design and crowded conditions found in some facilities, experts say — and they blame governments for failing to fund renovations and new construction.
Jodi Hall, chair of the Canadian Association for Long Term Care (CALTC), said the pandemic’s tragic toll has drawn public attention to a problem that’s been around for years – chronic underfunding of long-term care homes by all levels of government. She’s calling on Ottawa to step up.
Many existing nursing homes maintain four-bed, hospital-like wards, with residents separated only by a curtain. Older facilities also have shared washrooms and bathing areas, crowded dining rooms and narrow hallways.
“It raises a lot of challenges from an infection control perspective,” Hall told CBC.
“There are many lessons to be learned and, as we look to the future, this is one that we can’t continue to overlook.”
About 80 per cent of all COVID-19-related deaths in Canada have been in long-term care facilities. The Canadian Armed Forces has deployed more than 1,250 personnel to help care for residents in seniors’ homes in Quebec and Ontario, where there have been severe outbreaks.
Hall said homes with more modern designs and practices would have “assisted a stronger response” to the pandemic. Last month, the Public Health Agency of Canada (PHAC) rolled out a guidance document on infection prevention and control in long-term care homes — but Hall said some of those guidelines are “basically impossible” to follow in outdated facilities.
The CALTC has submitted four consecutive requests for federal funding in pre-budget presentations, but to date no investments have been promised.
She recently wrote to Prime Minister Justin Trudeau and several key ministers, saying it’s “imperative” that the federal government address the problem.
Shared rooms can be ‘devastating’
“Any existing outbreak management plan in a long-term care home, including the isolation of symptomatic residents, is hindered by the inadequate space and layout available in long-term care homes today. We are seeing how devastating these shared rooms can be during an outbreak,” she wrote.
“(Infrastructure) Minister Catherine McKenna has announced funding for shovel-ready projects and she is quoted as saying that her office is prepared to be flexible with its program rules in order to get money out the door to address the impact of COVID-19 on the Canadian economy. To date, however, we have not seen any support from the federal government on this issue.”
McKenna has said the government will take a flexible approach to finding projects that are “shovel-worthy” and can get started fast to help drive an economic recovery.
Her spokesperson David Taylor said the pandemic has emphasized the importance of protecting vulnerable seniors and supporting long-term care facilities.
“The government of Canada supports health care by providing the provinces and territories with long-term, predictable funding through the Canada Health Transfer, the largest major transfer of federal funding to provinces and territories,” he said in an email.
“The government is working closely with the provinces and territories to determine how it can provide additional support for health care, including public sector long-term care facilities, during these exceptional times.”
Less than 40 per cent of long-term care residential homes are private, for-profit projects; the rest are public, non-profit or a mix. Long-term care facilities fall under provincial jurisdiction, but Hall said capital project funding at the provincial level has been insufficient. She is not proposing any specific funding model but does want to see Ottawa support infrastructure improvements.
Pat Armstrong, a sociology professor at York University who led the 10-year international project Re-imagining Long-term Residential Care, said Canada needs a national long-term care law separate from the Canada Health Act. She said federal funding for long-term care facilities could be tied to certain conditions, such as improving the physical infrastructure of facilities.
While we won’t know for certain until there is a post-pandemic review of individual outbreaks, Armstrong said the outdated designs of many of the facilities — some of which were built in the 1960s — likely contributed to the fast spread of the virus.
“If you have four people in a room that only has curtains and is crowded, people are going to cough and spit and people with dementia are less likely to be able to carry out the hand sanitizing … or covering mouths. So the more crowded you are, the more likely it is to happen,” she said.
Infection control challenges
Many homes don’t have the capacity to properly separate those who have symptoms from those who do not, making infection control a challenge.
Armstrong said the lack of proper public funding for improved facility design reflects the low value Canadians attach to caring for the elderly – something she hopes will change after the pandemic finally ends.
“If we’re ever going to have an opportunity to put pressure on, thinking about how we care for our elderly, now is the time,” she said. “I think that we owe it to the people who have died that we learn something from this to make it better.”
NDP health critic Don Davies said the federal government has a responsibility to address the “disgraceful” state of long term care in Canada.
“Too many governments have ignored this important area of care for too long. We need to work at all levels to comprehensively address the deficiencies,” he said.
Davies said the federal government could help fund nursing homes by creating a dedicated federal transfer to the provinces and territories, while requiring that the funds be used for long-term care.
In its pre-budget submission of January 2020, before the outbreaks began in Canada, CALTC requested funding for the “construction, renovation and retrofit of 400 long-term care homes to meet current design standards and the needs of today’s seniors, especially those living with dementia, by 2023.”
It said long-term care facilities aren’t meeting current demand; many seniors are stuck in hospitals while they wait for an available bed. CALTC said the average daily cost of a hospital bed is $1,800, compared to $200 in a long-term care home.
A Conference Board of Canada study in 2017 projected that another 199,000 long-term care beds would be needed by 2035 — a vast increase over the 255,000 beds available in 2016.
The Canadian Institute for Health Information (CIHI) projected in 2017 that Canada’s population of people aged 65 and older would jump by 68 per cent in 20 years. It predicted the number of people aged 75 and older would double over the same time period.
Conservative infrastructure critic Luc Berthold said the provinces depend on reliable infrastructure funding from the federal government, but the Liberals have not lived up to their promises.
“This inability to work with the provinces is precisely part of the problem that has caused infrastructure funding — like that for long term care facilities — to languish,” he said.