The tragedy that unfolded in Canada’s nursing homes trained a wider public lens on the demographic and economic challenges facing the country’s patchwork eldercare model.<\/p>\n
These problems, decades in the making, were already in need of attention given Canada’s aging population. COVID-19 highlighted the urgency of addressing existing challenges while raising new questions around eldercare. They include how best to prevent the transmission of infection by underpaid support workers moving between multiple homes, and how to better protect vulnerable residents.<\/p>\n
As painful as the crisis in long-term care homes has been, it has highlighted the need to modernize an eldercare system built for the Canada of 50 years ago, not the Canada of the 2020s. It has also created a clear opportunity for Canada to make better use of innovative technologies and funding models to ensure that the growing ranks of older Canadians have access to the best long-term care options available.<\/p>\n
1. What has COVID-19 revealed about Canada’s LTC system?<\/i><\/b><\/p>\n
COVID-19 exposed a range of longstanding weaknesses in LTC. Topping the list: insufficient staffing, low wage levels and precarious employment that force many workers to move between jobs in multiple homes\u2014increasing the likelihood of transmission and the risk of infection to themselves and residents. <\/p>\n
Canada’s system is supported by hundreds of thousands of healthcare professionals, but it is the largest group\u2014unregulated healthcare aides or personal support workers\u00ad\u2014who are most likely to find themselves in this position. <\/p>\n
In Ontario, PSWs who work in LTC earn between $14 and $16 an hour<\/a>, less than two-thirds of what their counterparts earn in hospitals. As a result, they often juggle several part-time jobs<\/a> or exit for better opportunities elsewhere. They report high rates of burnout and dissatisfaction in their positions and frequently cite concerns about unsafe work environments. These conditions have made it difficult to attract and retain people to these roles and by extension, to meet accepted standards of care, including a recommended minimum of four hours of direct care per resident each day, a threshold no Canadian jurisdiction is currently meeting<\/a>. Roughly 80% of nursing home operators in Ontario reported difficulty filling shifts.<\/p>\n Canada’s LTC system is housed in buildings that were not designed for the current challenges confronting the elderly population. Many of these homes were designed in the 1960s and feature multi-bed wards which have been found to accelerate the spread of infection. Indeed, the operations hardest hit by COVID<\/a> were those in homes with multi-bed rooms.<\/p>\n The results are stark: One in 50<\/a> LTC residents in Ontario has died of COVID, far eclipsing the number of deaths among older Ontarians receiving home care.<\/p>\n Minimum staffing levels, improved wage rates and the elimination of sectoral pay gaps would help draw more people to critical PSW roles, enabling the development of surge capacity that would ensure a larger, prepared labour force in times of crisis. A concerted push to retrofit existing LTC homes to modern standards would help improve care and safety.<\/p>\n 2. How well was Canada’s eldercare system performing before COVID?<\/i><\/b><\/p>\n Canada’s LTC system was already struggling to meet the needs of a population that is living longer and experiencing more complex problems. Canada’s universal health system was built in the 1960s, when the average age of Canadians was 27 and life expectancy was less than 70 years. Today, the median age is 40.8 years and life expectancy is over 80. By 2030, nearly one in four<\/a> Canadians will be older than 65.<\/p>\n What’s more, the system is unbalanced: more than 40,000 Canadians are on wait lists for nursing homes due in part to a lack of home and community-based care. A further 20,000 are in ALC (alternate level of care) designated beds, that is, occupying more costly hospital beds due to a lack of available LTC spots. The problem is especially acute in Nova Scotia, where one-third<\/a> of all hospital beds are occupied by ALC patients.<\/p>\n The problem will only get worse. About 650,000 people<\/a> will be living in seniors’ residences or nursing homes in 2030, up from 450,000 now. Public and private resources needed to build the extra capacity will be at least $140 billion.<\/p>\n Crucially, the system itself, which devotes the majority of resources to LTC homes, is ill-fitted to provide the type of care that various surveys have suggested Canadians actually want. A 2015 survey<\/a> by Ipsos Public Affairs found the majority preferred care in or close to home. And the Canadian Institutes for Health Information found<\/a> that 22% of Canadians who were entering nursing home environments may have been able to receive care at home with appropriate home care and community-based supports.<\/p>\n 3. What’s the long run fiscal impact of shifting to a system focused on home and community-based care?<\/i><\/b><\/p>\n That’s hard to say, though various research institutes are looking into what this could mean for Canada. <\/p>\n The country was already spending less than other industrialized countries on LTC, committing 1.3% of GDP to publicly funded long term care health services in 2017, compared to an OECD average of 1.7%. And even before COVID, costs for LTC were expected to more than triple over 30 years, from $22 billion today to more than $71 billion in 2050.<\/p>\n
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