Honourable senators, I rise this evening to add my voice to Senator Seidman’s inquiry on Canada’s long-term health care system. I thank Senator Seidman for her leadership in sparking a much-needed conversation about the state of Canada’s long-term care homes.

This is an issue very close to my heart. My own parents, who were lucky to be able to remain in their home, have recently moved into an assisted living long-term care residential home. As the father of a son with autism who lives in a group home, I also understand the fear that comes with entrusting the care of a loved one, whether it be a senior citizen or someone with a disability, to the long-term care system. I think of this particularly because many long-term care residents, particularly elderly people, have cognitive disabilities.

Colleagues, the conversation prompted by this inquiry is long overdue. The pandemic and its results only serve to underscore the urgency.

The year 1984, as we just heard from Senator McPhedran, was a turning point in the history of Canadian health care. The Canada Health Act not only became the legislative instrument for our publicly funded health care insurance but also became a source of national pride. It enshrined in law the central purpose of Canada’s health care policy, to “protect, promote and restore the physical and mental well-being of residents of Canada.” Long-term residential care is part of this act.

Indeed, back in 1984, Canada committed to provide its senior population with a safe environment in which they could be cared for. However, for too many seniors, this commitment has not been fulfilled. For a long time now, the conditions in long-term care homes have not been entirely aligned with the principle guiding our national health care policy. As we all know, colleagues, there are indeed positive examples, and we have heard them in this chamber, but for many the reality has been quite different.

Since the onset of the COVID-19 pandemic, we have not ensured the safety of seniors in long-term care homes. I will let the numbers speak for themselves. Seniors living in nursing and retirement homes have been 77 times more likely to die from the virus than those living in their own homes. In fact, a report from the National Institute on Aging showed that 80% of COVID-19 fatalities in Canada were residents of long-term care homes, and 28% of long-term care facilities across Canada experienced outbreaks.

The situation in long-term care homes has not been the same across provinces and territories. It is particularly troubling in my home province. In Ontario, 43% of long-term care and retirement homes reported outbreaks. When the Canadian Armed Forces were called in to help in April of last year, many residents were in dire straits. Some were malnourished, dehydrated and left in soiled undergarments, while others had untreated pressure wounds and infections. Many died of complications from COVID-19 alone and in despair, without the dignity all human beings deserve. Yet issues in the long-term care system are nothing new.

As Senator Seidman and other colleagues rightly pointed out, the pandemic only brought to light the existing vulnerabilities within our long-term care system. Before COVID-19, long-term care homes in Ontario experienced seven times the rate of outbreaks of infectious diseases compared to hospitals. Colleagues, Canadians have been losing confidence in the long-term care system for many years. Indeed, over three quarters of Ontarians would rather not receive care in long-term care homes. This pandemic simply shows the damaging impact that failing to address a long-standing issue can have on the well-being of our society.

Reform in the long-term care system is long overdue. There is not enough time for me to address all the issues within our long-term care system, however I will outline a few.

Personal support workers account for the largest proportion of employees in the Ontario long-term care sector. From eating to dressing, bathing to toileting, they care for our loved ones with compassion, empathy and patience. PSWs also provide services in personal homes, as was the case for my 92-year-old parents. However, inadequate working conditions make it difficult for the province to keep PSWs. While the services provided are excellent, there is often bureaucratic dysfunction and confusion in the administration of these services.

My parents experienced this first-hand in their in-home services: too great a rotation of PSWs, uneven coordination of service times and an evident lack of training. Indeed, one quarter of PSWs leave the long-term care sector annually, while almost all of Ontario’s long-term care homes have difficulty filling shifts and recruiting staff.

Colleagues, minimum wage and no paid sick leave do not do much for employee retention. Chronic under staffing means PSWs work under stressful conditions. Many are newcomers to Canada and understandably may have challenges adapting. While they are dedicated to providing the dignified, respectful care that seniors deserve, the work overload can sometimes prevent them from doing so. This is particularly worrisome given Ontario’s 2010 Aging At Home Strategy, which introduced stricter admission criteria.

Since then, long-term care homes only admit seniors who meet a very high care-need threshold. This means that residents in long-term care homes need more medical and personal care. It is a sad fact that many PSWs will also experience violence as well as verbal abuse from those they are helping. Colleagues, these are the people who, in these times of self-isolation, are often the only company our seniors have.

Understaffing is worse in for-profit long-term care homes. In Ontario, for-profit nursing homes employ 17% fewer staff than non-profit ones. The impacts are undeniable. During the pandemic, Ontario’s worst hit long-term care homes were all for-profit. A study by the Canadian Medical Association Journal found that for-profit status is an important risk factor in terms of the size of a COVID-19 outbreak in a long-term care home. Indeed, when for-profit long-term care homes were experiencing an outbreak there were “twice as many residents infected . . . and 78% more resident deaths . . . compared to non-profit homes.”

More worrisome is the lack of enforcement from the Ontario Ministry of Health and Long-term Care, which left many long-term care home operators facing few consequences for their inadequate measures to protect the health and safety of residents.

Between March and October of last year, as few as 11 of the 626 long-term care homes in Ontario received proactive inspections — and this during a pandemic when residents of long-term care homes have been hardest hit.

Colleagues, it seems that the well-being and safety of seniors have been compromised for increased profit margins. The sad reality is that we are not investing enough in these homes to meet the ever-growing demand of our aging population.

In Ontario, only 7% of overall health care spending goes toward long-term care. In fact, according to the Financial Accountability Office of Ontario, between 2011 and 2018 the Province of Ontario maintained a steady number of long-term care beds with only 0.8% growth, while during the same period Ontario’s elderly population grew by 20%. As a result, in 2018-19, there were nearly 35,000 seniors waiting for long-term care beds in Ontario, while the Office of the Premier reported that this number reached 38,000 in July of last year.

Underfunding of long-term care homes has a ripple effect on the overall health care system. Hallway medicine in hospitals is particularly troubling. One quarter of long-term care residents are placed directly from hospitals, where they spend, on average, 54 days occupying a hospital bed after no longer requiring hospital care. They are simply waiting to be transferred to a long-term care home.

The problem was so big that the Ontario government created the Premier’s Council on Improving Health Care and Ending Hallway Medicine. In their January 2019 letter to the Premier of Ontario and the Minister of Health and Long-Term Care, the council decried the wait time of 146 days to access a long-term care bed. It has since become 161 days.

Compared with other OECD countries, Canada spends almost one third less on publicly funded long-term care. In Ontario, of a $63.5-billion annual health care budget, a little over $3 billion is spent on home care, of which some $2 billion is for direct services and $1 billion for administration.

Indeed, there is much for Canada to learn from our friends in Europe, where governments have performed much better regarding the well-being of their seniors during the pandemic. The Globe and Mail health reporter André Picard’s excellent new book Neglect No More offers examples from other jurisdictions that could serve as lessons for Canada. The overwhelming trend in the Nordic countries, as well as in the Netherlands, Germany and France is to offer more services in the home for those requiring them for as long as possible. Why should our seniors pay up to $10,000 or more of their savings monthly when they could receive services in the comfort of their own homes?

Since the onset of the pandemic, the consequences of failing to provide higher standards of care in the long-term care home system have shocked Canadians. Yet for years reports were made, calls for action were sent out and warnings were given. All were focused on the same thing: the critical need to reform the conditions of long-term care homes.

Colleagues, as parliamentarians, the decisions we take or do not take impact the lives of Canadians. It is part of our role as senators to bring forward issues in need of attention. This pandemic has shone a harsh and brutal light on the plight of seniors in Canada.

Governments across our country should learn from this experience and develop policies and standards that do not simply sit on the shelf but are acted upon. We need an active task force, not just another study. This will require both budget and leadership. We must heed the call of the Canadian Association for Long Term Care to ensure that long-term care homes have the resources they need to provide the level and type of care our seniors deserve. Establishing national standards should be part of this.

I wish to thank Senator Seidman again for her leadership on this issue in the Senate. I also wish to thank all our colleagues who have spoken. It is an incredibly difficult subject. Action is critically needed in the long-term care sector. Elder care is one of the most urgent social policy challenges we face in our society, regardless of where we live in our great and vast country. It requires order, common sense and funding. As the past months have shown, the lives of seniors in our communities — and looking ahead, our very own lives — depend on it. Thank you.