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Long-term Care System

Inquiry--Debate Continued

May 4, 2021

Honourable senators, as I listened to senators today, there is a theme that continues to jump off the page for me. That is serious, complex, national issues that senators are deeply passionate about. I believe that in each of these, we as senators can be the change at this moment.

I rise this evening to add my perspective to support the inquiry on long-term care. I want to begin by thanking Senator Seidman for bringing this important inquiry forward and for her continued advocacy in this area. I would like to thank as well those who have already spoken to this important issue. Your speeches have informed my thinking, and I hope to offer you the same degree of insight you have provided to me.

Colleagues, this is a matter that has kept me up at night on many occasions. While the pandemic has laid bare the issues that face our long-term care system, the fact is that it’s been in crisis for some time now. It’s been a hard year, and we have been forced to confront some hard questions about a topic most are uncomfortable with, that being the end of life. The current pandemic has, of course, focused our thinking on this, but our discussions around MAID as well have caused us all to reflect on what dying with dignity should look like.

Our discussions on these matters also turned my attention to hospice care, a crucial aspect of how we approach the end of life. Hospices are some of the only health care services that must fundraise for direct clinical care costs, including nurses and personal care workers who hold the hands of your loved one. I met with Hospice Care Ottawa, who told me that financial strain has made it impossible to open new hospice beds to serve their community. This makes no sense to me. The evidence is there: Hospices save our health care system money.

A residential hospice bed costs one third of an acute care hospital bed. It’s been estimated that 21 hospice care beds save the health care system more than $4 million a year, and yet only 60% of our hospice care system is publicly funded. There is something wrong with the math on this one.

We see such gaps in our long-term care as well. Like many of you, I have had to navigate our long-term care system for a loved one who needed critical or long-term care. I have observed the passing of six parents over the past two decades, each and every one very differently. Sadly, my most recent loss of a parent ended up by trying to say goodbye this fall on an iPad, but she died as the IT person was preparing to connect us to say goodbye.

Each loss is a reminder of the work that must be done collectively and now. My experiences with long-term care homes in some instances were less than pleasant. That’s not to say that all long-term care homes are bad or poorly run, of course. Some of you have told us about your good experiences, after all. But for such a critical piece in our system of care for the most vulnerable Canadians, I do not believe that the quality of care should come down to luck and circumstance. It should not depend on where you live or what you can afford. A minimum standard of care must be upheld so older Canadians who are unable to support themselves can rely on a degree of consistent and appropriate care anywhere in this fantastic country.

While most long-term care staff at all levels are doing the best they can with what they have, quite often that’s just not enough. Many care staff have found themselves in a system that required them to work in multiple homes with low pay and long hours. It was this situation that left our seniors in these homes extremely vulnerable over this past year, a time when their safety mattered the most.

While long-term care homes proved vulnerable to varying degrees across the country, some of the most telling evidence provided to us arose from the situation in my home province of Ontario. Though it seems like a lifetime ago, it was only a year ago that the military was called in to assist in our long-term care crisis. What they found was horrifying. I have no doubt you all read the report, but much has happened since then, and we need to remember what they saw, what they felt and what they heard.

They reported used medical equipment like catheters not properly cleaned before their next use. There was fear on the part of staff to use critical supplies because they cost money. Residents were left with food they were unable to eat because they could not feed themselves and there were not enough staff to do it for them. Staff were so overworked that they were unable to tend to patients sufficiently, leaving them alone, isolated and immobilized in bed for days at a time.

This, of course, led to long-term care patients making up an immensely disproportionate percentage of COVID cases in the early going, with 8 in 10 deaths in the first wave coming from these long-term care homes. We’ve all heard the numbers but I fear we may have become numb to them. We must remember that these were individuals who lived long and full lives. They had family and friends who cared about them. They did not deserve to die alone, isolated and afraid.

Hindsight being what it is, it’s easy to say much of this could have been avoided given what we know now about the virus. Perhaps we could have caught sick patients sooner and isolated them before they spread the disease. Maybe we could have gotten proper PPE for staff to protect them and their charges. But the sad fact is that we have been warned for years that catastrophe was looming and we chose to do little to address it.

On April 28, the Auditor General of Ontario released a report that investigated the provincial government’s handing of the long-term care crisis. She highlighted three long-standing issues that led to the cascading disaster that unfolded. The first was that, as far back as 2003, after the SARS outbreak, an expert panel made several recommendations to prepare for the inevitable “next time.” These were ignored by every government that followed. The second was that ongoing concerns — raised for well over a decade about systemic weaknesses in the sector — had not been addressed. Third, the sector’s lack of integration with the health care sector did not enable long-term care homes to fully benefit from needed, life-saving expertise.

We have known of those issues for some time now. We chose to mostly ignore them, and we paid the price. We cannot afford to ignore this crisis any longer. At the very least, we must use this tragedy to spur us into action instead of waiting for the next catastrophe to unfold.

First and foremost, more beds are required for those requiring access to long-term care. This is a growing problem that will only get worse if we remain inert. According to Ontario’s fiscal accountability officer, between 2011 and 2018, the number of LTC beds in Ontario increased by only 0.8%, while the number of people over the age of 75 grew by 20% in that same time. In 2017, it was reported that there was a shortage of 63,000 beds across Canada; a problem only set to grow as our population continues to age.

There is no doubt that the debate around long-term care leads to jurisdictional finger pointing, but there are several things that can be done at the federal level to encourage change. More money is needed, of course, to update and modernize existing facilities, but there are some outside-the-box ideas that merit further study as well.

Some of you were fortunate enough to join Professor Carolyn Hughes Tuohy for a discussion organized by Senator Boehm and Senator Seidman not long ago. In her paper, Federalism as a Strength: A Path Toward Ending the Crisis in Long-Term Care, she shared much with us. Like each of us, we know the problem; the time for talk is over. One suggestion she makes is a long-term care insurance benefit that could be attached to the CPP/QPP as a supplementary benefit to help with the costs of long-term care. A similar program exists in Germany, the Netherlands and Japan. International comparisons are worthwhile to see what we can learn and change to help us in the long run. Some of the jurisdictions I just mentioned take less of an institutionalized approach and instead encourage more independent living with supports.

Professor George Heckman from the University of Waterloo — my home — recently co-authored a paper calling for an entire reimagining of our long-term care system along these lines. This includes smaller, homelike settings that have been proven to lead to better health outcomes. Smaller, apartment-like homes also have the benefit of being less crowded, leaving far less risk of a virus like COVID-19 burning through an overcrowded ward of patients. He also calls for more training and supports for staff, as well as dedicated staff at various residences, rather than having them go from place to place. That means that we must invest in these staff, train them properly and ensure they are compensated fairly for this very important work.

It’s now clearer than ever that our approach to long-term care needs a serious rethink. Money is needed, but if it is then spent to prop up what already exists, that’s a path to failure and catastrophe all over again. There was absolutely no excuse for the scale of the tragedy that we witnessed, and it would be more shameful if we find ourselves here again.

I again thank Senator Seidman for beginning this very important conversation. I hope it is just a first step toward working to make meaningful change in a branch of our health care system that is in dire need of it. Senators, we need to be the game changers. Thank you.

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