Honourable senators, tonight I rise for the final speech of the session to speak to Senator Seidman’s inquiry on long-term care. As many have acknowledged, the pandemic has highlighted many significant and long-standing gaps in our long-term care system. This system was already in deep trouble with pre-existing issues when the crisis struck and resulted in high rates of infections and death.

Now, over a year since the beginning of the pandemic and a few months since the beginning of the rollout of vaccines, we have observed once again, as the crisis begins to fade, the urgency slips away and the memories begin to fade, but these critical issues remain.

Thank you, Senator Seidman, for raising this issue in the Senate. We do have a role to play in ensuring that the focus on this issue is maintained and that the pressure on Canada’s leadership to develop solutions continues.

When I consider the events that we are living through, I do so through the lens of my experience as a medical leader and as a surveyor with extensive experience in accreditation of health institutions and health systems of care, nationally and internationally.

Today, I hope to share some thoughts on how we got to this point and focus on potential solutions.

At the outset, using the data that has been gathered and what we now know about Canada’s experience, I can create a snapshot of the impact of the pandemic on long-term care homes and the patients in them.

As we know, if you were living in a long-term care home, you were more likely to be exposed to COVID-19.

In a report entitled Long-term care and COVID-19: The first 6 months, the Canadian Institute of Health Information found that in the first six months of the pandemic, one third of long-term care homes experienced outbreaks.

Being in a long-term home meant that you were much more likely to die of COVID-19 than most Canadians and, in fact, than most people worldwide.

In May 2020, long-term care residents accounted for 81% of COVID-19 deaths, which doubled the OECD average.

If you lived in a long-term care home, your quality of care decreased and you lost access to the outside world.

Visits from physicians dropped by 16% between March and August 2020, compared to the previous year.

During that period, assessments of care noted that no personal contact with family or friends in the previous week had occurred for many of the residents of long-term care homes. This included virtual contact or phone calls. This was three times more than in 2019.

In fact, front-line workers in health care faced a hazardous environment, accounting for one in five COVID-19 cases in Canada.

There are numerous studies that outline many of the long-standing challenges in long-term care that preceded the pandemic, and those of us who are familiar with their findings know that the breakdowns in systems of care across our country were not only predictable, they were inevitable.

Beyond reviewing all of these studies and reports, my office consulted with a number of experts across Canada to hear from them on what they saw as the root causes of these issues.

Many spoke about the challenges of the lack of integration across health systems of care, meaning the acute care system, long-term care and public health systems of care. In some provinces, such as Ontario and Quebec, these systems of care fall under the authority of different ministers, not under the Minister of Health.

In Ontario, there’s a designated minister for long-term care, while in Quebec a minister responsible for seniors.

This structural separation, people told us, set the stage for the lack of integration that unfolded. It caused gaps in communication, failed collaboration with long-term care officials who were, not infrequently, left out of critical pandemic planning and decision-making processes, with dire consequences and resulting in critical system failures.

They gave the example of long-term care institutions and front-line workers having poor access to personal protective equipment, tests and updated information on disease prevention. As an example, we heard from stakeholders about the significant and long-standing human resource shortages and gaps in the system of care that had historically resulted in the issue of overwhelming workload and increased staff burnout rate.

In a system of care challenged by steadily increasing volumes and complexity of care, besides the challenge of staff shortages, there was a lack of training and of mental health supports for providers. In some cases, there was even a lack of physical supports, such as a sufficient time for breaks or even spaces in which to take your breaks, all of which were in place and already having a deleterious impact on the workforce when the pandemic struck.

As the pandemic unfolded, this shortage of staff was further exacerbated as providers caught the virus themselves or were forced to quarantine due to exposure, a situation that was made worse by increasing vulnerability of staff who did not have access to PPE or testing equipment because of the shortages and delays.

In some cases, the very same measures that were implemented to prevent spread to and within long-term care homes, such as limiting workers from providing care in more than one location, further enhanced these staff shortages.

Colleagues, there has been much discussion about what comes next, but to understand our path forward we must examine the mistakes of the past that set the stage for the smouldering system failures that ignited during the pandemic.

It’s important to consider that at the federal level, this issue began as far back as the mid-1990s, when the government of the day made significant reductions to social transfers. Ever since, we’ve been under-investing in long-term care and many other areas of our social infrastructure.

What is our track record? Well, compared to our OECD peers, we are 10th out of 26 countries in spending as a percentage of GDP. Countries with model systems such as Norway, Denmark and Sweden spend twice as much as we do.

This pandemic shows us that the cost of these tepid investments far outweighs the need to maintain a decent debt-to-GDP ratio. What is the value of an economy, I’d ask, if those who are meant to benefit from it are languishing? Needed improvements cannot be focused on money alone, but undoubtedly there is need to significantly increase the available resources to ensure these systems function well.

Let me focus on what else is needed. Going forward, in addition to increased investments, we need to build accountability into the system. I believe that we should do this through the implementation of national standards that are tied to targeted funding. Standards are important to ensure a third-party evaluation of the conditions of long-term care homes for patients and employees, to ensure that all within the environment are treated with dignity.

One model proposes that targeted funds could be provided through a new framework similar to the Canada Health Act, which articulates core standards. Even further, Parliament could adopt legislation with specific criteria for federal funding of long-term care.

Many colleagues had the benefit of hearing from Dr. Tuohy from the University of Toronto in a recent webinar organized by Senator Seidman and Senator Boehm. She argues for the adoption of a national long-term care insurance, which would build on the existing Canada and Quebec Pension Plan. This provides an interesting mechanism for the funding of long-term care and for the standardization of services, as payment out of the fund could be solely limited to institutions that meet standards set collaboratively by the provinces and the federal government.

I strongly believe there needs to be some targeted funding that promotes desired outcomes. One option may be to provide special grants for research or pilot projects based on successful models in Canada. This would also foster greater cross-Canadian collaboration.

Finally, and importantly, what will those standards be? A report by the CMA and other organizations provides us with a number of options. I’ll share three that I believe are hitting the nail on the head. Long-term care homes should go through an accreditation process similar to that of hospitals. In hospitals, this is currently a voluntary activity paid for by organizations, but encouraged in some provinces through financial incentives. I believe there would need to be changes made to this process to make it a more effective requirement.

A second standard would be to provide reliable ways for patients and their families to have a voice. A third would be to focus on supports for employees, such as training, proper working conditions and mental health supports.

As proposed by a number of national groups, standards for long-term care should encompass the full continuum, ranging from home to residential care to palliative care, and focus on pushing the system towards desirable outcomes.

Colleagues, having stated the problems and potential solutions, there is one underlying societal issue we must consider, and that is ageism. When this chamber last examined aging 13 years ago, one of the recommendations was to launch a national strategy on public education campaigns and training for service providers in both health and social service programs against ageism. To quote the report, this was because “ageist stereotypes and prejudices unnecessarily limit the intrinsic value to society which older people bring.”

The environment leading up to the pandemic, and the position from which we are working from now, is that working with seniors is not as prestigious as working in other areas of health care. In fact, for many Canadians, we’d rather not think about these homes or those living and working in them or the conditions they face. We would rather not think about our own futures and how we may well end up there. We forget that those people are people too, who have lives, dreams, careers, families and deserve our respect and admiration. They suffer because we have ignored them, because we are not comfortable thinking about them, and therefore, we have not committed our energy and our talents to improving their lives.

Colleagues, there have been decades of reports, studies and tragedies that have informed us of the atrocious state of long-term care. What more do we need before we decide that people, regardless of their age, deserve to live with dignity? Is that a standard we’re willing to set for our society?

The issues that erupted in long-term care during the pandemic are not going away. A recent study by the Conference Board of Canada found that in the next 15 years, we’ll need another 200,000 beds, doubling the amount currently unavailable. This means we also need more folks to staff these beds. The reality that many of us have a hard time accepting is that we are the ones, colleagues, who may well end up in these beds. If not for the sake of Canadians, maybe for our own, we will make this issue a priority.

As we emerge from the COVID-19 pandemic, we are at a crossroads now. Do we go forward and return to normal, as if what was exposed to us never happened again? Or do we buckle down and pursue a stronger Canada where we define our success as more than GDP and our economic outputs, but by the number of families that can put food on the table, the number of children who have access to strong child care and early learning, and the number of seniors who, after spending their decades building this country, can spend their last years in dignity and respect? Thank you.

Honourable senators, I rise to speak to Senator Seidman’s inquiry on the weaknesses in long-term care systems exposed by the COVID-19 pandemic. I thank Senator Seidman for her leadership on this timely and critically important issue and Senator Moodie for her sound advice to us this evening.

Long-term care homes in Canada have been hit hard by the COVID-19 pandemic. The Canadian Institute for Health Information reports that more COVID-19 deaths occurred in long-term care homes in Canada than in any other wealthy nation. Among the provinces, Ontario has suffered some of the worst outbreaks, with deaths in long-term care accounting for 61% of all COVID deaths.

According to the Ontario COVID-19 Science Advisory Table, for-profit homes saw 78% more COVID deaths than did public homes. Yes, colleagues, 78% more deaths in for-profit homes. This is drawn from the Science Advisory Table’s report of January 2021, which also points to some key risk factors. A couple of them were mentioned by Senator Moodie, such as poor infection control and part-time staff who themselves became infected and moved between jobs in different homes as part of an effort to accumulate a livable wage.

In response to horrific stories emerging from long-term care homes, the Ontario government called in the Armed Forces in April 2020 to help several homes manage outbreaks that were out of control. It also launched the Marocco Commission to examine the issues and make recommendations on necessary changes.

The Canadian Armed Forces submitted a report to the Marocco Commission, detailing the horrific conditions they witnessed. The allegations are numerous and disturbing: a lack of personal protective equipment and other medical supplies, harsh treatment of residents, issues with cleanliness, infestation with mould, staffing shortages leading to resident deaths as a result of dehydration and malnutrition, and the list goes on. At one home, the Canadian Armed Forces said they suspected that COVID-19-related deaths paled in comparison to general deaths in the facility, which were much greater than they would normally be.

There were also existing challenges before the pandemic hit, including insufficient staffing, lack of sufficient training, and aging home infrastructure and overcrowding. In some cases, there were four beds to a single room. But things hit a breaking point with the arrival of the pandemic, and the issues were too deeply rooted to overcome quickly.

The Marrocco report set out 85 recommendations for improving Ontario’s long-term care system. Some of the recommendations include fast-tracking increases in staffing and care levels at all long-term care homes; separating the construction of the homes from the provision of care; improving working conditions and organizational cultures in long-term care homes to better attract, recruit, develop and retain staff, and reduce reliance on part-time staffing; implementing a streamlined expedited approvals process for creating new long-term care beds that accommodates the participation of existing and new not-for-profit and municipal licensees; and, importantly, developing an unannounced inspections regime and implementing enforcement mechanisms, including fines, for homes that are routinely non-compliant.

Colleagues, further to this, a recent paper on necessary long-term-care reforms, written by policy experts and health advocates, was published by the Canadian Centre for Policy Alternatives. The paper, Invest in Care, Not Profit, builds on the Marrocco report in recommending an orderly and phased reduction of for-profit long-term care; that already announced new licences for 30,000 long-term care beds be allocated entirely to the non-profit sector; increased funding for not-for-profit and municipal long-term-care providers and removal of the impediments preventing them from receiving funding currently; the creation of an agency with a mandate in resources to support non-profit homes and an independent task force to take up the Marocco Commission’s recommendation to:

 . . . urgently implement a streamlined, expedited approvals process for creating redeveloped and new long-term care beds that accommodates the participation of existing and new not-for-profit and municipal licensees.

Finally, as touched on by Senator Moodie, federal long-term care legislation should be established that recognizes that long-term care is necessary health care, and commit to ongoing federal funding for these essential services.

Honourable senators, the evidence is clear, it is overwhelming and it is tragic. Canada has a fundamental problem providing long-term residential care to those whose lives and well-being depend upon it.

We cannot commit the system to default back to business as usual. This has to end. Addressing these problems will require comprehensive reform, increased government funding, reduced wait lists, better standards of care and staffing, effective enforcement and far less contracting out.

There is a clear path forward and considerable consensus on necessary reforms, much of which is embedded in the Ontario government’s independent inquiry report and is now supplemented by Invest in Care, Not Profit.

It is now our responsibility to do everything we can to support the proposed changes. We must move forward. I look for your support in doing that, and I thank you for your attention.

Senator Seidman and honourable senators, I must inform the Senate that if the Honourable Senator Seidman speaks now, her speech will have the effect of closing the debate on this inquiry.

On debate, Senator Seidman.