By Trina Thorne and Carole Estabrooks

The global pandemic marked Canada as an outlier in one significant, tragic way. While seniors in most countries were hit hard, in Canada, a whopping 81 percent of all deaths in the initial months of the pandemic happened in long-term care, compared to a mean of 42 percent in other OECD countries.

A more recent, independent assessment has found that of Canada’s 30,420 deaths from COVID-19, 18,800 deaths have occurred in 1,871 residential facilities (as of January 9, 2022). 

Why were seniors in Canada’s long-term-care facilities so hard-hit compared to elsewhere?

Poor pandemic preparedness, lower daily care hours for residents, poor funding and resources, inconsistent inspections, and inadequate integration of health and hospital services are among many factors at play. Most of these problems long predate the pandemic. Governments at all levels have known about the problems in long-term care for decades and have done little to address them. 

In a recent study published in F1000 Research, we identify, along with our colleagues, more than 80 reports from governments, unions, nonprofit organizations, and professional societies commissioned to examine the state of long-term care in Canada from 1998 to 2020.  The reports range from a few pages to almost 1,500 pages; most identify the same basic problems and repeat the same basic recommendations. 

What will it take to make changes to long-term care in Canada?

Our study found the report recommendations over the past two decades have been consistent, evidence-based, and would have, undoubtedly, saved many lives had they been implemented prior to the pandemic. Inaction set the stage for increased deaths during COVID-19 and contributed to lower quality of life in long-term-care homes.   

What recommendations have been made recurrently that have been ignored by successive provincial and federal governments? 

The three main recommendations across reports spanning over two decades include increasing or redistributing funding to improve staffing, increase direct care and capacity; standardizing, regulating and auditing quality of care; and reforming, standardizing, and regulating education and training for long-term care staff.  Improving staff education and training and increasing behavioural supports and modernizing infection control measures were universally recommended in the reports. 

Why did these repeated pleas for change in long-term care go unheeded?  Issues of understaffing, undertraining and the negative impact of for-profit long-term care homes are repeatedly mentioned in the reports.  Countless media articles have also highlighted the findings of these reports over two decades.

In the aftermath of the pandemic’s first waves, some changes have happened in long-term care.  Several provinces have modestly increased wages and provide more full-time employment to stabilize the workforce. Ontario committed four hours of direct care per day for each resident by 2024, an increase on the national average of 3.3 hours. Alberta’s Facility Based Continuing Care report recommended, among other things, 4.5 hours of care, establishing full-time employment benchmarks for the workforce, and prioritizing quality of life for residents. The Quebec ombudsman’s final report also prioritized full-time jobs to enable a single-site format and limit the use of workers from employment agencies.

Although highly relevant infection-control deficiencies are noted and specifics of some recommendations, such as hours of care, may vary, many of the recommendations have been made many times over. These are solid steps in the right direction, but much more needs to be done, particularly on resident quality of life and staff quality of work life.

While much good could potentially come if the recommendations of the new pandemic reports are implemented, it remains the case that duplicative investigations of known findings have far less value than implementation of the solid existing recommendations.  Had the recurring recommendations been implemented, we would undoubtedly have improved working conditions, quality of care, and quality of life in Canada’s long-term-care homes, as well as prevented unnecessary deaths due to COVID-19.

Now we must try to introduce increased hours of care amid a growing and increasingly severe shortage of all levels of workers in long-term care.

Now is the time for action. Our governments need to move forward, prioritize recommendations—it cannot all be done at once—and begin the hard work of figuring out implementation, resourcing, and evaluation. This must include identifying and resourcing areas where gaps in knowledge make coherent decision-making impossible and are too major to ignore.