Overdue reform of long-term care is on the way, but don’t hold your breath
“The situation for too many people in long-term-care homes is unacceptable. It’s time for it to change and it will change. So we will start working as of today with the provinces and territories in order to establish new national standards for long-term care.” — Prime Minister Justin Trudeau, Sept. 23, 2020.
There is no doubt that the Liberal government recognizes the urgent need to overhaul the country’s long-term-care (LTC) system. The urgency was clear in the priority assigned to LTC in the Speech from the Throne and in Trudeau’s pledge on television a few hours later to bring in new national standards.
Trudeau was being disingenuous when he promised “new” national standards. There are no national standards for LTC and never have been. If there were, 80 per cent of the COVID-19 deaths in this country would not have been in nursing homes and seniors’ residences.
There is bound to be a disproportionate number of deaths in these facilities because of vulnerability of their aged populations. But the number could be reduced dramatically by the adoption of rigorous national standards, vigorously enforced.
It is one thing to recognize urgency and to talk about immediate work with provinces and territories, it is another thing to turn recognition and talk into results. Ottawa has, or can borrow, the billions that will be needed, but the provinces have constitutional jurisdiction in health, and they don’t like federal cash with strings attached.
Trudeau had barely finish speaking when the provinces — led by Quebec and Alberta, followed by Ontario — began attacking Ottawa for invading their jurisdiction. They will accept every cent they can squeeze out of Trudeau, but not strings that would tie them to national standards.
It is an old, tired game, played out over the decades. The provinces want money without accepting responsibility. The Ottawa guys want the provincial guys to do the heavy lifting and absorb the blame when things go wrong. In government, it’s called federalism. In more common precincts, it’s called a shell game.
In the end, most provinces will accept Ottawa’s cash and some strings, but the negotiations will be gritty and the end distant. As a veteran observer of the shell game, I will be astonished if national standards emerge before the next federal election, whenever that may be.
Old and often overcrowded nursing homes that lack air conditioning, pack patients in four-person wards and do not meet today’s standards for safety and sanitation must be torn down and replaced with modern homes in which each patient has a private room and bathroom to curb the spread of infections.
That would be a national standard. But old LTC homes are important institutions in small communities; their owners or operators are influential figures: they often have municipal leaders on their boards of directors. They will not go quietly or quickly, if they go at all.
Another national standard would be to issue LTC licences only to non-profit operations. But there is no reason to hope provincial governments will agree to eliminate the private for-profit sector. Most of these homes are in large chains, and the chains have accounted for some of the deadliest COVID-19 outbreaks. They succeed financially understaffing and paying below-industry wages.
Although Ontario Premier Doug Ford rails against for-profit chains, whether he will actually take these powerful players on is highly doubtful.
It is also far from certain that Prime Minister Trudeau will take the lead by getting the federal government out of the for-profit LTC industry. Through a little-known Crown corporation, the Public Sector Pension Investment Board (PSPIB), the government owns 100 per cent of Revera Inc., Canada’s second largest (after Extendicare) chain of for-profit homes.
Trudeau could insist that the PSPIB shed Revera and get his government out the business of making money on the backs of vulnerable seniors.
It’s a fine principle, but there is no indication that it is about to be embraced.
More’s the pity.
Trudeau was being disingenuous when he promised “new” national standards. There are no national standards for LTC and never have been