Standards only work when applied

During the pandemic, few places were more dangerous than long-term-care homes. In the first wave, for example, residents in nursing and seniors’ homes accounted for more than 80 per cent of all reported COVID-19 deaths.

COVID ran rampant through some facilities, overwhelming staff and in some cases, requiring the extraordinary step of bringing in military personnel for assistance. By July 2022, some 17,000 residents of long-term-care homes in Canada had died, according to data collected by the National institute on Ageing at Toronto Metropolitan University.

Yet COVID wasn’t the cause of all those problems that afflicted long-term-care homes with tragic outcomes.

Rather, the pandemic exacerbated systemic problems, revealing vulnerabilities of the system and the elderly residents who depend on it.

Those vulnerabilities include overworked staff, high turnover, neglect and abuse and weak management.

While the tragedy wrought by the pandemic has brought needed political attention and promises of change, this is not the first time the shortcomings of long-term facilities have been in the spotlight. Nor is it the first time we have heard promises of change, only to see such those commitments wane.

Against that backdrop then, it was welcome to see the introduction of new national standards for long-term-care homes in this country. One set of standards, developed by the Health Standards Organization, addresses quality of life while another set developed by the CSA Group focuses on nursing home operations and infection prevention and control.

Together, the guidelines are meant to improve the quality of life in long-term-care homes by putting a focus on resident care and ensuring a competent workforce in a safe and well-designed facility that is welcoming and homelike rather than an institutional environment.

By themselves, the guidelines won’t resolve the problems found in some long-term facilities. That will take funding. But they will establish benchmarks and best practices and will critically highlight areas where homes fall short. The HSO standards, for example, will be used by Accreditation Canada, which assesses 94 per cent of publicly operated nursing homes and 36 per cent of privately owned homes nationwide.

But here’s the rub. The standards will not be mandatory. That risks leaving in place the patchwork of standards that exist across the country. And it risks leaving uncorrected the very shortcomings that have left seniors living in troubling conditions.

The federal government says it won’t mandate the standards, punting responsibility to the provinces. It was disappointing then to hear the less-than-enthusiastic response from the Ontario government. Ontario Long-Term Care Minister Paul Calandra said that while his ministry will review the standards, he declared he has no interest in “watering down Ontario’s very high standards.”

Calandra’s comments suggest there is no room to improve what currently exists in Ontario. That’s hard to fathom, given these new standards were shaped by feedback from 19,0000 long-term-care residents, family members and caregivers among others.

As Laura Tamblyn Watts, CEO of CanAge, a national seniors advocacy group, noted, Calandra’s comments reveal a “disturbing arrogance in that thinking which helps no one — especially not Ontario seniors.”

Ideally, the standards will inspire change to provincial legislation so they become entrenched in laws and, ultimately regulation. They provide a modern, progressive perspective for governments and an industry often guided by institutional thinking.

As well, advocates suggest that any federal funding for longterm-care homes be tied to these standards. That would help ensure that government funding drives improvements.

The standards are an excellent foundation to ensure that life in long-term-care homes is what we’d want for our loved ones and indeed for ourselves. But unless steps are taken to ensure they are applied uniformly to public and private-care homes, there’s every chance the problems they seek to address will persist.