Experts urge federal standards, investment to fix long-term care system

Immediate improvements for nursing home workforce needed before next crisis hits, says U of A researcher who chaired expert working group.


Bolstering the long-term care workforce in Canada needs to be an immediate priority to prepare for a possible second wave of COVID-19, according to a U of A researcher who chaired a working group calling for national care standards. (Photo: Getty Images)

Canada needs to undertake some immediate actions to ensure that nursing homes are ready for a possible second wave of COVID-19, according to a University of Alberta researcher and chair of an expert working group charged with solving Canada's long-term care collapse.

"If we do nothing else, in the short and longer term, the workforce has to be addressed," said Carole Estabrooks, a professor in the Faculty of Nursing who chaired the Royal Society of Canada working group on long-term care. "I keep coming back to countries like South Korea, New Zealand, Australia and other countries that have done reasonably well during COVID-19 because they have a national strategy.

"Canada is a high-income, high quality of life country, but we have, I'm sad to say, the highest death rate in nursing homes of any country on this planet."

A staggering 81 per cent of COVID-19 related deaths in Canada occurred in nursing homes, compared with 28 per cent in Australia, 31 per cent in the United States and 66 per cent in Spain, according to the working group's policy briefing report published today.

"I think there's probably a tone of outrage underneath the report, because even if you know the long-term care sector well, you ask, how did we let this happen?" said Estabrooks.

The working group is part of a task force on COVID-19 established by the president of the Royal Society of Canada in April 2020, which was mandated to provide evidence-informed perspectives on major societal challenges in response to and recovery from COVID-19.

The 60-page report outlines a comprehensive list of steps needed to right the ship in the long term. However, Estabrooks noted the paper's main thrust is on immediate, necessary steps to bolster the labour force. They include setting national care standards, implementing infectious disease control training, expanding staffing-especially during outbreaks-and ensuring better data collection, access to mental health resources and appropriate full-time pay and benefits.

"It is not as if anybody can do the work," said Estabrooks. "This is complex care, yet in some parts of the country we're paying people $12 an hour to do this work and then wondering why the COVID-19 tragedy in long-term care happened."

National framework needed

Estabrooks recalled testimony given at a recent Canadian Senate inquiry by Health Minister Patty Hajdu, who recounted the story of two Philippine care aides in Ontario who contracted COVID-19 in the nursing home where they worked, then passed it on to others at the shelter where they were staying because they couldn't afford to live anywhere else.

"It is just tragic that we have not consistently provided adequate wages and benefits to this critical workforce-the care aides and personal support workers in nursing homes who provide upwards of 90 per cent of direct care," said Estabrooks.

She added Alberta and B.C. care aide salaries are reasonably good comparatively in Canada, but we must have adequate wages, full-time work and benefits such as sick time.

"We have glaring gaps in the data needed to effectively manage the long-term care system, primary among them data gaps about the workforce. Nationally, we do not have accurate counts of the numbers of care aides working in nursing homes. If you don't know how many care aides you have, how do you do workforce planning?"

Such gaps contribute to inconsistency in care, Estabrooks said, noting that it also led to a direct breakdown in safety when, as the pandemic struck, 25 to 30 per cent of care aides were working in more than one home.

"That was a source of infection spread, and this was about not being able to get full-time jobs with benefits," she said.

"If you cannot measure the important things in a system, then you cannot manage that system," she said. "This applies to the workforce but also applies directly to residents in nursing homes. For instance, if you don't know what resident quality of life is like in the residences, how do you know what to do or where to do it?"

She added, "(Workforce issues) are a critical cornerstone of care quality and our ability to ensure a good quality of life."

Addressing ageism and sexism

At the very core, however, are our attitudes toward aging, and toward women and the work that is primarily done by women, Estabrooks said.

She said it is obvious and appalling how voiceless the frail elderly are in Canada-especially those in nursing homes and with more advanced dementia-and how few advocates they often have.

Less obvious is how feminized the long-term care environment is, which Estabrooks said the report tries to hammer home.

"Two-thirds of the residents are women, two-thirds of people with dementia are women, 90 per cent of the paid workers are women, 75 per cent of the unpaid workers are women," she said. "This has implications-if your workers are all women and they are working in low-paid jobs and, for instance, they shut down schools, this is a problem for those who have children."

Equally as challenging is the heavy caregiver burden many workers carry when they have aging parents. Child care and respite care are two strategies we should be immediately addressing, even before a possible second wave of the pandemic arrives, Estabrooks said.

She noted that we are now seeing more and more families protesting the severe lockdowns put in place to curtail the spread of COVID-19 in nursing homes, separating loved ones and leaving seniors to live and die alone.

"I think what happened is that we brought these harsh restrictions to bear, sledgehammers really, to control spread. We were afraid-what if we got behind the eight ball and lost control?-and it was a legitimate fear because COVID-19 is highly contagious and will spread like a wildfire in a nursing home that is unprepared," she said.

"But it went on for months, and we know that these older adults did worse because of it, and we know that many of them died all alone-something most of us fear deeply.

"This is just not good enough."

Estabrooks said she still hasn't gotten over the day she watched on the news as a tree-cutting machine raised a woman in a bucket up to the third-floor window to see her mother.

"I thought, 'Oh my God, is this the best we can do?'"

In the end, Estabrooks said she is hopeful that change is coming, but worries about those who suggest the cost will be too high.

"It is going to cost more, and the federal government is going to have to help," she said. "At the end of the day, it's as simple as, "What can you expect when you live in Canada and get old? Will you be cared for in such a way that you not only have good quality care, but you also have a good quality of life, even in advanced dementia?

"What is that life-that life that raised us, that built the economy, that paid taxes-what is it really worth to us? I think it is worth a lot, that the value we place on a life lived should be no less than that which we place on one about to be lived."