That Canada’s seniors’ care system has problems has been made plain through the COVID-19 pandemic.
It is, said B.C. Minister of Health Adrian Dix, “a severe consequence of our ability to control the virus generally.”
Langley Care Society CEO Debra Hauptman expanded on that.
“It is evident that the COVID-19 virus affects the elderly population more severely than other segments of our population,” Hauptman told Glacier Media. “It is more challenging to control, due to the advanced age and frailty of our residents, our facility physical design with communal spaces, but also the nature of this virus which is highly virulent and can be spread by asymptomatic, infected workers and visitors.”
The society runs Langley Lodge, where an outbreak was declared April 28. It left 25 dead before the outbreak ended.
Hauptman said residents average 85 years old with complex care needs.
“Care levels need to be augmented to meet the higher acuity levels of the elderly in long term care, and ensure that operators can also perform the more intense levels of infection prevention and control in typically large facilities more frequently than pre-COVID,” she said.
“Due to the pandemic, there is an awakening nationally to the critical situation that we have for seniors’ care and there is momentum for change,” Hauptman said.
“Those older adults deserved a good closing phase of their lives and a good death,” the Royal Society of Canada (RSC) said in a June analysis. “We failed them.”
As of July 16, 189 people died as a result of the virus in B.C. – 123 or more of them seniors in multiple assisted living or long-term care facilities. The system deals with a range of seniors – those needing assisted living to those who can no longer look after themselves due to physical or perhaps mental and dementia issues.
A key issue, the Canadian Centre for Policy Alternatives (CCPA) said in a June report, has been increasing government reliance on the private sector to deliver seniors’ care.
There’s significant red tape to negotiate, training issues, now-pending unionizations and the threat of pending legal actions that could hamstring the system.
Victoria has moved on some issues, through visitation rules, staffing changes and addressing personal protective equipment concerns (PPE).
Researcher Andrew Longhurst divides care into assisted living and long-term. The former is preventative care aimed at delaying entrance to long-term. If that’s handled, reliance on the latter is less, he said. But, he added, there’s a shortage of publicly funded long-term care.
Severe staffing and training problems exist across the board and B.C.’s system needs a thorough review, he said.
Also in June, the Royal Society of Canada said “profound, longstanding deficiencies in the long-term care sector” contributing to the pandemic’s magnitude, far worse in Canadian facilities nursing homes than in comparable countries.
“The pandemic just exposed long-standing, wide-spread and pervasive deficiencies,” the RSC said.
Financing of care
Some critics charge B.C. has moved too far with the private sector handling seniors’ care.
“This financialization of seniors’ care – in which the real estate assets associated with this care are treated as financial commodities to be bought and sold on international markets – is at odds with the basic social purpose of providing care to vulnerable seniors, many of whom have low or moderate incomes,” a February CCPA report said.
“It is the failure of provincial governments to invest in new public and non-profit-owned assisted living units that has contributed to the shortfall in publicly subsidized spaces.”
The CCPA wants changes starting with increased funding for non-profit organizations and health authorities to increase publicly subsidized assisted living unit capacity.
Second, it wants to see detailed disclosure and public of reporting of ownership, costs and quality of services to enhance accountability and transparency.
Hauptman isn’t so sure. She said governments know what they spend and receive detailed financial reports from private operators at regular intervals. Financial model misinformation is frustrating, she said.
“The private sector has invested in new facilities, we have mortgages, some organizations fundraise for equipment and quality of life programs for our residents,” Hauptman said. “We can only spend the funding that we receive from government, and it is much more apparent now that we have been underfunded for an appreciably long time.”
For the RSC, though, it’s less about who runs or funds facilities than it is about staffing, data, a lack of standards and a lack of seniors’ voices in the conversation.
The RSC makes 16 recommendations for change, foremost of which are that funding must be adequate and sustained, with Ottawa leading the way. And, the RSC said, quality and end of life care are non-negotiable.
Regulation
At the legal heart of providing services to seniors sit the Hospital Act, the Community Care and Assisted Living Act and the Assisted Living Regulation.
The RSC called provincial and territorial laws “disparate and piecemeal.”
Buried in the fine print is the general health and hygiene section saying facilities must make a plan describing the procedures to be followed to promote general health and hygiene amongst residents and prevent the spread of infectious disease in the assisted living residence. The accompanying handbook specifically addresses this.
Despite those requirements, provincial medical health officer Dr. Bonnie Henry on June 29 had to stress that facilities “must have required written safety plans.”
The RSC goes further.
“Provincial and territorial governments must assess the mechanisms of infection spread from multi-site work practices and implement a robust tracking system,” it said. “When the COVID-19 outbreak occurred, nursing homes lacked capacity to handle the surge.”
Further, it said, data collected must include resident quality of care and life, resident and family experiences, and quality of work life for staff. And, the collection should be independent of the sector and government.
B.C.’s Office of the Ombudsperson said “the problem with having two different legislative frameworks is that different standards, fees, and monitoring and enforcement processes apply to each, and neither seniors nor their families are generally aware of which legislation governs their facility. This creates unnecessary disparities in the care provided to seniors in residential care.”
Facilities also found themselves subject to inspections not by provincial government inspectors but by health authority officials with results posted online.
“Neither of these steps offers a long-term solution that provides seniors and their families with the confidence that consistent standards will apply no matter where in the province they receive residential care,” the ombudsman said.
Inspections, though, won’t solve all issues.
The Office of the Seniors Advocate of B.C. tracks inspections and complaints. However, complaints or past disease outbreaks don’t necessarily correlate with a COVID-19 outbreak, as is evidenced by the Lynn Valley Care Centre, which saw 20 deaths but few past problems.
Hauptman said, “There are inspections, quality reviews, investigations, financial reporting requirements, WorkSafe requirements, accreditation, and food services licensing requirements.
“This is due to the nature of our business, providing 24-hour care for the most frail in our population,” she said. “There are differences in the types of regulations. It would likely not have any measurable benefit to try to streamline these.”
The ombudsperson has twice studied the situation – in 2012 and again in 2019. The second study found the government had not implemented multiple recommendations.
For instance, the ombudsperson suggested all B.C. health care assistants (HCS) be required to register with the BC Care Aide (HCA) and Community Health Worker Registry. But, only those working in publicly funded facilities were required to do so. The same applies to criminal record checks.
“This leaves a significant gap in protection for seniors,” the office said.
The RSC said hands-on care is now almost entirely given by unregulated workers – care aides and personal support workers receiving the lowest wages in the healthcare sector with minimal training.
“They often have insufficient time to complete essential care and are at high risk for burnout and injury,” the RSC said.
Workforce change, the RSC said is key. It wants national standards and workforce benefits. Also lacking in many cases are physical, occupational, speech and recreational therapists and technicians; recreational opportunities and access to uninsured medical services.
Legal action
Further compounding problems for future care of seniors is the looming threat of class action lawsuits from families of those who have died. They’ve already begun in Ontario and lawyer Darryl Singer of Diamond & Diamond firm said he’s had multiple inquiries about similar actions in B.C.
The law firm is behind a $120-million class action case filed in Ontario aimed at several private sector operators, some of which also operate in B.C., Singer said.
He said the situation is a prime example of private health care. “This is a perfect example of why we don’t want to do this,” he said, saying private care can lead to cases of maximizing profits through lowering staffing levels.
“The cost of contingency planning and the cost of having adequate staff are all things that can eat away at profit,” Singer said.
“They knew or ought to have known if they failed to take these steps it was reasonable to foresee that people were going to get sick and die,” Singer said.
What homes should be doing now is getting ready for a second and third wave, Singer said.
Another threat, Singer said, is if the class action succeeds, it’s insurance companies that would pay out. That could lead to insurance companies refusing to insure such facilities in future, he explained.
It’s not the first COVID-related legal action in Ontario. The Ontario Nurses Association got an April judge’s order that companies provide staff with masks and also to separate staff and clients to prevent disease spread. The need for such was to be determined by health professionals and not companies, the judge said.
However, the PPE shortage has been a global issue for the health care sector, one the RSS said provinces need to handle.
“We are just starting to have more supplies in the supply chain and things have eased substantially,” Hauptman said. “In March and April, there was very limited supplies in Canada and it created challenges across the sector. Once the federal government announced that shipments had arrived and were being sent out to the provinces, the situation improved dramatically.”
University of Windsor Faculty of Law class action clinic director Jasminka Kalajdzic said companies not being sued will be looking for the court’s decision so they can be proactive in providing care.
“If private market actors can’t do business in a way that is effective and safe and does harm to customers, they shouldn’t be in the market.”
But, would that leave a scarcity of seniors’ homes if some withdraw from the market?
Kalajdzic doesn’t think so.
“It would open up space for other companies,” she said. “That’s capitalism.”
But, she said, the situation certainly indicates a need for discussion about the role of the state in regulation of homes.
PPE scarcity has also manifested itself in B.C. in the amount of 2020 COVID-19 sickness claims to WorkSafeBC. Some 337 of a total 533 were pandemic-related by June 1, 82 of those coming from long-term or seniors’ care workers. It’s a situation that removes workers from the job, placing greater stresses on those remaining in the workplace.
In the end, the RSC said, “reform and redesign must tackle not just the pandemic crisis, but also long-standing systemic failures.”
“To fail in doing this leaves us with our currently woefully inadequate (long-term care) system and the certainty that the next crisis will create similar or more catastrophic outcomes.”
