Advocates push Ottawa to fix long-term problems with long-term care

OTTAWA - Advocates and experts in long-term health care say now is the time for Ottawa to intervene when it comes to the inhumane treatment of seniors in nursing homes across the country.

When the number of deaths related to COVID-19 started mounting in April, federal officials promised to work with provinces to better protect seniors in the future.

Then came damning military reports, outlining cases of abuse and acts of negligence in the Ontario and Quebec long-term care facilities where troops had been deployed to help during the pandemic.

In Ontario, the military found insect infestations, aggressive feeding of residents that caused choking, bleeding infections, and residents left crying for help for hours. The Quebec report was less critical, but the military did find widespread staff shortages affecting patient hygiene.

Federal and provincial politicians expressed disgust and dismay at what the military uncovered and promised action, but researchers, experts and advocates say they've been raising the same concerns for years to no avail.

"This is rampant in long-term care," said Diana Pepin, who became a vocal advocate for reform after her 86-year-old mother was abused in an Ottawa care home.

She captured several incidents of abuse against her mother using a hidden camera in 2018, including a personal support worker who told her non-verbal mother she should die as she was getting her ready for bed.

There has been inquiry after inquiry, but little has been done to fix the problem, she said.

While disappointed it took military interference to bring the issue to the foreground, she said this should finally spur some kind of federal action.

So far, Ontario and Quebec have asked the federal government for money to try to fix systemic issues, but experts say that's likely not enough.

"We have to do this together as a country," Carole Estabrooks, who has collected data on long-term care for 15 years as the head of the Translating Research in Elder Care program at the University of Alberta.

"We have to stop the bickering and the jurisdictional issues and act together so that we have some national standards, some national expectations, some resources that are attached to that."

Unlike the bulk of Canada's universal health-care system, the federal government has no jurisdiction over long-term care.

If Canadians believe their acute-care system should exist under federal legislation that guarantees certain principles, it's not unreasonable to expect that continuing care should exist under the same national framework, Estabrooks said, adding that it should include home care, as well as nursing homes and retirement residences.

NDP Leader Jagmeet Singh has advocated for the long-term care system to be brought under the Canada Health Act, the legislative framework underpinning universal health care.

In an NDP-hosted virtual town hall Tuesday evening, former federal health minister Jane Philpott said she believes there's a role for the federal government to play.

"We need to stop using jurisdiction as an excuse to not have federal leadership," said Philpott, a former Liberal and then Independent MP who is set to take on a new role as dean of the health sciences faculty at Queen's University. She declined an interview request.

Prime Minister Justin Trudeau said respecting provincial jurisdiction will be an important part of responding to the issues with long-term care.

"The Constitution of Canada is not an excuse. It lays out the divisions of powers and responsibilities and we respect the province's jurisdiction over long-term care facilities," he said Wednesday during an exchange with Singh during the special committee on COVID-19 in the House of Commons.

When asked about setting national standards for long-term care, the prime minister said he didn't want to "short circuit" those discussions by making "aggressive proposals."

The Trudeau government waded into the area of seniors care in 2017 when Philpott was health minister, having agreed to give the provinces some $6 billion over 10 years for home and community-based care. That money came with some common standards and benchmarks to track the progress of those funds.

That made for some difficult conversations with provinces who didn't want the federal government stepping on their turf, said Dr. Samir Sinha, director of geriatrics for Sinai Health System in Toronto, who had knowledge of the talks.

Sinha said some of the criteria for measuring the success of the funding have still not been developed.

"In the end, we spent $6 billion with very little accountability and we're no further ahead," he said.

The costs associated with long-term care without making significant changes could be massive, according to Ryerson University's National Institute on Ageing.

The institute projects public spending in nursing homes and private homes will grow from $22 billion in 2019 to somewhere between $71 billion and $98 billion annually in 2019 dollars by 2050.

On the high end, that would represent over one-quarter of all projected personal income tax revenue just to maintain the level of care provinces are providing now, the institute said.

During Trudeau's Wednesday news conference, he said he'd be speaking with premiers about the situation in long-term care during his weekly call with them Thursday, but for now, the government is focused on responding to the COVID-19 pandemic in long-term care.

Whatever the eventual solution, Pepin said residents and families must be consulted.

"They should not be dismissed, they deserve to be brought to the front and I really would like to see the federal government ask us to help them," she said.

This report by The Canadian Press was first published May 27, 2020.

— With files from Teresa Wright in Ottawa