Wellesley Institute’s New Normal is a vision of a better Canada, Ontario, and Greater Toronto Area where everyone thrives post-pandemic.
In the lead-up to this provincial election we will examine issues raised in our New Normal series to see how the commitments of our leading political parties stack up. Do they seek to bring the change we need the most – change towards a fairer, stronger, healthier province we can all be proud of?
In this first New Normal Election Analysis we examine seniors care. Throughout the COVID-19 pandemic, our seniors have been at incredible risk. This is in part because older people are more vulnerable to infection and because we had an insufficient quantity and quality of care for older adults in place pre-pandemic. But it is also linked to pandemic policy decisions such as the amount of support and resources, including personal protective equipment or PPE that were made available to help keep seniors safe. The public’s commitment to protect others decreased deaths, but despite this, in the first waves of the pandemic 75 per cent of those who died were in long-term care; and older people were the major at-risk group. One calculation was that over 4,500 deaths could have been prevented in the early waves by better policies regarding our seniors.
Our Seniors Care New Normal examined how prior to the pandemic our seniors were being left behind. There were long waits for homecare and long-term care for all, and waits were even longer for racialized groups who wanted access to culturally and linguistically appropriate services. We documented how inadequate provision of care negatively impacts not just seniors, but their family and caregivers – and the costs it imposes on our acute healthcare system. We called for a New Normal with an expansion of person-centred and home-like long-term care and homecare, where the promise of the Residents’ Bill of Rights is fulfilled, and people get equitable access to culturally appropriate care. For this platform review, we also checked for specific commitments to Indigenous reconciliation efforts in this area.
Green Party of Ontario
The Green Party of Ontario has yet to release their official platform on seniors’ care – we will update if new information is released.
Ontario Liberal Party (OLP)
The Ontario Liberal plan includes a commitment to end for-profit long-term care by 2028. They commit to audits, inspections, and sanctions on long-term care homes that misdirect funds or endanger residents, and repealing laws that protect long-term care homes from liability. To address insufficient and outdated spaces in long-term care homes, they commit to building and redeveloping 58,000 non-profit long-term care spaces that are more home-like and increasing funding to non-profit long-term care homes to ensure excellent standards of care, including four hours of direct care per day.
The OLP has also promised increased investments in home and community care. They propose to guarantee home care to all seniors who need it, starting with an increase to the annual budget for home and community care by $2 billion through 10 per cent annual increases that will prioritize non-profit care. They estimate this will allow 400,000 additional older adults to access home care by 2026.
They further commit to funding assisted living alternatives, creating a dementia care network, and fully funding clinical costs for hospices.
The OLP commits to support the development of Indigenous long-term care homes. They propose to develop and mandate health equity standards, including by collecting race-based data. They plan to find ways to increase culturally competent care, but their platform had no details.
Ontario New Democratic Party (ONDP)
The Ontario NDP platform includes commitments to improving home and community care and long-term care. Their major commitment is to transition away from for-profit care and build a new, public long-term care system, starting with building 50,000 new and modern beds. They will prioritize building small, modern, and family-like homes across the province to ensure residents can live in a more comfortable, home-like setting, and slowly phase out older long-term care beds.
The ONDP also propose to end for-profit home and community care. Additionally, their plan includes establishing provincial standards for home care, starting with creating a basket of core services that Ontarians will be entitled to receive – such as nursing care for medication management and help with meal preparation. They also promise to create a means-tested Caregiver Benefit Program that would provide informal family caregivers with $400 a month.
We were unable to find specific commitments around assisted living, dementia care, or hospice care.
The ONDP commits to guaranteeing “First Nations elders have access to culturally appropriate home, community, and long-term care.” They propose creating training and resources for home and community care programs on culturally appropriate care and developing a job-matching program to match personal support workers (PSWs) and other care workers with communities they share cultural and linguistic ties. A section entitled “Guarantee Health Equity” commits to race-based data collection but does not explain what a guarantee might mean in this area, save for a promise to make long-term care 2SLGBTQA+ affirming, with no further details.
Progressive Conservative Party of Ontario
From the budget proposed on April 28, Ontario now has over 31,000 new and over 28,000 upgraded long-term care beds “in the development pipeline” and intends to build more than 30,000 net new beds across the province by 2028. The government has indicated no intention of reducing the for-profit role in the system.
The proposed budget promises an increase of $1 billion over three years for the provincial home care budget, and a refundable Ontario Seniors Care at Home Tax Credit for low- to moderate-income senior families, initially costed at $110 million per year.
The budget would invest $100 million in additional funding over the next three years to expand access to community care programs – including assisted living services, adult day programs, meal services, caregiver supports, and transportation. They proposed an additional $5 million a year for three years for dementia services, but we were unable to determine whether this is more than a health care inflation-level increase.
On culturally appropriate or person-centred care, the budget stated that “many” new long-term care beds will be in homes that offer culturally and linguistically appropriate services to better serve Ontario’s seniors. No information was provided as to which cultures or languages would be addressed, or how many was defined as “many.”
Will these promises lead to a New Normal for seniors’ care in Ontario?
Unfortunately, there is a significant data gap making this difficult to assess. Although estimates of the size of this population are available, with Statistics Canada putting Ontario’s population over the age of 65 at 2,600,000 and over the age of 75 at 1,120,000, assessments or estimates of how many people need long-term care and home care are difficult. Based on an assessment by the National Institute on Aging (NIA) between 13 per cent and 21 per cent of those over 65 in Canada are receiving some kind of long-term care, which would mean Ontario needs between 338,000 and 546,000 beds – without factoring in a growing and aging population. Wait-lists for long-term care may also be suppressing demand. Our home care system is already strained with the number of patients it currently manages, and it is likely that many who are entitled to access are not aware it is an option. The NIA also reports an estimate that This makes it impossible to assess what investments are needed, and highlights the absolutely necessity of an equity-driven needs assessment for the entire system.
On Long-Term Care, all parties are placing renewed attention on the issue. New beds, the previously announced commitment from the government to minimum hours of care, and the ONDP and OLP interest in ensuring more home-like settings are important. However, no party is providing a measurable, trackable commitment to a long-term care system that would meet Ontarians’ needs, and all parties need to do far better in terms of offering specifics for system reform that will improve the lives of those in long term care homes. Voters need to hear what a future state of the system will be, and how we will get there. All parties should have specified how they would achieve equitable access based on an analysis of population need, and provided clear plans to end inequitable wait times. They did not.
On home and community care, it is again heartening that all parties propose additional investments. The OLP language pledging a “guarantee,” and the ONDP commitment to a “basket of services” are both very encouraging and could, if further developed, lead to Ontarians knowing what they can expect. To achieve a New Normal, however, parties need to be goal- and data-driven. Our next government should complete a needs analysis that focusses on equity, and then set the goal must of ensuring every Ontarian who needs it receive all necessary and appropriate care. This would enable government to create a plan, in partnership with the public and the sector, that will demonstrate when and how that goal will be achieved.
On culturally appropriate and person-centred care, we look forward to more details on the ONDP commitment to work towards better matching care providers with communities that can benefit from their cultural knowledge, as well as what they mean by, and how they intend to deliver, a guarantee of health equity. The OLP commitment to health equity standards is welcome, but needs more detail.
It is unacceptable that the government has no commitment to or mention of care for Indigenous older adults in their budget, and we are concerned the ONDP commitment needs to be broader, and the OLP commitment clearer.
No party is delivering a commitment to a vision of the future with measurable steps. For example, they might begin by ensuring that within five years every person living in long-term care from a defined number of larger linguistic and cultural groups will be in a culturally appropriate home, paired with a plan for how other linguistic and cultural groups will be accommodated, building towards a complete plan in 10 years. Delivering this change is crucial to delivering on health equity in our long-term care system.
We urge all parties to adjust their thinking away from “what investments or small changes (however important) can we announce,” towards immediately developing a vision for a New Normal that all Ontarians can share in. Investments and policy changes should be part of an equity-focused plan that will get move us steadily and swiftly towards a system that delivers on health equity and gives us a more resilient seniors population and health care system. Based on their commitments so far, although progress would be made, we do not believe any party will deliver the New Normal for seniors’ care Ontario needs.
We urge them all to rethink their approaches to aim, and deliver, on a New Normal.