More than 200,000 older adults and persons living with a disability live in long-term care homes in Canada. Recognizing that provinces and territories are primarily responsible for managing long-term care, the federal government invited input in summer 2023 on the development of a Safe Long-Term Care Act to help ensure care residents get the care they deserve.
While there are many issues that are important for improving long-term care, Wellesley Institute chose to focus its submission on equity. This is an area that is not often considered, but will be crucial for future success. Population demographics show the older population will become more racially and ethnically diverse over the coming years. Long-term care systems need to develop so they are capable of offering equitable care to elders. Our reports show that both access to and quality of care for older minoritized individuals needs to be improved.
Here are the highlights of Wellesley Institute’s submission, in answer to the federal government’s questions.
How should governments and stakeholders cooperate to improve the quality and safety of long-term care?
The federal government must ensure all stakeholders collaborate to develop a long-term and sustainable strategy to improve the equity, quality and safety of long-term care. Wellesley Institute research has demonstrated that those from certain language and cultural backgrounds wait longer for access to appropriate long-term care. This highlights the critical need for the federal government and other partners to deliver on an equity approach to long-term care reform.
Canada should elevate expectations and ensure Canada becomes a global leader in this area. The federal government should take a lead on convening partners, including other levels of government, to develop an overall health equity plan that includes specific goals and outcome measures for advancing equity in long-term care. To ensure accountability, they should have strings attached to funding for provinces and territories that is dependent on meeting federally set targets. The government can also support this through quickly moving forward on the proposed national health data system, including mandating the inclusion of race-based and other sociodemographic data, such as language, gender and sexual diversity, and socio-economic status.
How can governments and stakeholders cooperate to help foster the implementation of the new, national long-term care standards?
Government and stakeholders should ensure that equity-centred care is a key focus in the implementation of the national long-term care standards. This includes allowing long-term care residents to be active in decision-making and providing care, food and activities that are culturally appropriate and available in different languages to reflect diverse cultural and linguistic needs. The federal government should start federally enforcing appropriate staff-to-resident ratios so that staff are able to provide the necessary equity-centred care that residents deserve.
Ensuring a diverse and robust long-term workforce is critical for meeting the national standards. Currently, many long-term care staff are poorly paid, are working precariously in shift or part-time positions and have little professional development opportunities. The federal government must work with other levels of government to develop a workforce strategy that addresses workforce precarity and other issues including low wages, comprehensive health benefits, opportunities for development and safe and inclusive working conditions.
Research and evidence has also shown that private, for-profit care is not conducive to decent work and quality care. In the long-term, the federal government should lead provinces and territories to ensure private care is wound down and replaced by public, not-for-profit long-term care.
How can governments and stakeholders cooperate to address health human resources challenges in long-term care, including staff retention and recruitment?
There is much to be done to ensure that long-term care staff are provided with decent work – including having a Thriving income that reflects their physical, social and mental needs, and Thriving workplaces that include comprehensive health benefits, opportunities to advance in their fields through professional development, and safe, anti-racist and inclusive working environments. Ensuring and enforcing decent work is necessary to address health human resources challenges, including staff retention and recruitment.
How should we enhance public reporting on long-term care to strengthen transparency and accountability in the sector?
Mandating, collecting and publicly reporting sociodemographic data including on race, language and gender and sexual diversity will enable better health equity analyses that can be used to strengthen transparency and accountability in the long-term care sector. Developing both the raw data and combined scores will allow the public, researchers and governments to monitor progress and identify and address inequities during implementation of new and updated policies and programs.
What type of information would you like to see in a pan-Canadian public report on long-term care?
The COVID-19 pandemic brought a lot of needed attention to Canada’s long-term care system, which paved the way for important changes in sector practices. To help build on this progress, a pan-Canadian public report should answer: What positives can we draw from Canada’s response to the long-term care crisis? What changes that were made, and strengths that we have, should be highlighted?