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Time to free Canada’s long-term care system from its backward history

Canada’s response to senior care has desperately needed improvement for many years

COVID-19Canadian PoliticsHuman Rights

81 percent of COVID-19 deaths in Canada were in long-term care, nearly double the OECD average. Photo from Flickr.

The COVID-19 pandemic has exposed the failure of Canada’s long-term care (LTC) facilities. A review of history, however, suggests that our response to senior care has needed improvement for a long, long time.

For centuries, families traditionally took care of their elders. For families unable to do so, and for elders without the means to care for themselves, the historical alternative was the almshouse or poorhouse (both now thankfully obsolete).

Introduced to North America in the 17th century by English settlers, the function of these houses was to provide shelter for those who couldn’t support themselves, suffered mental illness, or were orphaned or elderly. Living conditions were often substandard, being financed by local communities with little to no regulation. It wasn’t until the Municipal Institutions Act, enacted in Upper Canada in 1866, that municipalities and provinces were required to inspect and regulate these institutions.

Operating alongside the almshouses of the late 18th and 19th centuries were privately supported boarding houses for the elderly. In her 1977 paper “A History of Long-Term Care Facilities for the Elderly in Canada,” Barbara Emodi described a two-tiered system of public almshouses and privately owned “boarding houses” for seniors. Wealthier families would keep elders at home, often soliciting outside care support. If that was impossible, a family could make arrangements for care to be provided in a private boarding house. Poorer elders and families relied upon public institutions. This is not unlike the current system of private and public LTC facilities.

Eventually the boarding houses evolved into private hospitals, which sprang up all over the country in the 1920s and 1930s—the grandparents of today’s nursing homes and LTC facilities. Being under the jurisdiction of provincial governments, standards varied from province to province. Even today, provision of LTC falls to provincial and territorial governments; a current bone of contention.

Advocacy groups, including the Council of Canadians and the Canadian Labour Congress, are petitioning the federal government to bring LTC under the scope of the Canada Health Act. Spurred by the thousands of deaths related to COVID-19 in Canadian LTC facilities, these groups are asking the federal government to work with the provinces and territories to create strategies and standards of care to protect seniors in LTC and the staff members who work with them. But requests like this one are not a new development.

Throughout the 20th century, the federal government provided few guidelines and little to no funding for LTC. In 1966, the report of a Senate special committee on aging noted that Canada’s health policy was preoccupied with parent and child healthcare to the exclusion of other age groups, particularly the elderly. With just 3 percent of the population then over 75, senior care was not a politically urgent or advantageous issue for the federal government at the time.

Kim Karrys waves to her mother and a friend in Providence Healthcare in Scarborough. The facility saw an outbreak of positive cases of COVID-19 in the long-term care section of the hospital. Photo by Michael Swan/Flickr.

In 1976, Tommy Douglas—today widely deemed the father of universal healthcare in Canada—pleaded with Parliament, saying that “a lot could be done in this country by the establishment of more nursing homes, and the provision of home-care treatment.” His plea fell on deaf ears.

In the 1980s and early 1990s, the Mulroney government changed the nature of public healthcare funding. This continued into the Chrétien era, culminating in the infamous 1995 budget that introduced the Canada Health and Social Transfer, which cut federal transfers for healthcare, postsecondary education, and social assistance, and merged them into a single funding envelope. Money reserved for extended healthcare, including LTC, disappeared.

Fast forward to 2014 and the Harper government’s “Action for Seniors” report. This document emphasized community partnerships encouraging seniors to stay active, pointed to the Canada Pension Plan and Old Age Security as resources providing financial stability for seniors, and described tax breaks to allow seniors to age in their homes. Not once was LTC mentioned. Certainly most Canadians would prefer to stay active and age at home, but the reality is that for many seniors, diseases such as dementia and other health conditions, together with the cost of home care, leave publicly funded LTC facilities as the only viable answer. This is a familiar story going back centuries.

In Canada today, LTC homes are a conglomeration of private and public facilities, much like their distant cousins the almshouse, the boarding house, and the private hospital. Private facilities charge their clients high premiums, while public facilities use a sliding scale that takes 70 to 80 percent of a resident’s taxable income. Services for seniors not provided by these facilities are subsidized by the provinces and territories as best they can on budgets often stretched to the limit.

As the country seeks to recover from the economic downturn caused by the COVID-19 shutdowns, provincial and territorial governments are making it known that they will be running multi-million-dollar deficits. As such, it is likely that LTC will once again be pushed to the back burner in favour of more urgent economic concerns such as jumpstarting “normal” life again and creating jobs (infrastructure projects to facilitate employment, for example). It will be the same old tug-of-war between the federal coffers and the always-increasing needs of the provinces and territories.

In May, after deploying the military to LTC facilities in Ontario and Quebec, and learning of the deplorable conditions there, Prime Minister Justin Trudeau and Health Minister Patty Hajdu announced that following the COVID-19 crisis, the federal government would help provinces and territories improve nursing and home care—but neither offered federal money. By 2030, 23 percent of Canada’s population will be over 65. Improving LTC is a universal responsibility. We cannot afford to continue repeating these federal-provincial jurisdictional debates or propping up this patchwork of public versus private regulation and funding.

History affords us a lens with which we may look back, spot mistakes, and, if we are wise, correct them. A situation that began before Confederation in 1867 has piggybacked upon itself for generations, repeating the same mistakes in one form or another. If we are to do better for seniors, the LTC system in Canada must break free from this historical pattern.

Jennifer Cole holds a BA in history from Simon Fraser University and has been a family caregiver working in long-term care for the past ten years.

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