The federal government has increased its presence in long-term care (LTC) in response to the high level of public attention that followed the high numbers of COVID-19 deaths in LTC homes in Canada relative to other countries, particularly during the first wave of the pandemic. In response, the federal government announced a new investment of C$3 billion (about €2.2 billion) in the 2021 Federal Budget to support provinces and territories (PT) in adopting national standards for LTC homes and improving workplace conditions (Canada, 2021). Health Standards Organization, the Standards Council of Canada and Canadian Standards Association are working together to revise the existing 2020 national standards for LTC, the first draft was released to the public for feedback between 17 January and 17 March 2022 (HSO, 2022), and is expected for publication by December 2022 (Health Standards Organization, n.d.). Though quality standards already exist and are in place across all provinces and territories, poor outcomes for residents of LTC homes have spurred calls for national standards tied to investment (Canadian Medical Association et al., 2020; Marrocco et al., 2021).
LTC in Canada includes home care and institutional care settings (referred to as LTC homes) settings. As with health care, LTC is administered by PT governments with some federal funding support. Subsidized home care is frequently insufficient, leaving those with high needs to depend on LTC homes which are regulated and funded for professional services but not accommodation costs by provinces and territories. The LTC sector faces longstanding challenges of underinvestment, poor access, and quality of care. For decades, demand for LTC home placement has exceeded available supply (Royal Society of Canada, 2020; Wong et al., 2021). Consistent research findings have alerted authorities to longstanding issues related to short staffing: low wages, workplace violence, and poor personal health (Estabrooks, 2021), suboptimal mix of health professionals (that is, decrease in nurses and increase in unregulated care providers) (Wyonch, 2021), outdated infrastructure, and a lack of infection control training and prevention practices (Office of the Chief Science Advisor of Canada, 2020; Wong et al., 2021). Inquiries and audits prompted by the pandemic identified widespread reports of resident abandonment, neglect, and abuse, which can be traced back to poor quality workforce and care standards (CSBE, 2022; Loewen, 2021; Marrocco et al., 2021; Royal Society of Canada, 2020).
The development of national standards and new investments from the federal government may help address some of these issues, but there are no mechanisms in place to enforce national standards in Canada’s decentralized federation. The standards will be advisory only, although the federal funding is tied to an obligation for PTs to publish specific action plans outlining investments and performance metrics (Canada, 2021). As such, improvements to LTC systems will depend on priorities and actions at the PT level. The level of detail of these particular action plans is not yet known, leading some experts to question whether there will be sufficient transparency to the public to motivate or support impact (Pizzino & Souliere, 2022). There is considerable support among key stakeholders, such as the Canadian Medical Association, for the federal government to take a leadership role in developing standards and supporting their adoption through investments – further stating that such investments could be used strategically to enforce these standards (Canadian Medical Association et al., 2020; HSO, 2022; Pizzino & Souliere, 2022).