Dr. Samir Sinha Speaks at National Standing Committee About Reforms Needed for Long-Term Care

Dr. Sinha’s appearance before the Standing Committee on Human Resources, Skills and Social Development and the Status of Persons with Disabilities (HUMA).

Hello, I'm Dr, Samir Sinha, Director of Health Policy Research at the National Institute on Ageing.  The NIA is a Ryerson University-based think tank focused on addressing the realities of Canada’s ageing population.

Additionally, I serve as the Director of Geriatrics at Sinai Health and University Health Network and was recently appointed as a member of the federal government’s National Seniors Council, and invited to Chair the Health Standards Organization (HSO) Technical Committee that has been tasked to develop the new National Long-Term Care Services Standard for Canada.

I first of all want to take a moment to acknowledge the 23,253 older Canadians, representing 95% of Canada’s deaths thus far from COVID-19, as well as their families.

There's a growing public discourse on the role of governments to address the inadequacies of our supports for older Canadians during this pandemic including in the provision of long-term care, and growing calls for the Federal Government's greater leadership in these areas.

While other countries acted clearly and decisively to develop stronger systems of long-term care, as they aged, Canada didn't.  This inaction cumulatively helped to sow the seeds of the tragedy we have been witnessing, where 62% of Canada’s deaths to date from COVID-19 have occurred in LTC settings, the highest rate of any G20 country. 

I publicly noted early on that while LTC homes were becoming the epicentres of Canada’s pandemic, there was no national mechanism in place to track these outbreaks in a consistent way.  Neither PHAC nor CIHI were doing this. Our NIA thus took on the task of systematically collecting all the data related to resident and staff cases and deaths at the individual home level, and, had we not done that, the truth of what happened in LTC might have remained obscured. 

Our highly accurate record, developed with CIHI’s support, has become the basis of many important studies and analyses.  However, my point here is that – something important like this should not have been left to goodwill of the provinces or university research centres, but should have been a clearly enabled function of the federal government’s pandemic response. Moving forward, a clear protocol and systems need to be in place in the future to ensure we're never caught off guard in this way again.

PHAC was helpful in coming up with some early guidance to help provinces and territories look at more standard Infection Prevention and Control Measures and the treatment of COVID-19 cases in LTC settings, but it’s not clear why the agency could not have been enabled or supported to provide much needed guidance to the provinces and territories to navigate other important challenges such addressing the effects of social isolation and resident access to family members.  

It was our NIA, on our own initiative, that decided to lead on the creation national LTC guidance. First, with the release of our spring 2020 "Iron Ring" guidance [followed by “Titanium Ring” in 2021] which continues serve as the evidence base around how provinces and territories should respond to COVID-19 in congregate living settings.

In July 2020, we released our "Finding the Right Balance Guidance Document to Support the Re-Opening of Canadian LTC Homes to Family Caregivers and Visitors.” Now with the majority of LTC residents and staff being vaccinated, the lack of guidance being issued — as the CDC has done in the United States — is forcing residents and families in homes across too many parts of the country to remain isolated from each other, producing serious physical and mental health consequences. Again, the NIA is helping to develop new evidence-based guidance to enable our provinces and territories to safely re-open their homes. But, it should be official government bodies like PHAC leading this work.

I am glad that the federal government is now providing much-needed leadership with the creation of new National Standards for Long-Term Care. Enabling this with $3B will also be helpful to ensure the provision of a more consistent and higher standard of care across Canada. In being asked to Chair HSO’s Technical Committee, I am thrilled to see an unprecedented level of public engagement in this work so far. 

In the future, with our NIA research showing that at least 430,000 Canadians have unmet homecare needs, while 40,000 are on wait lists for LTC homes, even before the pandemic – we need to do more to support more Canadians to age well and in their homes for as long as possible.

Our research shows that Canada spends 30% less than the average OECD country on the provision of long-term care, and close to 90% of our public LTC dollars on institutionalizing people rather than caring for them in their own homes, where they want to be.  Our Pandemic Perspectives reports that virtually 100% of older Canadians want to do everything possible to remain in their own homes for as long as possible. Our Bringing LTC Home report shows that this could be done well and for lower costs too.

Of course, people have the right to pay privately for their own home care services, but this is not an option for the majority of Canadians who don't have the financial resources to so. The recent commitment to increase Old Age Security payments for older Canadians 75 years and older will enable some to better meet the growing costs associated with ageing and ageing in place, but we need to think bigger, as other countries have — perhaps by enabling the creation of a national long-term care insurance program and/or further improvements to the Guaranteed Income Supplement (GIS) program.

So where do we go from here? 

While it’s good that most political leaders have agreed that long-term care is ‘broken,’ we need to ensure that we pair our immediate actions with efforts to determine how best to fix, develop and fund the long-term care system that all Canadians should look forward to as we age. In this regard, I am glad that our NIA has been helping to ensure we can define the issues properly, ask the right questions, find the right answers and ways of implementing them as quickly as possible. 

Much of what we need to do has been well known for years and luckily isn't rocket science.  But it will take political will, and a federal, provincial and territorial coordination of efforts. We thus recommend the federal government to fully support the work ahead that will enable the creation of new National LTC Standards and to help its provinces and territories in addressing these issues once and for all.