“Canadians are telling us that they’ll do anything necessary to avoid having to move into a [long-term care] home,” said Dr. Samir Sinha.

Sinha, Director of Geriatrics of the Sinai Health System and the University Health Network in Toronto, was commenting on a survey released last week by the National Institute on Ageing (NIA) and the Canadian Medical Association (CMA). 

He said survey respondents “want governments to make up for lost time and act urgently to improve the state of long-term care, including the development of national standards and better integration of long-term care into the wider healthcare system.”

The majority (86 per cent) of all Canadians surveyed—and 97 per cent of Canadians aged 65 years and older—are concerned about the current state of long-term care in Canada.

Michael Nicin, executive director of the NIA, told Respect the Covid-19 pandemic has confronted Canadians with some realities they may have been aware of for a long time, but which are now impossible to ignore. 

“When I look at the data and not just now, but we’ve done this over time, I think what’s perfectly evident is that Canadians are realizing with Covid that we’ve all collectively been burying our heads,” Nicin said.

The national survey, conducted by Ipsos, gauged the perspectives of 2,005 Canadians on how the second wave of the pandemic has impacted the state of Canada’s long-term care systems. 

Three-quarters (73 per cent) of Canadians believe
that the high number of deaths in long-term care homes related to Covid-19 could have been reduced if governments had acted sooner. Only 45 per cent of Canadians surveyed believe that federal, provincial, and territorial governments have learned from the first wave of the Covid-19 pandemic and will work to ensure minimal loss of life moving forward. 

Unsurprisingly, 85 per cent of all Canadians surveyed—and 96 per cent of Canadians aged 65 years and older—report that they will do everything they can to avoid moving into a long-term care home.

“If you’re a Canadian who was in long-term care or your family went through long-term care before Covid, you’d be fully aware of a lot of the challenges the sector is facing,” Nicin said.

“But when Covid hit, there’s no denying it anymore. And so even Canadians who might have not been paying attention, maybe it wasn’t pertinent to their lives—middle-aged Canadians, younger Canadians—I think we’re seeing that completely wash away. And the national tragedy we’ve been watching unfold for the past year is now evident to anyone who’s got their eyes open even a little bit.”

Sinha says the situation has led to a lack of trust among Canadians which extends from the long-term care system to various levels of government. “The second wave of the COVID-19 pandemic has done little to restore the faith of Canadians in long-term care,” he said. 

“This survey shows that the Canadian public, and older Canadians in particular, have lost trust in their governments’ ability to safeguard LTC residents.” 

Perhaps paradoxically, the survey also shows strong demand from Canadians for governments to address the problems.

“I think what Canadians are saying here is let’s establish this as a legitimate equal to what we do in the Canada Health Act, and leave less room for governments or other actors to mess about with the daily operations of long-term care,” Nicin said.

“From my perspective, what we’re seeing goes back to that sort of ‘poor cousin’ thing, where because long-term care is not a part of the Canada Health Act, it’s not writ large in negotiations between the federal government and the provinces. It’s much easier to toy with,” he said. 

“And so it’s much more prone to political cycles, political decision-making. In that sense, I could see where perhaps all Canadians are telling us ‘let’s stop playing around with long-term care. Let’s not leave it up to political cycles.’”

Nicin and the NIA believe long-term care should be funded and administered as healthcare, under the terms of the Canada Health Act. The survey, he says, shows Canadians feel the same way.

“I think the way most Canadians conceive of it is that long-term care should be a part of the Canada Health Act—that it be a guaranteed service with standards and funding arrangements between the federal government and the provinces, and fully integrated that way,” he said.

“In reality, that’s always going to be a challenge. You’re from Alberta. You know, what are the odds that the provinces will play ball with the federal government on something so massive as renegotiating a fundamental piece of Canadian legislation? But I think it does express Canadians’ unwillingness to carry on with the sort of two-tiered ‘poor cousin’ kind of model.”

According to Nicin, staffing problems in long-term care are an example of how the sector is a “poor cousin” to established provincial health care. Low hourly wages and predominantly part-time work have led to a situation where personal support workers often have to work at two or more facilities to earn a living.

“If you’re a personal support worker, so those health care workers just under the level of nurses in a hospital, you might make thirty dollars an hour. And that’s because it’s a part of the Canada health system, that’s a regulated profession. But if you’re doing the same job in long-term care, you could be making roughly half of what they are. So this is where we start seeing some of the structural challenges—if you want to make a little bit more money, you’re probably not going to stay in long-term care.

“That’s just one example,” he said. “I think Canadians are saying we can’t treat long term care like it’s the poor cousin anymore. We really have to raise it to the standards that we do for primary care, surgical care, and any other level of health care that we have in Canada.”

Canadians, Nicin says, want to age at home. And he says NIA research suggests older Canadians are safer staying in their homes where possible. 

“It’s not just a desire. We know from work we’ve done that you’re about 74 times safer at home during Covid than you are in a long-term care facility,” he said.  “And I think we’re tipping people into long-term care sooner than they have to be. There’s a lot of things governments could have done, and should do, and can do going into the future to keep people at home for longer.”

Older Canadians, especially those in long-term care,  have been front-of-mind for Canadians as the pandemic has progressed. How long will that last—will Canadians be able to sustain their attention on the issues of seniors’ care?

“The ‘sustainable’ question is going to be a question mark,” Nicin said.

“I think during a crisis we’re certainly seeing a lot of interest and a lot of focus. I’ve been in politics and aging issues for most of my career, and what we’ve all experienced this year is clearly unprecedented. The other thing that’s unprecedented to me is that the amount of attention long-term care has received over the past year has never happened in my lifetime. And I’m pretty sure it hasn’t happened in any lifetimes before mine either,” he said. 

“Our institute first discovered that about 80 per cent of all deaths from Covid in Canada happened in Long-Term Care facilities. When you see that kind of disproportional effect on not only the older population, but the population in long-term care specifically, I think it does tug at the heartstrings of Canadians. 

“There’s about 12,000 people [in long-term care] who have died so far,” Nicin said. “You could magnify that by any number of family members, friends, loved ones who have lost someone this year. So not only is it an abstract public policy problem that’s on the front page of the newspapers, but a lot of people have felt it personally this year. They probably lost people or suffered a little bit. And so in that sense, I think it’s front of mind, both in terms of the politics and policy, but also in terms of what people have experienced.”

It is not a surprise that Canada’s population is aging—we’ve seen it coming for decades. We are just at the beginning of an era of increased demand for services and amenities for older Canadians, and long-term care is one part of that.

“The picture is not pretty,” Nicin said, “and this is why I think we have to be sober not only about the problems that we’re facing in long-term care, but what’s going to be possible in the short, medium and long term. 

“If we’re looking at a tripling of the population over the age of 85 in the next 20 years or so, we’re also looking at a tripling of costs in long-term care just to maintain the standards that we have right now,” he said.

“It’s not going to be an easy problem to solve.”