After promising to establish national standards for long-term care in response to the tragic outcomes of COVID-19, the federal government has now washed its hands of that responsibility. It is instead passing the buck to a toothless accreditation industry to create updated standards.
Accreditation is voluntary, non-enforceable, and unregulated. It’s a process that long-term care operators can purchase as customers.
In fact, when the pandemic started, a majority of long-term care homes in the country were already accredited according to existing standards — but that accreditation failed to protect residents from widespread COVID-19 outbreaks and fatalities.
This band-aid solution is a far cry from what experts, advocates, and many residents, staff, and family members of those in care homes have long been asking for.
It brings us no closer to the federally-regulated standards that are needed to improve quality and accountability and take profit out of seniors’ care.
Federal support for accreditation
In his fall 2020 throne speech, Prime Minister Trudeau promised to work with the provinces and territories to set new, national standards for long-term care (LTC).
But in the newly released 2021 budget, the federal government instead lauded the work of the Health Standards Organization and the Canadian Standards Association — two groups that joined together last month to launch updated standards for the sector.
Accreditation is voluntary, run by private bodies that sell a host of products and services to LTC operators who want accredited status.
Facilities that meet the new updated standards, which are set to take effect in 2022, will be formally accredited by Accreditation Canada.
The government says the work of these groups will inform its “ongoing discussions with provinces and territories on improving the quality of life of seniors in long-term care.”
The idea is not new. Close to 70 per cent of all long-term care homes in the country are already accredited according to the existing standards — including 83 per cent of homes in Ontario, as well as all of homes in Quebec, where the process is mandatory.
And yet, this accreditation didn’t stop the horrors we’ve seen in LTC facilities during the pandemic.
COVID-19 outbreaks and staggering death rates in homes across the country plainly suggest that accreditation did not ensure the staffing levels, quality of care, or accountability processes needed to protect residents.
At least two of the largest for-profit operators in the country that also saw some of the highest fatalities in their homes, Extendicare and Sienna Senior Living, had accreditation status throughout the pandemic.
The Commission on Accreditation of Rehabilitation Facilities awarded Sienna with “an exemplary 99.5% conformance to the extensive accreditation standards.” It also accredited Extendicare homes with “exemplary standing.”
Accreditation is no replacement for federal legislation
Rather than trust ineffectual accreditation groups to set desperately-needed standards, the government needs to work urgently to pass new federal legislation.
For decades — long before the pandemic exposed the systemic disregard for the elderly in Canada — health care advocates have been calling for federal leadership in ensuring comprehensive, accessible, and high-quality long-term care.
And the idea has wide popular support. A poll from last May showed that an overwhelming 86 per cent of Canadians support bringing long-term care facilities under the Canada Health Act.
Last month, advocates representing more than a million Canadians released a legal opinion setting out a concrete proposal for what that could look like.
The proposed reforms would oblige the federal government to not only fund the long-term residential care sector, but to also take on responsibility and accountability for it. The reforms also establish criteria and conditions that would need to be met by provinces to qualify for LTC federal funding.
In particular, the legal opinion highlights the importance of standards around the quality of care (especially staffing levels and care hours), accountability (including surprise inspections and public reporting), and public/non-profit delivery.
The standards agenda led by the accreditation industry barely scratches the surface in meeting these needs.
Worse, it relieves the state of its duty to regulate long-term care.
It relies instead on voluntary opt-in and self-regulation from LTC operators and doesn’t contain any mechanisms for accountability and enforcement. Unlike a regulator, Accreditation Canada can’t impose fines or other punitive measures.
The process also lacks transparency. LTC homes pay Accreditation Canada for an assessment as customers and can choose not to publicly release details of the reports.
Take profits out of care
Most importantly, the focus on accreditation distracts from the root cause of the awful human toll suffered in LTCs during the pandemic: the profit motive in care.
In its recent budget, the federal government committed to prioritizing funding support for not-for-profit child care providers. It can and must do the same for long-term care.
Even before the pandemic, leading researchers from Canada and around the world have consistently demonstrated that elderly residents in for-profit homes receive substandard care.
A study published in the Canadian Medical Association Journal found that the number of COVID-related deaths in for-profit LTC homes in Ontario was almost twice as high as non-profit ones.
More than 70 per cent of all long-term care home deaths in the first wave of the pandemic in Ontario took place in for-profit homes. During the second wave, for-profit facilities experiencing an outbreak had almost 10 times the number of fatal cases per bed than non-profit homes with outbreaks.
The last few decades have seen a massive boom in for-profit LTCs as the federal government offloaded care costs to provinces — and the provinces, in turn, turned to the private sector to fill the gap. As these for-profit companies expanded and consolidated, some grew into financialized corporations, “selling” senior care in the service of returns for investors and shareholders.
They have benefited from a steady supply of income from government subsidies and long waiting lists from an aging population.
And they have continued to prosper throughout the pandemic, despite the harrowing death rates inside the homes. In Ontario, as the first and second waves of the pandemic raged on, three of the biggest for-profit companies paid out dividends to the tune of more than $170 million.
Chartwell — Canada’s largest operator of seniors homes, chaired by former Ontario premier Mike Harris — boosted its 2020 executive bonuses, claiming perfect scores on its COVID-19 response, employee engagement, and public reputation. This, despite the fact that there were at least 246 COVID-related deaths in at least 19 Chartwell LTC homes in 2020, according to data compiled by writer and journalist Nora Loreto.
These corporations have for too long put profits and shareholder value before quality elderly care — and they’ve done so with impunity.
An accreditation framework that focuses on technical or clinical standards over questions around ownership and governance models in the sector will undoubtedly fail to bring the quality of care we need.
The only fix for ensuring quality and accountable care is the political will to deprive these profiteers of public funding.
The window to fix long-term care is closing
Canada has had the highest number, among all OECD nations, of long-term care home deaths attributable to COVID-19. And the pandemic has spawned a broad consensus — across the political spectrum — that how we care for the elderly in this country is in dire need of fundamental change.
The for-profit long-term care industry is keen to see this political moment pass with superficial changes that will not hurt their bottom line. A toothless accreditation framework does just that.
We need to keep up pressure on the federal government to institute meaningful changes: bring LTC under federal legislation and eliminate for-profit care.