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by By Laura Kadowaki, MA

The National Institute on Ageing reports that long-term care home residents account for 82% of COVID-19 deaths in Canada (National Institute on Ageing, 2020). The COVID-19 pandemic has exposed structural problems with long-term care homes that are the results of years of underfunding and neglect. Advocates and researchers have been raising flags for years about the inadequate staffing levels, health human resource shortages, and poor working conditions plaguing long-term care homes. Under normal conditions these problems result in poor quality care and negative care outcomes, under pandemic conditions the results have been deadly. With the nation’s gaze currently on long-term care homes, the COVID-19 pandemic provides a policy window not just to reinvest in long-term care homes, but also to rethink their position within the broader continuum of care and how we should care for older Canadians. 

Canadians have consistently expressed that they wish to remain in their own homes and communities for as long as possible. A recent survey of Baby Boomers and older adults found 86% of respondents wish to age in place (Mustel Group, 2020). The impact of COVID-19 on long-term care home populations will likely strengthen negative perceptions of long-term care homes and reinforce older adults’ desire to be cared for in the home and community. There will likely always be a sub-population of older adults who will require intensive care in long-term care homes, and for these older adults we should explore new smaller scale models of care (e.g., Greenhouse model). These focus on quality of life and home-likeness rather than reproducing institutional environments that are less attractive, especially after the COVID-19 long-term care crisis. However, research from the Canadian Institute for Health Information (2017) suggests that up to one-third of residents in long-term care homes could possibly be cared for with home and community-based supports. This policy option would not only align with the desires of older adults, but research also suggests that it can be a less costly option for care. For instance, research from Hollander and Chappell (2002) has supported integration approaches by showing that home care can be a less expensive alternative to long-term care homes, even after accounting for the costs of informal care. 

Many provinces have now acknowledged these facts and have developed visions of providing care at home for older adults. However, they have yet to invest enough in the care required to make this a viable alternative for many older adults. For example, in BC the Seniors Advocate reports that despite 51% of home support clients being at high or very high risk of long-term care placement, most (86%) receive 2 hours or less of home support per day (Office of the Seniors Advocate, 2019). Furthermore, services that provide respite to caregivers (e.g., adult day services, in-home respite) also have been woefully underinvested (Office of the Seniors Advocate, 2015). The scope of home support services available in most provinces is also quite narrow and may exclude supports for instrumental activities of daily living such as transportation, housekeeping, meal preparation, and grocery shopping. During the COVID-19 pandemic, the need to provide such supports to isolated and frail seniors has been recognized as a priority through grassroots volunteer movements and community initiatives, with some funding support from governments. This raises the question of why providing support to isolated and frail seniors (e.g., assistance with shopping, social connection) should be a societal responsibility during a pandemic, but not at other times?

In the context of COVID-19 there is growing pressure for the Federal Government to become more involved in funding long-term care homes. The likely response will be to inject additional funding into long-term care homes, and this may help to alleviate problems over the short-term. However, focusing solely on long-term care homes would be short-sighted given stated policy objectives of providing care in the home and preferences for care of older adults. A more thoughtful approach would be to initiate a national conversation with Canadians on what type of care we want to provide to our older adult population; a necessary part of this conversation will be discussing how we can adequately finance an integrated care model. There is the need to formally recognize services such as long-term care homes, home care, and home support at the federal level as necessary services for older adults and to ensure that all Canadians are entitled to a general basket of services. Researchers have suggested that this could be achieved by expanding the Canada Health Act or introducing a separate tax-financed or social insurance scheme (Chappell & Hollander, 2011; Lanoix, 2017; Hébert, 2016). While such an endeavour no doubt will be difficult, the alternative of continuing to neglect our older adult population can no longer be an option.