The Need for National Standards for Long-Term Care

Many difficult but necessary lessons must be learned as we experience the trauma of the pandemic. None are clearer and more pressing than the need to do better for older adults in long-term care.We should never repeat the experience of facilities scrambling to cope, with overburdened staff, poor planning and inadequate facilities and supplies. It did not need to happen. As stated tellingly in the recent report by Ontario's Long-Term Care COVID-19 Commission:“The province's lack of pandemic preparedness and the poor state of the long-term care sector were apparent for many years to policymakers, advocates and anyone else who wished to see.”Ontario is not unique. This is a national problem. Our current patchwork of voluntary standards for long-term care homes is inadequate. It is a powerful argument for national standards, which must be adopted as widely as possible.It is encouraging to see that Finance Minister Chrystia Freeland's budget recognized the shortcomings in long-term care as she committed $3 billion in funding over five years to support provinces and territories in “ensuring standards for long-term care are applied and permanent changes are made.”A process is now underway that can bring meaningful change and I am honoured to be asked to participate. It is a joint effort of the Canadian Standards Association (CSA Group), the Health Standards Organization (HSO) and the Standards Council of Canada (SCC).Drawing upon extensive consultations from across the country, we will be developing two sets of standards that are intertwined and complementary.Dr. Samir Sinha, Director of Geriatrics, Sinai Health and the University Health Network in Toronto, will chair a committee for HSO that will focus on creating standards of care built on compassion and dignity, on the wellbeing of residents and their families and that will speak to the importance of a healthy and competent workforce.My role is to lead the work for CSA Group on creating a national standard for the buildings that house long-term care homes. We will touch on cleaning and disinfection processes, waste removal and ventilation. We will also explore how emerging technologies can improve conditions for residents and staff alike.Both sets of standards are essential to each other. Excellent staff can be undercut by inadequate facilities; a great building is of little use if the people working within cannot cope.I speak from personal experience. Before the pandemic, I spent several months in a rehabilitation centre recovering from serious injuries caused by an accident. At one point, staff had to move me out of my room because it was needed to isolate a patient with an infection. I was surprised when they moved me into a three-person room in the same space where the infected person had been staying. It could have been disastrous.I later learned that the very busy staff were not aware that there was a standardized infection control protocol. And this happened at a facility that is among the best in the nation.COVID-19 has taught us that effective infection control is crucial. We aim to give clear protocols for every facility from coast to coast to coast.For instance, we will look at the challenge of multi-bed rooms. It may not be practical in older facilities to have one person per room, but perhaps we can protect people through improved air purification systems and better methods for separating patients, rather than relying on hopelessly inadequate curtains.We will be seeking advice from people on the frontlines, including residents, caregivers and experts from a broad spectrum of disciplines. The standards will be developed from the bottom up, with input from every part of Canada, taking into careful consideration cultural and regional differences.Making the standards truly national will demand a similar approach from government. Provinces and territories must have meaningful input. We must have a minimum that applies everywhere. I do not pretend this is easy, but it is essential.When I took on the task of developing these new standards, I did so with the determination that our work must not gather dust on a shelf. Older Canadians deserve better and we must not fail them.Alex Mihailidis is Scientific Director of AGE-WELL, a national research network, and is also the Associate Vice President, International Partnerships at the University of Toronto.