Research Update: COVID-19 and the Future of Long-Term Care
Note: this is excerpted from the August 2020 edition of our “Research Update” publication. The Edmonton Social Planning Council, in collaboration with our volunteers, strives to provide stakeholders and community members with up-to-date reviews, prepared by our volunteers, on recently published social research reports and publications.
Reviewed by Mona Haimour
The impact of the COVID-19 pandemic on vulnerable and priority populations, particularly the elderly that are living in long-term care (LTC) facilities, has been eye-opening and challenging. Figures show that 81% of COVID-19 deaths in Canada were recorded in long-term care nursing homes. This is higher than the average for Organisation for Economic Co-operation and Development (OECD) countries, at 42%. Not only are the figures staggering, but evidence shows that the physical and social environments where the elderly are left to die are inhumane.
In their high-level and peer-reviewed policy briefing report titled Restoring Trust: COVID-19 and the Future of Long-Term Care, experts from reputable Canadian universities (York University, Conestoga College, University of Toronto, Université de Montréal, University of Alberta, University of Ottawa, Mount Saint Vincent University, and University of Calgary) share their research findings on challenges encountered with respect to Canada’s response to, and recovery from, COVID-19. These experts form the Royal Society of Canada (RSC) Task Force on COVID-19, chaired by Professor Carole Estabrooks (University of Alberta). The purpose of this initiative is to synthesize and frame evidence that will help policy-makers make informed and shared decisions.
To understand the real story of the LTC COVID-19 deaths and what it will take to solve this enduring crisis, the RSC has adopted a systematic and comprehensive approach to guide their work. This is evident in three focus areas: context and policy status before COVID-19, vulnerabilities exposed as a result of COVID-19, and principles for action and leading options.
Findings from the review of the context and policy status before the pandemic show that the complexity of the health and social profiles of our elderly (e.g., advanced age, dementia, chronic medical conditions, low immunity status, limited access to uninsured services, etc.) that live in the LTC-nursing homes is beyond what the capacity of the current workforce is capable of and trained to provide care for. Other key findings such as the ongoing decline in the ratio of regulated health care professionals to unregulated health care professionals (care aides and personal support workers), heavy workloads, lack of formal training and education, as well as low wages and poor employee benefits have been identified as chronic issues that caused direct negative impacts on patient safety and quality care.
Additionally, the review shows that the LTC facilities had not met the safety regulations related to the prevention and control of communicable diseases. These included lack of visitation policies and practices, shortages of personal protective equipment (PPE) and other essential supplies, and inadequate training on how to use PPE and conduct screenings for COVID-19. These vulnerabilities along with the chronic issues that emerged from the analysis of the context and policy status have hindered LTC capacity to combat the COVID-19 pandemic, resulting in preventable deaths.
Moving forward, the RSC has provided recommendations that derive from the collected evidence, targeting all levels of governments (federal, provincial, and territorial). The RSC has called for a reform and redesign of the current LTC sector. The key recommendations focus on adopting a strategic, targeted, and sustainable approach to solve the enduring LTC workforce crisis. These recommendations include establishing national standards that focus on revamping the LTC infrastructure by providing continued funding support for pandemic resources and beyond, staffing and staffing mix in nursing homes, and establishing appropriate and regulated education and training for the LTC workforce.
The implementation plans for these standards should be taken seriously and start immediately by stakeholders at the provincial and territorial level of government. Meaning, urgent action plans should be put in place with emphasis on enhancing the quality of staff education and training, as well as working conditions of the health care professionals—regardless of their level—including work benefits and mental health support. Moreover, emphasis on the need and value of creating a robust and transparent data collection system that captures and tracks the essential variables and elements related to quality of care and quality of life for both the residents and health care professionals is a crucial step toward a better and safer future for LTCs.
While it is evident from the policy briefing report that Canada’s LTC sector is in dire need of change, many concerning questions begin to arise as a result of uncertainty, like who is going to take initiative and be the voice for fundamental change in the sector? Furthermore, it is unclear how soon this will happen, given that the COVID-19 pandemic is far from over. Another concern lies with the health and well-being of our elderly people and their families. Their voices, along with those of health care professionals and front-line workers, should be heard, expressed, and valued as well.
Estabrooks, C. A., Straus, S., Flood, C. M., Keefe, J., Armstrong, P., Donner, G., . . .Wolfson, M. (2020). Restoring trust: COVID-19 and the future of long-term care. Royal Society of Canada. https://rscsrc.ca/sites/default/files/LTC%20PB%20%2B%20ES_EN.pdf
ABOUT THE RESEARCH REVIEWER:
Mona Haimour is an Assistant Professor at the Department of Health Systems and Sustainability at MacEwan University. Her commitment to enhance women’s health and public health started during her work overseas. She specializes in sustainability, priority populations, and health equity. Her personal interests include running, jumping rope, and reading.