Research Update: Long-Term Care and Federalism
A review by Rebecca Jansen
In the wake of COVID-19, faults within Canada’s provincially regulated long-term care facilities became prominent news headlines. As some of us may recall, 80% of Canadian deaths occurred in long-term care facilities during the first eight months of COVID-19 (p. 3). These glaring statistics not only drew public attention to long-neglected issues but reignited calls for an entirely new long-term care system. As author Carolyn Hughes Tuohy advocates, a more substantial role from the federal government may just be the answer to our perils. In her paper Federalism as a Strength: A Path Toward Ending the Crisis in Long-Term Care, published by the Institute for Research on Public Policy, Tuohy outlines an augmented federalized long-term care strategy. A professor emeritus of political science at the University of Toronto’s Munk School of Global Affairs and Public Policy, her policy-focused approach embodies what she deems a mosaic type of reform.
A mosaic reform first requires taking advantage of the current political climate to build on existing models, rather than dismantling them entirely. The author also calls attention to where federal and provincial jurisdictions overlap concurrently, specifically old age security and immigration. Fundamentally rethinking the model of public finance for long-term care to resemble a pension rather than health insurance would be a vital first step. It would allow for a scheme that is more “sustainable, equitable across economic classes and regions, [and] adaptive to demographic change,” while “harness[ing] the fiscal capacity and risk-pooling reach of the federal government” (p. 16). Tuohy suggests creating a Canadian version of long-term care insurance that would be attached to the existing Canada Pension Plan/ Quebec Pension Plan (CPP/ QPP) as a supplementary benefit, funded through employer and employee contributions (p. 17). “But unlike the CPP/QPP, it would be assignable to a qualifying third-party provider of institutional or home care…[where] need would be assessed through existing provincial mechanisms” (p.17).
In addition to federal finance reform, Tuohy also sees immigration reform as a way forward. At present, one-third of long-term support workers in Canada are immigrants (p. 21). Amending immigration policy for health care personnel could expand the workforce and raise national qualification standards. These amendments could theoretically ensure better quality in service and care, relieve chronic workforce storages, and create a self-regulation regime across the country. Immigration reform could therefore address the various care-related shortcomings of the current long-term care system, while simultaneously preparing for the surge of long-term care beds that will be needed over the next 15 years, as predicted by the Conference Board of Canada (p. 14).
Tuohy also stresses the need for rigorous federal–provincial negotiations to mobilize policy action. As such, fertile ground must be prepared for such talks to occur. Tuohy suggests two routes toward first steps: public pensions (specifically the Department of Finance) and health care providers. Both routes require cross-country consultations and commissions of inquiry. Conveniently, this approach would not require a “separate institutional apparatus” (p. 24), allowing for ease of decision-making and implementation. In addition, holding a commission of inquiry would capitalize on building a high-profile, national strategy consensus, which will keep attention focused on long-term care once COVID-19 passes.
Ultimately, to see effective change, federal and provincial governments, along with public and private providers, need to work together—which will be no easy feat. Tuohy offers a collective but pragmatic approach, exploiting the strengthens of federalism while providing techniques to mitigate potential weaknesses. She addresses issues of responsibility, reflects on comparative systems used abroad, and offers clear and practical steps forward. What remains to be seen is the time needed to see positive change on the front lines. Policy reforms take time; how do we mitigate safety risks and provide better quality of care in the meantime, especially in the wake of COVID-19?
Tuohy, C. H. (2021). Federalism as a strength: A path toward ending the crisis in long-term care. IRPP Insight (No. 36). Institute for Research on Public Policy. https://centre.irpp.org/research-studies/federalism-as-a-strength-a-path-toward-ending-the-crisis-in-long-term-care/?mc_cid=75a9683844&mc_eid=4a6bf13a01#study-tab-text
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Rebecca Jansen is currently a graduate student at the University of Alberta studying Educational Policy Studies specializing in Adult, Community and Higher Ed. With over ten years of experience as an adult and community educator, her primary research focus is on embodied learning, indigenization, and policy reform to realign power imbalances within social institutions that impact local communities.