Category: ESPC Publications: Research Updates

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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?

Publication Source:

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 

Get to know our volunteer:

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.

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A review by Laurel Van De Keere

Introduction

The year-in-review report COVID-19 in Canada: A One-Year Update on Social and Economic Impacts was published by Statistics Canada in March 2021 using statistical information provided by Canadian citizens, businesses, governments, and other institutions. The report provides a snapshot of the socio-economic impacts of COVID-19 on Canadians one year after the country first entered lockdown in March 2020, and points the reader to the Statistics Canada website to obtain more detailed information through an analysis series, dashboards, and the Canadian Statistical Geospatial Explorer. Report findings are organized and presented in four broad themes: the ongoing response to COVID-19, indirect health impacts, social and economic inequalities, and recovery efforts.

Canadians’ Continued Response to COVID-19

The report begins by pointing out that one year into the pandemic, the majority of Canadians were continuing to abide by public health best practices such as physical distancing, mask wearing, and self-isolating following possible exposures. However, vaccine hesitancy increased over the same period, with young adults, those having completed grade 13 or less, and Black and other visible minority Canadians being less likely to get a vaccine. The report notes that vaccination is critical to protecting essential health care workers, among whom visible minority groups are overrepresented, and to protecting Canadian workers with limited opportunities to work from home—such as those working in social services, education, and retail; the majority of whom are female.

Health Impacts

In addition to increased mortality rates among seniors, young males, and Black and other visible minority groups in urban centres, Canadians experienced a number of indirect health impacts from COVID-19. As part of the pandemic response, many non-urgent medical procedures were cancelled across Canada, including disruptions to cancer screenings, which the report suggests may lead to increases in cancer rates and deaths. Self-reported perception of mental health decreased among all types of Canadians with the onset of pandemic restrictions, notably among youth and working-age populations, but improved during periods of eased restrictions and school re-openings. Most health care workers reported worsening mental health and stress levels compared to prior to the pandemic. Calls to police services in response to shoplifting, break and entering, vehicle theft, and assaults all declined compared to the year prior, giving way to an increasing proportion of mental health-related calls for wellness checks, emotional crises, and domestic disturbances.

Social and Economic Impacts

The report draws from assorted Statistics Canada data to illustrate the uneven nature of COVID-19’s social and economic impacts, both during and following the pandemic. On average, COVID-19 posed a greater risk to Indigenous and other visible minority groups due to higher rates of underlying health conditions. At the time of publishing, these groups were also experiencing higher levels of unemployment, financial difficulties, and representation in low-wage jobs, making it more difficult to meet basic household financial commitments than before the pandemic. Young Canadians were also particularly hard hit by job losses and increased barriers to enrolment in education and training. While returns-to-work following the easement of restrictions were the highest amongst professions with work from home capacity (such as finance, insurance, education, and professional, scientific, and technical industries), sustained work interruptions continued to disproportionately impact financially vulnerable families and low-wage workers, worsening pre-existing earnings inequalities. In many cases, impacts on these groups had widened pre-pandemic inequalities, threatening the possibility of an inclusive recovery.

Recovery

By March 2021, economic activity remained lower than pre-pandemic levels based on indicators in nearly every sector, despite the assistance provided by a variety of emergency response supports. As a demographic group, young females were the least likely to have returned to pre-pandemic employment levels, with workers in lower paying service industries such as accommodation, food services, arts, entertainment, and recreation also remaining severely affected. Productivity levels rose in more digitally-intensive industries compared to pre-pandemic levels. The report notes that by March 2021, it remained unclear whether many of these changes would be temporary or permanent, but suggests that immigration and investments in automation, robotics, infrastructure, and sustainable technologies may be cornerstones to economic recovery in Canada.

Discussion

Statistics Canada’s report distills a wealth of statistical information about COVID-19’s current and possible future impacts on Canadians in a textually and visually-accessible format. Due to the breadth of topics covered, at times the report glazes over important trends, such as the pandemic’s impacts on Canadians experiencing homelessness, recent immigrants, or Canadians with substance dependences. To its credit, while not covered in the report, some of the resources referenced throughout the report do link to further data that paints a broader picture of important trends left out for the sake of brevity.

One useful feature of the report is a series of questions woven throughout; for example, “to what extent will the adoption of new business technologies [such as automation] affect workers?” (p. 43) and “will investment in new [environmental and clean technology products] provide reasonable stimulus for job and income growth?” (p. 47). These questions may serve as a useful tool to encourage personal or group reflection, or to identify possible areas for further research.

Publication Source:

Statistics Canada. (2021). COVID-19 in Canada: A one-year update on social and economic impacts. http://www150.statcan.gc.ca/n1/en/pub/11-631-x/11-631-x2021001-eng.pdf?st=Vl542iPF

Get to know our volunteer:

Laurel Van De Keere holds a Master of Arts degree in International Development Studies and has spent the last decade developing strategic policy for the provincial and federal governments. She is passionate about personal wellness and human rights, supporting various global and local initiatives related to these causes.

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The Edmonton Social Planning Council, in collaboration with our volunteers, strives to provide stakeholders and community members with up-to-date reviews on recently published social research reports and publications.

In this issue, we have the following reviews:

• A Pandemic of Inequalities – Reviewed by Mayrane Galante
• Long-Term Care and Federalism – Reviewed by Rebecca Jansen
• Early Learning and Child Care in Alberta – Reviewed by Hanna Nash
• Taking Stock at the One-Year Mark: The Socio-Economic Impacts of COVID-19 in Canada – Reviewed by Laurel Van De Keere
• Reviewing and Restructuring Canada’s Immigration Policy and Programs After COVID-19 – Reviewed by Jayme Wong

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Note: This is excerpted from the March 2021 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.

A review by Jessica Shannon

Authored by Alison H. McIntosh, an Edmonton-based academic researcher and organizer, Privatization Pressures in Alberta Health Care was published by Parkland Institute (2020), an Alberta research network that examines public policy issues.

McIntosh discusses the current pressures to expand privatization within three areas of Alberta’s health care system: diagnostic laboratory services, home care, and telehealth. Revealing parallels between the United Conservative Party’s (UCP) privatization effort and public sector budget cuts with Klein-era neo-liberal policies, McIntosh highlights a reoccurring pattern of adverse effects that impact working conditions, equitable access to care, and quality of care for Albertans. 

Diagnostic Laboratories

The Klein-era of the 90s saw massive cuts to diagnostic laboratories, leading to a restructure and ultimately a “brain drain” of experts from the province. The consequences resulted in a shortage of skilled workers who could run these labs. Diagnostic errors increased—which remains an issue. Even so, McIntosh reports that there has been some success in moving service delivery to private non-profit labs. However, it is difficult to compare costs between private non-profit and for-profit labs at this time. The author recommends greater government oversight of transparency and accountability within the for-profit private sector’s health services, as well as provisions for standards of care and necessary skill level. 

Home Care

The privatization of home care, McIntosh reports, is problematic because profit margins in this sector are low. Such margins underscore how home care workers and recipients—often already marginalized populations—are placed at further risk when this vital service is privately contracted out. McIntosh recommends the expansion of the Canada Health Act to accommodate formal care, insured under universal health care. Moreover, unions should increase capacity for bargaining power with governments. Both measures would ensure equal access to care for all patients and improve working conditions and living wages for workers.

Bolstering her argument, McIntosh points out that home care is a tool meant to promote independence within homes and communities. It is also preventative in measure, cost-wise and health-wise. For events related to long-term care, a “one-day stay in the hospital can cost up to $1,000, while a day in a long-term care facility costs around $130, and home care costs about $55″ (p.16). Furthermore, those receiving formal home care experience increased physical and mental health. There lies a balance between fiscal and qualitative measures, however, the current UCP budget does not reflect this balance. Rather, it fixates on the fiscal at the expense of the health outcomes and needs of Alberta’s aging population.

McIntosh also reports that expanding public home care services could greatly improve the lives of not just recipients of this service but also the lives of informal caregivers, freeing them up to generate more income and pension contributions. A better quality of life for both parties—such are the benefits of a public form of home care. 

Telehealth

Telehealth is a tool meant to expand access to care. However, McIntosh points out that the target populations of telehealth services (e.g., rural populations or seniors) have not been reached. Instead, younger urban populations are utilizing these services. Moreover, McIntosh reports that telehealth is often overused due to ease of accessibility, leading to a decrease in quality of care. The danger is that publicly funded health care sees an increased usage of these services, yet this rise in frequency and cost does not necessarily correlate to improvements in care or equitable access. 

Discussion

McIntosh provides an informative overview of relevant issues regarding health care privatization in Alberta, related to three key areas that the UCP government wishes to capitalize on. She clearly discusses what these intentions mean for Albertans and their health, doing well to show that the debate to privatize needs go well beyond questions concerning “the bottom line.” A sharp reminder echoed through the report: cuts to public funds means costs are recuperated elsewhere, whether through working conditions, quality of care, or patient outcomes—all of which are ultimately cuts in quality of life for Albertans. The irony is that these three areas ought to be considered as the primary measures for a sound health care system—not only fiscal measures.

Fiscal considerations alone, the report shows, clearly fall short of providing adequate care for Albertans. Profit motives do not translate well into motives to improve outcomes for those involved with health care services—whether for staff members, patients, or informal caregivers. That said, McIntosh does well to show that fiscal concerns are important too, and that in some areas, such as home care, both may be possible.

McIntosh makes a clear case for the power of investing in a public service and how a healthy society is a prosperous society. Her report begs the question: if government support and oversight—as well as transparency, fair wages, expertise, and standards of care—are all related to health outcomes, can we afford to neglect them?  Can we really afford the many and varied hidden costs of privatization?

Publication Source:

McIntosh, A. H. (2020). Privatization pressures in Alberta health care: Laboratory services, home care, and telehealth under austerity. Parkland Institute. https://d3n8a8pro7vhmx.cloudfront.net/parklandinstitute/pages/1801/attachments/original/1599505978/privatization_pressures.pdf?1599505978  

Get to know our volunteer:

Jessica has a background in Kinesiology and Physical Therapy from Dalhousie University (2016) and the University of Alberta (2019), respectively. A local to Edmonton, Jessica cares about her community and how health and wellness policy impacts the activity, mobility, and well-being of its citizens.

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Note: This is excerpted from the March 2021 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.

A review by Jayme Wong

“System Impacts and Responses” and “Shelter Impacts and Responses” are both part of a three-part series called A Brief Scan of COVID-19 Impacts on People Experiencing Homelessness written by Jakob Koziel, Maria Savidov, and Andrea Frick. The series was published in 2020 by the Bissell Centre, an Edmonton-based non-profit organization that works with communities to empower people to move from poverty toward cultural, social, and economic prosperity. The first part of the series, “Health Impacts and Responses” can be found on the Homeless Hub’s website (see source link).  

Research for part two, “System Impacts and Responses,” and part three, “Shelter Impacts and Responses,” was conducted between March and September, 2020. The authors state in part three that it “is not meant to be an academic paper or systematic review but rather a summary and snapshot of the emerging media reporting and academic investigations of the pandemic’s impact on [vulnerable] populations during a specific timeframe” (p. 4). They suggest that the series’ purpose is to spark further research interest into the links between homelessness and COVID-19. 

Koziel et al. suggest that COVID-19 will cause a greater burden on the hospital care system and that individuals experiencing homelessness “will be twice as likely to be hospitalized and two to four times more likely to require critical care than the general population . . . in addition to a higher infection and fatality rate” (p. 4). In “Shelter Impacts and Responses,” the authors state that transmission rates are especially high among individuals experiencing homelessness due to transiency, challenges to physical distancing in crowded and communal spaces, and the lack of access to personal protective equipment (PPE). 

The number of individuals experiencing homelessness is predicted to increase due to rising trends in unemployment and home evictions. Social service agencies are anticipating an increase in the need for housing support. Providing more options for permanent housing is the best solution to combat COVID-19 among homeless populations, the report suggests. This is due to the fact that permanent housing supports opportunities for isolation and reduces the strain on hospital and shelter space. However, a long-term solution is only possible if access to food, health education, and resources for addiction, mental health, and trauma are also available. 

Temporary housing in hotels or motels is considered the second-best strategy to mitigating system impacts. Converting unused public space into temporary housing is a promising alternative to shelters, which may already be over-capacitated or forced to turn people away due to social distancing measures and limited bed space. However, using public spaces to house individuals experiencing homelessness is not a permanent solution. These public spaces lack the additional resources needed to provide food, hygiene, and testing, and are not staffed with people equipped to deal with trauma, homelessness, and drug use. In part two, Koziel et al. state that “sheltering those experiencing homelessness is the preferential strategy in mitigating the spread of COVID-19 compared to doing nothing” (p. 6). The temporary housing strategy has been successfully utilized in several American and Canadian cities, including Edmonton. 

Despite the significant system and shelter impacts, Koziel et al. note that innovative collaborations have developed as a result of the unique issues posed by COVID-19. These collaborations include partnerships between non-profit organizations and governments to provide more resources to homeless individuals, restaurants and food banks to provide meals to camps and medical services, and even health care providers and telecom companies to provide affordable phone services that help isolated individuals stay connected. 

The reports fail to adequately address responses and strategies on mitigating shelter impacts. Koziel et al. suggest three responses: (1) enforcing protective measures in shelters (e.g., social distancing and PPE), (2) enforcing shelter closures and restrictions, and (3) finding alternatives to shelters. Given the already limited funds and resources accessible to shelters, protective measures are difficult—reduced staffing makes it difficult to consistently and constantly disinfect areas; social distancing in shelters is challenging due to the rising number of individuals facing homelessness. Even the authors admit in part three that, although protective measures are the most effective to prevent the spread of infection, “addiction and mental health challenges among residents, as well as a lack of medical care access, can make it difficult for residents to adhere to public health directives while costs and potential unavailability of PPE may make it difficult to implement PPE procedures” (p. 5–6). Similarly, shelter closures and restrictions may cause more problems for people seeking shelter and additional support, and alternatives to shelters, as discussed in part two, are only temporary solutions. 

While the series was only published in 2020, we are now living the reality of the research predictions. Evidence of the disproportionate impact of COVID-19 on people experiencing homelessness is supported by emerging research. The trends observed within the three-part series will only increase and worsen if social action is not taken immediately. 

Publication Source:

Koziel, J., Savidov, M., & Frick. A. (2020). A brief scan of COVID-19 impacts on people experiencing homelessness. Bissell Centre. https://www.homelesshub.ca/resource/brief-scan-covid-19-impacts-people-experiencing-homelessness 

Get to know our volunteer:

Jayme Wong graduated from the University of Lethbridge in 2014 with a BA in English and Philosophy, and more recently graduated from the University of Alberta in 2020 with an MA in English and Film Studies. She currently works at a local non-profit, the Learning Centre Literacy Association.

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