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Ottawa willing to strike separate deals with provinces to address problems in long-term care, senior official says

Ottawa willing to strike separate deals with provinces to address problems in long-term care, senior official says
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“It may take some time. Our hope is that we can get there as quickly as possible,” said a senior federal official who spoke on a background-only basis.

The official said Ottawa foresees working with a kind of “coalition of willing provinces in the beginning” to begin the work of building up a pan-Canadian approach, in the same way the Liberal government has mused about approaching a national pharmacare program, and the same way the official said health care was developed in Canada. Prime Minister Justin Trudeau pledged in the throne speech to pursue national standards.

However, it is far from clear what the Trudeau government believes those standards should be, never mind if it can convince provinces to go along with them.

It’s also unclear how much drive there is behind it. Newfoundland and Labrador Health Minister Dr. John Haggie said while federal-provincial health ministers have met virtually almost weekly, talks have been focused on the immediate urgent needs provinces have in the face of the COVID-19 pandemic, and no meeting has focused on national standards for seniors.

Federal health minister Patty Hajdu’s office disputes that, saying she has discussed long term care in at least four of those meetings, in bilateral calls as well, and said Trudeau discussed it with premiers on Jan. 7.

“While the development of strong and coherent national standards will take time, we are committed and have already begun this important work,” said Hadju spokesman Cole Davidson in a written statement.

From the start, some advocates and the New Democrats in Parliament have called on Ottawa to enshrine long-term care, now solely a provincial responsibility, in the federal Canada Health Act, and make federal standards enforceable under law, just as the basic principles of universal, portable, publicly paid health care are.

However, in the absence of a national consensus, some say Ottawa should resort to province-by-province agreements and use other mechanisms too to implement practical changes.

“I think side deals are going to be the only way you can actually get us to where we want to be in the end,” said Dr. Samir Sinha, director of geriatrics at Sinai Health System and the University Health Network.

Time, however, is of the essence, he says, adding, “The federal government does have potentially national standards already in front of it.”

Sinha said Ottawa should rely on accreditation and standards development organizations that already exist, and are recognized by the Standards Council of Canada, a federal crown corporation, such as the Health Standards Organization which sets standards for things like infection control, and Accreditation Canada, which measures performance against those standards in the health and social services sector.

In some cases it is a matter of evaluating HVAC systems, floor plans and physical facilities. In others, it’s about practical levels of care, like hand hygiene practices.

Accreditation Canada already accredits all hospitals in Canada, and 58 per cent of long-term-care homes. That includes an agreement with Quebec which sees it accredit 100 per cent of that provinces’ publicly-funded long-term-care facilities.

In the rest of Canada, the picture varies. In some cases, provinces make accreditation through Accreditation Canada mandatory, in others it’s voluntary, and in some it is voluntary and incentivized, with provincial funding tied to accreditation.

Some facilities turn to an American accreditation body to seek accreditation.

But Sinha believes that Ottawa should expand and enhance the role of the Canadian agencies and organizations to oversee and accredit nursing homes here, and tie funding to homes meeting their standards.

Sinha said the first wave showed a lot of homes that saw outbreaks were old and outdated, built to comply with 1970s standards, with many not even having air conditioning in people’s rooms.

Ottawa could also leverage federal infrastructure dollars to ensure long-term-care home developers upgrade their facilities to national standards, he said.

“You must make sure your building is compliant not with 1972 or 1992 or, in Ontario, 2015 design standards.”

The coronavirus has so far killed more than 17,200 Canadians. Most of them — 70 per cent — are seniors in long-term care, according to statistics tracked by Ryerson University’s National Institute on Aging.

The tragedy is playing out unequally across the country.

Ontario had a brutal first wave in long-term-care homes, and in the second wave is again struggling to bring infections under control, with outbreaks in 58 per cent of long-term-care homes, and senior residents deaths making up 66 per cent of all COVID deaths in the province.

Trudeau has offered federal help including federal Red Cross personnel who’ve been dispatched to aid in 20 Ontario facilities, and repeated the offer Wednesday. Premier Doug Ford says he’ll take “any help.”

Alberta which avoided severe outbreaks in long-term care in the first wave, and took a less restrictive approach to lockdowns, is now seeing big spikes in its numbers, with outbreaks in 70 per cent of its long-term-care homes, and marking 811 deaths or 63 per cent of all its COVID fatalities, according to the National Institute on Aging’s tracker.

Quebec suffered a devastating toll in the spring but has wrestled outbreaks down to about 44 per cent of its long-term homes.

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Newfoundland and Labrador has had no outbreaks in its nursing or personal-care homes and is not opposed to the principle of federal funding tied to agreement on national standards for long-term care, as long as Ottawa steps up with more money, Haggie says.

Still Haggie says solutions that might work in the GTA won’t necessarily “translate” to the needs of his province with its aging population — 25 per cent is over 65 — dispersed over a wide territory where the costs of providing services is a perennial challenge.

Quebec and Saskatchewan remain staunchly opposed to Trudeau’s call for national standards.

Quebec Premier François Legault issued a statement to the Star through his spokesperson, saying “Despite the challenges we face, long-term care is a provincial jurisdiction, not a federal one. Prime Minister Justin Trudeau should stick to what he’s accountable for.”

“Any form of intrusion by the federal government into our areas of jurisdiction is unacceptable. We won’t tolerate it.”

Legault, who heads the Council of the Federation, said that “all the provinces still form a strong and united common front at this stage.”

However behind the scenes, Ontario is no longer as adamant.

A senior provincial official, speaking on background, said Queen’s Park acknowledges the long-term-care problem is complex and will require a huge injection of funds to fix, and so Ford’s government is not opposed to having conversations around long-term care and will not jeopardize access to funding by any refusal to discuss national standards.

Still, nobody, not least Ford believes more standards are a simple answer.

Ivana Yelich, a spokesperson for Ford, said in a written reply to the Star that the second wave of COVID-19 has clearly shown “more funding is needed to address the long-standing systemic concerns in long-term care.”

She said the $1-billion pledged to date “is a good first step, but we need a long-term solution.”

“National standards won’t fix decades of underinvestment in our long-term-care homes, but new investments such as our commitment to increasing average daily direct care per resident to four hours a day over a four-year period will make a world of difference.

“The premier will continue calling on the federal government to ensure any commitment to increase the Canada Health Transfer takes into account these necessary long-term investments to support our most vulnerable seniors and those who care for them.”

Sinha, however, said the “four-hours-a-day formula has been floating around for 10 years.”

Although Ontario has committed to reaching it by 2026, Sinha questioned whether it is the right standard, and what it means for regions where not enough nursing or registered nurse practitioner resources exist. “Does it mean you have to shut down the home?”

The real answer, he believes, is to look at “do we have existing bodies that have actually created standards; are these standards after this horrific pandemic where they need to be?”

“Could we actually establish a standard that the federal government wants to get behind and endorse and then use that as the mechanism through which we can offer more money and more skin in the game to provinces that are willing to up their game and implement those better standards that we need.”
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