At least two cheers for Ontario’s long-term care reforms, which were announced Tuesday by the province’s health minister, Helena Jaczek, with support from the premier, Kathleen Wynne. Among the measures are amendments to The Residents Living Together Act that will require nursing homes to hold two independent reviews every three years of care provided. And, for the first time, nursing homes will be required to provide patients with at least two hours of activities for every hour of care they are receiving. Finally, staff in long-term care homes will be held responsible for preventing outbreaks of such infectious diseases as Legionnaires’ disease and C. difficile and for introducing preventative practices to help limit the risk of infection.
These are good first steps. Indeed, the ability of long-term care homes to establish independent reviews of care is a well-intentioned proposal that appears to set up a valuable safeguard against abuse or negligence. Whether such steps will result in better care is another matter. For one thing, there is scant evidence of improved care anywhere else in Canada. Officials in Britain are in such a constant state of worry that they are now so convinced of the need for the system to be reformed that they are considering enacting regulations to force home care to a new standard.
In Canada, for the past few years, complaints of neglect have increased in homes for the elderly. Some of the reform in Ontario is reminiscent of the Royal Commission into the Safety of British Nurses, which, with the help of an industry panel that included retirees and nurses, recommended in 1996 that nursing homes be treated as “health care facilities.” While it turned out that nursing homes were not, in fact, necessary health care facilities, they nevertheless should have been accorded appropriate regulatory functions.
But if Ontario can remedy their failings, it should be able to do the same with all of them, so that they can, again, become health care facilities. Ontario has a population that is not primarily elderly, but one that is elderly. At almost 140,000 people, the province’s elderly are the largest segment of its population. These aging households are spending more and more on long-term care, spending more money and, despite the best efforts of facilities, asking for more and more time from their long-term care providers. Only worse is that these patients in Ontario are paying a higher rate than their counterparts in other provinces, at more than C$70 a day to be cared for by licensed long-term care homes in Ontario.
Each large province has its own nursing homes. Canada needs to monitor each one of them to ensure they remain healthy and deliver good care and comfort to their residents. But to do so comprehensively, a national body is required to monitor and oversee the system across Canada, just as the Royal Commission on Nurses did.
The Canada Pension Plan already imposes similar requirements on employer and employee pensions, to ensure that people are being fairly treated by their employers. In private long-term care facilities, there are no such mechanisms to ensure that conditions improve. For example, long-term care homes must provide special facilities for the elderly and infirm. Yet a lack of regulation means that the same facilities that do not offer a room with a walker or a shower that is heated cannot force residents into separate entrances and admit them even if their condition requires them to leave the building.
Here is a chance for the NDP government in Ontario to be an innovative leader in ensuring that any regulations it passes are well-crafted, workable and reasonable. For the first time, these regulations will apply to all long-term care facilities, and the province should take advantage of that opportunity.