DISCUSSION PAPER
A Higher Standard
Setting federal standards in long-term care and continuing care
Pat Armstrong and Marcy Cohen
November 23, 2020
[Excerpts] Introduction
The COVID-19 pandemic has highlighted the critical importance of federal government leadership in health care. The pandemic’s impact has been particularly dramatic in long-term care homes, exposing a fragmented and under-resourced system that is heavily reliant on for-profit delivery.
There can be no question that federal leadership is urgently needed in the development of a coordinated approach to long-term care, along with the broader system of home and community-based health services for seniors and people with disabilities (i.e. continuing care). Both the 1964 Hall Royal Commission on Health Services1 and the 2002 Romanow Commission on the Future of Health Care in Canada2, as well as a host of other research, have called for such leadership.
Ongoing concerns about fragmentation and silos within our health care system are legendary. This includes the lack of coordination and communication across di erent parts of the health system—primary, continuing (long-term, home and community based) and hospital care. Effective coordination is essential to facilitate e ective transitions and communication. There is also fragmentation within continuing care itself, where a more comprehensive approach is needed that includes health promotion, prevention, medical and social care, rehabilitation, and palliation.
The idea of working locally in neighbourhoods and/or small communities to support a more integrated and comprehensive approach—including linkages with primary and specialized care, community social supports and affordable housing—is one that has caught the imagination of many who work in or receive continuing care services. Developing, supporting and scaling-up innovative models for service integration and improving connectivity across the health and social support sectors are of paramount importance for the health and well-being of seniors and people with disabilities.
Access based on need and not on ability to pay
An increasing number of the services that older adults and people with disabilities require to maintain their health and wellbeing are not available through the public system and must be paid for through the private market. Many of the people who require continuing care services, however, cannot afford to pay for them privately and some have diffculty in even covering their basic monthly expenses for food and accommodation. Access must be based on need and not ability to pay, as is the case for physician and hospital services.
Not-for-profit delivery
There is a body of accumulated research demonstrating a pattern of lower quality care in for-pro t services. At the same time, there is little justification for profit making in this sector, in which the human right to basic care should be paramount. There is no evidence that for-profit services or a managed market competition in the provision of care services lowers cost, improves quality, access or choice. It is, however, more difficult to ensure health-focused governance, given the responsibility of for-profit firms to their shareholders. Policy and funding at the federal and provincial levels should be developed with a view to eliminating profit taking in publicly funded continuing care.
National standards for long-term care homes
According to the Canadian Institute for Health Information, “countries with centralized regulation and organization of [long-term care],” such as Australia, “generally had lower numbers of COVID-19 cases and deaths.” National standards have helped, but as a recent Royal Commission report from Australia acknowledges, they would be more effective if they provided “incentives to improve,” which would require standards that are transparent, specific and measurable.
To access the full report, click on: A Higher Standard: Setting federal standards in long-term care and continuing care.
