The problem is the absolute patchwork of oversight when it comes to long-term care facilities. That problem should be solved with a national strategy. One of the after-effects of the pandemic will be a genuine interest in working collectively to upgrade the level of seniors’ care across the country.

By Sheila Copps
First published in The Hill Times on May 25, 2020.

OTTAWA—The latest post-mortem theory on Canada’s COVID deaths is that beefing up hospital resources fuelled the death rate in nursing homes.

That appeared to be the dubious conclusion in a front-page story last week in The Globe and Mail.

An elderly patient was transferred from an Oshawa hospital into a long-term care home, where she died three weeks later.

The inference in the article is that the transfer caused her death.

But the context reflected a superficial, and misguided critique, of the current triage system in Canadian hospitals.

For the past 40 years, critics have been pointing out that up to one-third of acute care hospital beds are being taken up by long-term patients who would be better served in a retirement facility setting.

The COVID crisis prompted a long-overdue transfer of patients from hospitals to nursing homes to free up acute care beds to treat patients in acute, current distress.

It appears more likely the reason this unfortunate death happened was entirely because the long-term care home to which she was transferred to was a COVID-19 hotbed, with 77 deaths.

But the journalists fail to ask the key question. Why do some retirement homes have zero infections while others are rampant?

The issue is not patients’ transfer, but rather the level of hygiene and best practices in nursing homes.

In a good home, infection isolation strategies were in place long before the pandemic struck. In a retirement home, if a flu bug is not properly managed by isolation and hygiene practices, it can and will spread like wildfire.

Proper medical practices, employed by medical staff and personal care workers, prevent the virus affecting a patient in one room from spreading to the rest of the facility.

Appropriate lockdown strategies, early in the game, while difficult for families, have also kept the virus out of some facilities.

So, the problem is not caused by moving chronic patients out of acute care hospitals. The problem is caused by lack of oversight of the chronic-care facilities that house our seniors.

The Globe report said that most patients have a preferred list of long-term care homes. Families aren’t stupid and when it comes to checking the quality of care in a retirement facility, you only have to look at the waiting list.

The longer the wait-list, the better the care.

The best long-term care facilities have not been hotbeds of infection.

The Globe goes on to reveal another shocking headline that “nobody is tracking deaths inside seniors’ facilities at a national level.”

That should surprise no one because health data is collected and managed by provincial governments.

Each province tracks its seniors’ facilities deaths.

But the real questions were not asked by the reporters.

Why are there some facilities with vulnerable patients who have managed to completely avoid COVID-19 infections while others are hotbeds?

What is the infection correlation between publicly run facilities versus privately provided care homes?

What impact did the reduction in inspections of Ontario nursing homes have on the infection rates?

What is the influence of differing labour laws in different jurisdictions?

British Columbia moved immediately to restrict health-care workers from working in more than one facility. Quebec waited until mid-cycle to do the same thing.

What is the correlation between salary scales in individual facilities and infection rates? Some of the largest companies in the private elder care business had zero national strategy to secure sufficient personal protective equipment for their patients and employees.

They left the decisions on equipping homes and health-care staff up to each retirement facility. Some obviously did not do a very good job.

Contrary to The Globe claim, the move of chronic care patients out of hospital is actually key to saving and supporting health care.

The problem is the absolute patchwork of oversight when it comes to long-term care facilities.

That problem should be solved with a national strategy. One of the after-effects of the pandemic will be a genuine interest in working collectively to upgrade the level of seniors’ care across the country.

Let’s not just throw money at the problem. We need to ensure proper accreditation and real consequences when homes fail to meet the basic statutory requirements. When was the last time a home was shut down because of improper eldercare, bedsores, and infection spread, all signs of a poorly managed facility?

Let’s tackle the real problem. We need an end to the patchwork of oversight currently governing Canadian nursing homes.

Sheila Copps is a former Jean Chrétien-era cabinet minister and a former deputy prime minister. Follow her on Twitter at @Sheila_Copps.

Instead of trying to go it alone, provinces are stronger when they work together.

By Sheila Copps
First published in The Hill Times on April 27, 2020.

OTTAWA—The death of separatism is an unintended outcome of the COVID-19 pandemic.

For the first time in my memory, provincial governments are looking to the federal government as more than just a cash machine.

They are actually working together, pooling resources and information in an effort to fight the spread of a pandemic that knows no borders.

Alberta Premier Jason Kenney has been positively glowing in his exhortations for partners across the country to work together.

While announcing the redistribution of excess Alberta personal protective equipment, the premier was effusively collegial.

It was a far cry from only a few short months ago, when Kenney was lauding the Wexit movement for shining a light on Alberta’s oil troubles.

Premiers across the country have been working together with the prime minister to solve the common problem of access to COVID-fighting information, protective equipment and health care human resource shortages.

Without a scintilla of criticism, the Quebec government called in the Canadian military to supplement the shortage of personnel in the province’s long-term care facilities.

Pre-pandemic, a similar move would have prompted a howl from those separatists who think Quebec’s strength lies in going it alone.

The pandemic also gives us a better picture of the shared benefits of acting as a strong team. Compare the infection and death rates in our country to those in the United States, and it is abundantly clear that a national, public health-care system is a better weapon against an anonymous virus than the hodgepodge of medical supports available south of the border.

At press time the American death rate was 40 times higher than Canada’s, with only ten times the population.

So, one lesson has been learned from our time together in collective self-isolation. Canada works better as a country when we all work together.

On the domestic level, we have an oversight of just what is working and what is not.

The death rate in Quebec is almost double that of Ontario and the gold standard bearer for COVID containment is the province of British Columbia.

With a population of more than five million people, the province has suffered fewer than 100 COVID-related deaths. Quebec’s population is almost 8.5 million, but their death rate is 11 times greater than that of B.C.

Pandemic post-mortems will undoubtedly delve deeply into the reasons for the mortality discrepancies among different provinces.

Some of the provincial differences are self-evident.

The first, and probably most significant, was the difference in the date of spring break between Quebec and British Columbia.

Quebec’s break was in early March, at a time when the ferocity of the virus was not yet fully understood by politicians.

Self-distancing had not yet started, and Quebecers brought the virus back home with a vengeance.

In the case of British Columbia, it was the latest school recess in the country, and by the time break-week arrived, the province had already clamped down on travel, effectively limiting the viral path.

Provinces also have different regimes managing their long-term care facilities.

British Columbia did not allow personal service workers to operate in more than one nursing home.

That regulation is cited as one of the reasons that the rapid spread of COVID-19 in Ontario and Quebec homes was not replicated in British Columbia.

During the pandemic, Ontario and Quebec have modified their regulations, but the issue of health workers’ pay has not been addressed in kind.

Most health care aides would love to work in one facility only. But the companies that manage many of these facilities for government focus on hiring part-time workers to keep their costs down.

Discussion is ensuing about topping up the pay in these low-wage high-risk health environments, but that is only part of the problem.

The other part is the lack of government oversight into what is actually happening in nursing homes.

Quebec Premier François Legault is promising a fulsome investigation into the deplorable situation in some of the homes in his province. His effective communication skills managed to build public confidence early in the crisis, but the widespread number of deaths in long-term care homes has been eroding his credibility.

Ontario cut the number of inspections in its homes to only nine of 626 homes last year, with the lack of oversight partly responsible for inspection spread. Three years ago, all facilities were inspected annually.

The post-mortem will spawn serious changes to disparate long-term care regimes.

Instead of trying to go it alone, provinces are stronger when they work together.

Sheila Copps is a former Jean Chrétien-era cabinet minister and a former deputy prime minister. Follow her on Twitter at @Sheila_Copps.

When we say we respect elders, the time has come to prove it. Giving the federal public health agency authority to nationally accredit nursing homes would be a good start.

By Sheila Copps
First published in The Hill Times on April 20, 2020.

OTTAWA—Canada’s dirty little secret is now out in the open.

While we all claim respect and reverence for seniors, when the time comes, they often find themselves in substandard conditions with little recourse or options.

The number of COVID-19 deaths in institutions is a clear signal that we need to revisit the deficiency of end-of-life and continuing care solutions.

It is also proof positive that running 13 independent nursing home systems makes absolutely no sense.

Because of the scarcity of COVID-fighting equipment, the federal and provincial governments have actually been coordinating international purchases and domestic distribution.

Incredibly, this is the first time in the history of our country that we have actually had agreement from all parties to cooperate on purchase requirements.

The federal government is also stepping in to offer updated guidelines for nursing home operations across the country.

But guess what. Their recommendations have zero legal authority. The federal government is responsible for guaranteeing the health of what we eat in Canada but has zero responsibility governing the health of our people.

The COVID death rate in institutional care is shining a light into an area that health advocates and the children of ailing parents have known for years.

The management and standards of public nursing facilities is a dog’s breakfast.

Several years ago, my own mother had to be institutionalized because of her increasing dementia.

Luckily, she was in a position to secure a place in a private facility that specialized in memory wards, a euphemism for people who no longer retain their memories.

She was thriving for almost two years but in the last four months of her life, she went rapidly downhill.

The community care experts who track placement for vulnerable seniors suggested it was time to move her into a public facility where there would be more focus on heavy care. We were given a list to visit, and quickly discovered the differences in facilities even in a single city.

There were at least three outstanding facilities, that would pass muster on any nursing inspection. The waiting list to get into these places was up to three years.

We were given another list that had immediate openings, and my husband and I scheduled tours with several of them.

The first one we visited was a retrofitted warehouse conveniently located beside what appeared to be a brothel motel.

The stench of urine was so pungent when we opened the front door that we recoiled. Patients were in the sunroom, some of whom were literally naked as their hospital gowns had come undone, and nobody seemed to think that their dignity was worth preserving.

I left the facility in tears, and vowed that I would never, never, never put a loved one into a place that was not even suitable for a dog.

I expressed my concern to community care and the workers agreed that there were some nursing homes in the nation’s capital that were absolutely substandard.

Luckily, my mother was able to stay in the private facility until she passed away, but to this day, images of the poor quality of some nursing homes in Ottawa still stings.

The other thing that stood out during my mother’s time in institutional care was the untiring devotion of staff, many of whom are surviving on minimum wage.

Dealing with demented patients is not an easy task, as they can suffer from inexplicable mood swings and sometimes, uncharacteristic violent behaviour. It is not uncommon for nurses and personal service workers to be slapped, cursed or spit on by people who have literally lost control of their minds.

I called the workers my mother’s saints, because they cared for her with dignity and gentleness, and never lost sight of the fact that she was a person, not just a patient.

Last year, the Ontario government rolled back a planned minimum wage increase. Many of these saints saw their wage hikes go up in smoke, while the workload did not get any easier.

Many nursing homes are owned by holding companies, that are focussed on one thing, the bottom line. And cutting food and care budgets help get to that bottom line.

If we learn one thing from this COVID nightmare, it is that the time has actually come to put our money where our mouth is.

When we say we respect elders, the time has come to prove it. Giving the federal public health agency authority to nationally accredit nursing homes would be a good start.

Sheila Copps is a former Jean Chrétien-era cabinet minister and a former deputy prime minister. Follow her on Twitter at @Sheila_Copps.