CANADA
Standards group calls for sweeping post-pandemic changes to how long-term care homes operate
Karina Roman
A right to privacy
Which is why the CSA document includes a section on respecting the rights of residents with the capacity to "consent to sexual and intimate acts" and to "engage in such activity as long as it is not illegal." The CSA also calls on long-term care facilities to offer residents privacy for "intimate acts" and "conversation."
But these standards won't automatically become binding when they're finally published in the fall because they're not in legislation yet.
The federal government has promised a new long-term care act that it insists will respect provincial jurisdiction over the long-term care sector. It's not clear whether provinces would be compelled to adopt and enforce the standards in that law, or whether they'd have the option of drafting their own revised standards.
And adopting and enforcing the CSA's recommended standards — especially the ones dealing with physical infrastructure and staffing — would be expensive.
"You can't meet a standard if you don't have the money," Michele Lowe, executive director for the Nursing Homes of Nova Scotia Association, told CBC News before the draft standards were made public.
"There's been this narrative that long-term care facilities and operators should have done better and they chose not to do better. But the reality in many of these cases is they didn't receive the funding from the department of health in those provinces."
The pandemic and the profit model
Larry Baillie's father Glenn Baillie died during a particularly dire long-term care home outbreak in Winnipeg in 2020. He said he agrees that funding is a big problem — but so is the industry's for-profit model.
"One year before (the pandemic), the physical therapist told me, 'We don't have enough money to provide care, but they had enough money to pay the shareholders,'" he said, adding he strongly supports the idea of national standards.
"Do not be fooled. For-profit means for-profit."
The Liberals promised $9 billion for long-term care during the last election, in addition to the $3 billion over five years already provided in the last budget.
"What price do we put on folks living in long-term care? These are our parents, our grandparents, as well as the workers that … are exposed as a result of going to work in the morning," said Mark Hancock, national president of CUPE, a union representing about 90,000 long-term care workers across the country.
New standards will be costly
The CSA is proposing different standards depending on whether a facility is an existing structure or a new build. For example, it calls on existing long-term care homes with rooms housing multiple residents to convert them into rooms for a maximum of two residents.
It says existing facilities should ensure they have a single room available to manage communicable infections or palliative care, and should provide private roll-in showers if resident washrooms don't have individual shower enclosures.
Mihailidis concedes that not all long-term care homes will have the resources to do everything the CSA recommends.
"We tried to provide as many different options and clauses and approaches so that if a home needs to pick and choose, they can do so," he said.
Hancock said he hopes to see the promised funds in the upcoming federal budget. He said he wants to see that funding linked to improved standards in the sector, even though health care is a provincial responsibility.
"We've seen in many cases that provinces are paying lip service to the federal government," he said. "So I think there's some real need to have teeth in these standards."
In the mandate letter Health Minister Jean-Yves Duclos received when he took over the portfolio, Prime Minister Justin Trudeau tasked him with introducing new legislation to improve the state of long-term care. The government has said such legislation would respect provincial and territorial jurisdiction but has not said when it will be tabled.
Larry Baillie said that what happened to his father and others in long-term care could have been prevented if Canada's health care policy valued seniors.
"We should … not look at them as an older person laying in a bed, but look at him as Glenn Baillie, owner of Spoke & Edge (ski shop) and president of Rotary," said Baillie. "We need to cherish them."
The proposed standards are subject to public input for the next 60 days.
Karina Roman
- Friday-cbc.ca
A national standards association is calling for profound changes to the way Canada's long-term care facilities are run after the pandemic exposed serious weaknesses that contributed to thousands of deaths.
The package released today by the Canadian Standards Association runs to 338 draft recommendations for new long-term care standards.
Among other things, the CSA is calling for single rooms with private bathrooms for long-term care residents, dedicated hand-hygiene sinks and better contingency plans for staffing shortages when "catastrophic" events occur.
In the first few months of the pandemic, more than 80 per cent of Canada's known COVID-19 deaths happened in long-term care and retirement homes — the highest such rate among nations in the Organisation for Economic Co-operation and Development (OECD).
According to the National Institute on Ageing's latest numbers, more than 16,000 residents of long-term care homes in Canada have died because of COVID-19. Thousands of staff members in long-term care facilities have been infected as well, and more than two dozen of them have died as a result.
"We really took a different approach in the development of these standards," said Alex Mihailidis, chair of the CSA Group technical subcommittee that developed the draft standards. He said the advisory group that came up with the standards included long-term care residents and family members.
"The hope here is that they all now have skin in the game … The hope is that they will lead the charge to see change from within," he said.
The CSA draft standards released today are part of a larger package of standards requested by the federal government last spring. The first part of that package, released at the end of January by the Health Standards Organization (HSO), proposed standards for the quality of direct care that covered things like staffing and residents' rights.
Infection control, private bathrooms
The CSA draft standards are comprehensive and include detailed infection control measures covering such things as PPE supplies, laundry and waste management and rules for cleaning a room after an outbreak or death.
They also cover aspects of day-to-day functions — such as helping residents eat, bathe and go outside — and visitation policies. They include a section on staff training and education as well.
The CSA document proposes new standards for the design of long-term care facilities themselves. It calls for single-occupancy rooms with private bathrooms and improvements to ventilation and medical gas systems.
© Evan Mitsui/CBC
A national standards association is calling for profound changes to the way Canada's long-term care facilities are run after the pandemic exposed serious weaknesses that contributed to thousands of deaths.
The package released today by the Canadian Standards Association runs to 338 draft recommendations for new long-term care standards.
Among other things, the CSA is calling for single rooms with private bathrooms for long-term care residents, dedicated hand-hygiene sinks and better contingency plans for staffing shortages when "catastrophic" events occur.
In the first few months of the pandemic, more than 80 per cent of Canada's known COVID-19 deaths happened in long-term care and retirement homes — the highest such rate among nations in the Organisation for Economic Co-operation and Development (OECD).
According to the National Institute on Ageing's latest numbers, more than 16,000 residents of long-term care homes in Canada have died because of COVID-19. Thousands of staff members in long-term care facilities have been infected as well, and more than two dozen of them have died as a result.
"We really took a different approach in the development of these standards," said Alex Mihailidis, chair of the CSA Group technical subcommittee that developed the draft standards. He said the advisory group that came up with the standards included long-term care residents and family members.
"The hope here is that they all now have skin in the game … The hope is that they will lead the charge to see change from within," he said.
The CSA draft standards released today are part of a larger package of standards requested by the federal government last spring. The first part of that package, released at the end of January by the Health Standards Organization (HSO), proposed standards for the quality of direct care that covered things like staffing and residents' rights.
Infection control, private bathrooms
The CSA draft standards are comprehensive and include detailed infection control measures covering such things as PPE supplies, laundry and waste management and rules for cleaning a room after an outbreak or death.
They also cover aspects of day-to-day functions — such as helping residents eat, bathe and go outside — and visitation policies. They include a section on staff training and education as well.
The CSA document proposes new standards for the design of long-term care facilities themselves. It calls for single-occupancy rooms with private bathrooms and improvements to ventilation and medical gas systems.
© Evan Mitsui/CBC
Crosses representing residents who died of COVID-19 on the lawn of Camilla Care Community in Mississauga, Ont. on Jan. 13, 2020. The long-term care home was among those in Ontario hardest-hit by the pandemic.
Mihailidis said CSA drafted the standards with the goal of keeping residents safe while giving them more control over their lives.
"We kept in mind throughout … even though it's quite technical in some places, that these are people's homes," he said.
"We are not developing a standard for a hospital or medical facility. These are most likely the last homes that many individuals would be living in."
Mihailidis said CSA drafted the standards with the goal of keeping residents safe while giving them more control over their lives.
"We kept in mind throughout … even though it's quite technical in some places, that these are people's homes," he said.
"We are not developing a standard for a hospital or medical facility. These are most likely the last homes that many individuals would be living in."
A right to privacy
Which is why the CSA document includes a section on respecting the rights of residents with the capacity to "consent to sexual and intimate acts" and to "engage in such activity as long as it is not illegal." The CSA also calls on long-term care facilities to offer residents privacy for "intimate acts" and "conversation."
But these standards won't automatically become binding when they're finally published in the fall because they're not in legislation yet.
The federal government has promised a new long-term care act that it insists will respect provincial jurisdiction over the long-term care sector. It's not clear whether provinces would be compelled to adopt and enforce the standards in that law, or whether they'd have the option of drafting their own revised standards.
And adopting and enforcing the CSA's recommended standards — especially the ones dealing with physical infrastructure and staffing — would be expensive.
"You can't meet a standard if you don't have the money," Michele Lowe, executive director for the Nursing Homes of Nova Scotia Association, told CBC News before the draft standards were made public.
"There's been this narrative that long-term care facilities and operators should have done better and they chose not to do better. But the reality in many of these cases is they didn't receive the funding from the department of health in those provinces."
The pandemic and the profit model
Larry Baillie's father Glenn Baillie died during a particularly dire long-term care home outbreak in Winnipeg in 2020. He said he agrees that funding is a big problem — but so is the industry's for-profit model.
"One year before (the pandemic), the physical therapist told me, 'We don't have enough money to provide care, but they had enough money to pay the shareholders,'" he said, adding he strongly supports the idea of national standards.
"Do not be fooled. For-profit means for-profit."
The Liberals promised $9 billion for long-term care during the last election, in addition to the $3 billion over five years already provided in the last budget.
"What price do we put on folks living in long-term care? These are our parents, our grandparents, as well as the workers that … are exposed as a result of going to work in the morning," said Mark Hancock, national president of CUPE, a union representing about 90,000 long-term care workers across the country.
New standards will be costly
The CSA is proposing different standards depending on whether a facility is an existing structure or a new build. For example, it calls on existing long-term care homes with rooms housing multiple residents to convert them into rooms for a maximum of two residents.
It says existing facilities should ensure they have a single room available to manage communicable infections or palliative care, and should provide private roll-in showers if resident washrooms don't have individual shower enclosures.
Mihailidis concedes that not all long-term care homes will have the resources to do everything the CSA recommends.
"We tried to provide as many different options and clauses and approaches so that if a home needs to pick and choose, they can do so," he said.
Hancock said he hopes to see the promised funds in the upcoming federal budget. He said he wants to see that funding linked to improved standards in the sector, even though health care is a provincial responsibility.
"We've seen in many cases that provinces are paying lip service to the federal government," he said. "So I think there's some real need to have teeth in these standards."
In the mandate letter Health Minister Jean-Yves Duclos received when he took over the portfolio, Prime Minister Justin Trudeau tasked him with introducing new legislation to improve the state of long-term care. The government has said such legislation would respect provincial and territorial jurisdiction but has not said when it will be tabled.
Larry Baillie said that what happened to his father and others in long-term care could have been prevented if Canada's health care policy valued seniors.
"We should … not look at them as an older person laying in a bed, but look at him as Glenn Baillie, owner of Spoke & Edge (ski shop) and president of Rotary," said Baillie. "We need to cherish them."
The proposed standards are subject to public input for the next 60 days.
Draft standards for LTC building design, infection prevention publicly released
OTTAWA — Experts have released a new set of draft standards for long-term care, this time focused on building design, materials and infection prevention and control.
CSA Group, formerly the Canadian Standards Association, developed the draft in parallel with care-giving standards from the Health Standards Organization, released two weeks ago.
Alex Mihailidis, chair of CSA Group’s technical subcommittee, says his organization's standards are more prescriptive and look at everything from the heating and ventilation systems to the types of technology that should be available to residents.
He likens HSO's standards to the software of long-term care, whereas CSA Group has looked at the hardware.
"If we can take any type of silver lining over the past two years when it comes to long-term care homes, it really taught us a significant lesson across many of the aspects in operations," Mihailidis said.
The COVID-19 pandemic highlighted serious systemic problems with infection prevention and control as well as other issues inside long-term care residences across the country.
Data gathered by The National Institute on Aging finds 16,345 long-term care residents had died of COVID-19, as of Feb. 8, since the pandemic began.
Throughout the process of developing the new standards, Mihailidis said, there has been a focus on improving the operations and safety of the residences while balancing the notion that people live in the spaces and deserve the comforts of home.
"They are not acute-care settings, they're not hospitals. How do we design long-term care homes, having that balance of quality of life versus infection prevention, control and safety?" he said.
The draft draws on best practices from around the world where increasingly long-term care is being designed as a cluster of neighbourhoods, with separate dining and multi-purpose rooms to help balance safety and quality of life. In the event of an outbreak, neighbourhoods can be contained without affecting the entire residence.
The standards also spell out specific requirements for such things as plumbing, heating, ventilation, air conditioning and security, he said.
While some of those requirements might sound most helpful for the development of new homes, Mihailidis said the goal is to make the new standards applicable to the more than 2,000 homes that already operate in Canada.
"The way we tried to do that really is by providing options or different approaches that homes can take and try to get as close to the standard as possible," he said.
The draft has been released for public review, with CSA group accepting feedback until April 11. The experts plan to then refine the standards and release a final version at the end of the year.
It is not yet clear how they will be implemented and enforced.
The HSO's standards for care are expected to be adopted by Accreditation Canada, which sanctions nearly 70 per cent of such homes in Canada.
That will not necessarily be the case for the CSA Group's more prescriptive look at what needs to be done to improve the residences themselves.
The federal government has promised to develop legislation related to the safety of long-term care, which could enshrine the standards in law. That would require the co-operation of provinces, which have jurisdiction over the homes.
"Where the enforcement's going to come, though, is from the residents, the families of the residents, the staff who work in these homes, and hopefully the operators themselves," Mihailidis said.
"This is really going to be a groundswell of bottom-up support from all these different stakeholders."
This report by The Canadian Press was first published Feb. 11, 2022.
Laura Osman, The Canadian Press
The Canadian Press
OTTAWA — Experts have released a new set of draft standards for long-term care, this time focused on building design, materials and infection prevention and control.
CSA Group, formerly the Canadian Standards Association, developed the draft in parallel with care-giving standards from the Health Standards Organization, released two weeks ago.
Alex Mihailidis, chair of CSA Group’s technical subcommittee, says his organization's standards are more prescriptive and look at everything from the heating and ventilation systems to the types of technology that should be available to residents.
He likens HSO's standards to the software of long-term care, whereas CSA Group has looked at the hardware.
"If we can take any type of silver lining over the past two years when it comes to long-term care homes, it really taught us a significant lesson across many of the aspects in operations," Mihailidis said.
The COVID-19 pandemic highlighted serious systemic problems with infection prevention and control as well as other issues inside long-term care residences across the country.
Data gathered by The National Institute on Aging finds 16,345 long-term care residents had died of COVID-19, as of Feb. 8, since the pandemic began.
Throughout the process of developing the new standards, Mihailidis said, there has been a focus on improving the operations and safety of the residences while balancing the notion that people live in the spaces and deserve the comforts of home.
"They are not acute-care settings, they're not hospitals. How do we design long-term care homes, having that balance of quality of life versus infection prevention, control and safety?" he said.
The draft draws on best practices from around the world where increasingly long-term care is being designed as a cluster of neighbourhoods, with separate dining and multi-purpose rooms to help balance safety and quality of life. In the event of an outbreak, neighbourhoods can be contained without affecting the entire residence.
The standards also spell out specific requirements for such things as plumbing, heating, ventilation, air conditioning and security, he said.
While some of those requirements might sound most helpful for the development of new homes, Mihailidis said the goal is to make the new standards applicable to the more than 2,000 homes that already operate in Canada.
"The way we tried to do that really is by providing options or different approaches that homes can take and try to get as close to the standard as possible," he said.
The draft has been released for public review, with CSA group accepting feedback until April 11. The experts plan to then refine the standards and release a final version at the end of the year.
It is not yet clear how they will be implemented and enforced.
The HSO's standards for care are expected to be adopted by Accreditation Canada, which sanctions nearly 70 per cent of such homes in Canada.
That will not necessarily be the case for the CSA Group's more prescriptive look at what needs to be done to improve the residences themselves.
The federal government has promised to develop legislation related to the safety of long-term care, which could enshrine the standards in law. That would require the co-operation of provinces, which have jurisdiction over the homes.
"Where the enforcement's going to come, though, is from the residents, the families of the residents, the staff who work in these homes, and hopefully the operators themselves," Mihailidis said.
"This is really going to be a groundswell of bottom-up support from all these different stakeholders."
This report by The Canadian Press was first published Feb. 11, 2022.
Laura Osman, The Canadian Press
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