Development of a federal Safe Long-Term Care Act: Discussion paper

On this page

• The need for a Safe Long-Term Care Act
• Long-term care in Canada
• Responsibility for long-term care
• Federal involvement in long-term care and related areas
• National long-term care standards
• Potential elements of a Safe Long-Term Care Act
• Public input on the future of long-term care

The need for a Safe Long-Term Care Act

More than 200,000 older adults and persons living with a disability reside in long-term care homes.^{Footnote i} Residents often receive help from family and friend caregivers.

The COVID-19 pandemic highlighted long-standing systemic challenges in long-term homes across Canada including:

• staffing
• infrastructure
• quality of care
• infection prevention and control

These challenges had a larger impact on the older adults and persons with disabilities who live in these facilities. We recognized the undue hardship being faced by long-term care residents and their loved ones. As such, we took immediate action to support provinces and territories by:

• sending the Canadian Armed Forces to provide direct operational support in some long-term care homes
• transferring funding to provinces and territories for improvements to long-term care

Long-term care residents deserve to live in dignity, comfort and respect. That is why the Minister of Health and the Minister of Seniors were mandated to develop national long-term care standards and a Safe Long-Term Care Act. In January 2023, the Standards Council of Canada (SCC), Health Standards Organization (HSO) and the Canadian Standards Association (CSA) Group released 2 new complementary, independent long-term care standards. These standards provide guidance for delivering long-term care services that are safe, reliable and centred on residents' needs.

While provinces and territories are primarily responsible for delivering long-term care, we are working collaboratively with provinces and territories to improve the quality, safety, equity and availability of long-term care. Now that the standards have been released, we are turning our attention to developing the Safe Long-Term Care Act. This will build on past efforts to support long-term care throughout the COVID-19 pandemic.

Long-term care in Canada

Long-term care homes provide on-site delivery of 24 hours per day, 7 days per week, supervised care, including:

• personal care (for example, bathing, toileting)
• professional health services (for example, nursing)
• services such as meals, laundry and housekeeping

The complexity of care is growing as more residents have cognitive impairments or significant physical care needs. The sector is facing workforce challenges, such as:

• wages
• training
• retention
• recruitment

Many homes are older constructions that are not designed and operated to provide safe, person-centred care. For example, many homes with older designs have shared rooms and shared bathrooms that compromise privacy and infection prevention and control.

We've heard that most people in Canada, including those with disabilities, would prefer to age at home or in their community, close to family and loved ones. Those who need long-term care and residents of long-term care homes, as well as their family members, are seeking safe, high-quality, home-like settings. They want long-term care homes where:

• the health care team recognizes designated family members or friends as essential caregivers
• care responds to the diversity of residents' needs
  • for example, relating to their gender and sexual orientation, their ethnicity, their experiences with trauma, their socio-economic status, their religious beliefs, and their desired quality of life
• care is provided in a safe environmentx
  • that is, a physically, socially, culturally, linguistically, emotionally and spiritually safe environment

The Canadian Institute for Health Information (CIHI) reports that as of March 31, 2021, long-term care homes in Canada are:

• 46% publicly owned
• 54% privately owned

Ownership type varies across provinces and territories. For example:

• 100% of long-term care homes are publicly owned in the Yukon, Northwest Territories and Nunavut
• 98% are publicly owned in Newfoundland and Labrador
• 88% are publicly owned in Québec
• 86% are private, not-for-profit homes (for example, owned by a religious charity) in New Brunswick
• 65% are privately owned in British Columbia
  • 37% are owned by private for-profit organizations
  • 28% are owned by private not-for-profit organizations
• 57% are private for-profit homes in Ontario

Responsibility for long-term care

Provinces and territories are primarily responsible for delivering health care including how:

• services are delivered
• long-term care homes are regulated
• the workforce is managed and compensated

CIHI reported that provinces and territories spent $28.5 billion on long-term care in 2022. To operate, long-term care homes must:

• undergo inspections
• meet the requirements set by provinces and territories through legislation, regulations, policies and standards

Additionally, some jurisdictions complement their legislation and regulation with voluntary or mandatory accreditation by an approved third-party accrediting body. According to HSO, across Canada:

• 67% of homes are accredited by Accreditation Canada
• 16% by the Commission on Accreditation of Rehabilitation Facilities (CARF Canada)

This varies across provinces and territories. Accreditation is mandatory in 5 provinces:

• Alberta
• Quebec
• Manitoba
• Saskatchewan
• Newfoundland and Labrador

Where accreditation is voluntary, the rate of accreditation varies from:

• 100% in the Northwest Territories and Yukon
• 84% in Ontario
• 21% in New Brunswick
• no accreditation in Nunavut

We can help support improvements in long-term care by having Health Canada:

• share promising practices
• invest in research and in common reporting measures
• transfer funding to provinces and territories through bilateral agreements

However, some federal departments are responsible for providing or funding access to long-term care for specific groups, such as:

• veterans
• Indigenous People
• people in federal correctional facilities

While the long-term care sector is outside the scope of the Canada Health Act , provinces and territories can choose to use Canada Health Transfer funding to help cover the cost of providing long-term care services.

Federal involvement in long-term care and related areas

We have made important investments in recent years to support long-term care and home care.

With the onset of the COVID-19 pandemic, and the recognized impacts on long-term care homes and their residents, we responded immediately with help by:

• creating the Safe Long-Term Care Fund (2020 Fall Economic Statement) to transfer $1 billion to the provinces and territories to protect people living and working in long-term care.
• providing $19 billion to provincial and territorial governments through the Safe Restart Agreement to help them restart the economy. This included $740 million to support vulnerable populations through infection prevention and control measures to protect those in long-term care and those receiving home care and palliative care.
• providing $10.7 million, since 2020, to Healthcare Excellence Canada. This funding has enabled more than 1,500 long-term care homes and retirement homes across Canada to implement promising practices for preventing and addressing COVID-19 infection. Their next program, Reimagining Long-Term Care: Enabling a Healthy Workforce to Provide Person-Centred Care , will support participating long-term care homes to address gaps in the safety and quality of care.

On February 7, 2023, we confirmed our commitment to provide $3 billion over 5 years to support provinces and territories in their efforts to improve long-term care in their jurisdictions (originally announced in Budget 2021). This funding will help support:

• workforce stability, including through wage top-ups and improvements to workplace conditions
  • for example, staff to patient ratios, hours of work
• strengthened enforcement including through accreditation and regular inspections
  • for example, enhanced inspection and enforcement capacity, quality and safety improvements to meet standards

In addition, Budget 2023 included an investment of $1.7 billion over 5 years to support hourly wage increases for personal support workers and related professions, as federal, provincial, and territorial governments work together on how best to support recruitment and retention.

Recognizing that people in Canada, including those with disabilities, prefer to age at home, we are also advancing work in home care. For example, beginning in 2017, we provided $6 billion over 10 years to provinces and territories to improve access to home and community care services, including palliative care. After the first 5 years of this investment, provinces and territories have implemented new initiatives to:

• improve access to care
• better coordinate and integrate care
• support caregivers to help more people in Canada receive the care and services they need so that they may remain at home longer

In October 2022, we announced that the National Seniors Council would serve as an expert panel to examine measures, including a potential aging at home benefit, to support Canadians who wish to age at home.

National long-term care standards

Since March 2021, the SCC, HSO and CSA Group have been collaborating to develop 2 new complementary national standards for long-term care. They undertook the process at arm's length from the federal government. Over 20,000 people in Canada participated in the consultations on these standards to reflect what people expect from long-term care. Participants included:

• health care leaders
• long-term care home residents
• families of long-term care residents
• members of the long-term care workforce
• other interested people in Canada

While these standards are independent, we provided close to $850,000 in funding to HSO and CSA Group to support their engagement and consultation process. The consultations revealed the need to:

• put residents at the centre of care
• ensure workplace conditions enable a healthy and competent workforce
• embed measurement and accountability for the quality and safety of long-term care

On December 1, 2022, CSA Group posted their standard, Long-term care home operations and infection prevention and control . This standard addresses the design, operation and infection prevention and control practises in long-term care homes.

On January 31, 2023, HSO released their standard, Long-Term Care Services , which addresses the delivery of safe, reliable and high-quality long-term care services. It focuses on:

• safe, reliable and high-quality care
• a healthy and competent workforce
• resident- and family-centred care practises
• an organizational culture that is outcome-focused and strives towards the safety and well-being of all people in Canada

These standards complement our ongoing work with provinces and territories to help support improvements in long-term care.

We recognize that provinces and territories are primarily responsible for managing the delivery and operation of long-term care facilities, including how and whether they adopt the standards.

Potential elements of a Safe Long-Term Care Act

The new act could outline a pan-Canadian vision and principles for the safe operation and delivery of care in long-term care homes to:

• reflect the new national standards
• encourage provinces and territories to adopt the standards

The vision could describe:

• high-quality care and building design and operations that are person-centred, inclusive and culturally safe
• buildings that are designed and operated to offer safe care
• a long-term care workforce that is supported and can respond effectively to the diverse needs of residents
• governance that ensures accountability for the design and delivery of safe, high-quality care and buildings balanced with meaningful quality of life

The principles could include ideas about long-term care that are important to people in Canada such as:

• evidence-based care
• respect for resident safety and choice
• culturally safe and trauma-informed care
• care that is integrated with other parts of the health continuum
• operational, design and care decisions that reflect the participation of residents, essential caregivers, families and staff

Examples of actions that could be supported by the Act:

• the creation of a framework and action plan on long-term care (example: palliative care framework and action plan). These could focus on themes such as training and education, public awareness, data collection and research, and promising practices.
• build on existing long-term care indicators (example: CIHI measures) to add new measures or use different systems (example: United States 5-star ranking). This could help to tell a national story about long-term care through regular reporting (example: The State of Canada's Forests Annual Report) that highlights promising practices and improvements.
• develop a mechanism to identify promising practices in 1 part of Canada and replicate those in other areas.

We are committed to working collaboratively with provinces and territories to improve the quality, safety and availability of care in long-term care homes. A Safe Long-Term Care Act will:

• focus on results and accountability to people in Canada
• reflect the shared responsibility of all levels of governments with respect to the well-being of older adults and persons with disabilities

Legislation will be respectful of provincial-territorial jurisdiction. That is, it won't mandate standards or regulate long-term care delivery.

While federal authority can be used to develop federal legislation to promote improvements in the quality, safety and accessibility of long-term care, any federal legislation must respect the:

• constitutional division of powers
• jurisdiction of provinces and territories to manage and deliver long-term care

Public input on the future of long-term care

To help to ensure long-term care residents get the care they deserve, we are interested in hearing from people in Canada about:

• the changes they would like to see in the long-term care sector
• how we can continue to work collaboratively with provinces and territories and the long-term care sector to improve the state of long-term care across the country
• how we can work with the provinces and territories, stakeholders and other key partners to encourage the adoption of the new national long-term care standards while respecting provincial and territorial jurisdiction

In particular, we want to hear from:

• people residing in long-term care homes
• their caregivers and loved ones
• members of the long-term care workforce

We hope you can take the time to share your thoughts by participating in the safe long-term care consultation. The online questionnaire closes on September 21, 2023.