Standards, which include measures to ensure well-being of staff, will be 'useless' if not backed by legislation and funding, says expert
Canada’s long-term care (LTC) sector is in dire need of attention. Advocates have been trying to highlight the issue for years, with the pandemic finally serving to spotlight the many things currently wrong with LTC.
CSA Group has worker collaboratively with the Health Standards Organization (HSO) to create complementary standards to improve LTC. The draft standards are currently under public review until March, with a view for them to be published in the fall. CAN/HSO 21001:2022 Long-Term Care Services standard is a revision of the organization’s existing LTC standard (last updated in 2020). While the standards are certainly admirable, there are some worries that they don’t go far enough.
Pat Armstrong, a research professor at York University and noted expert on LTC, was on the committee to develop the HSO standard.
“I think there’s some very interesting stuff in both sets on standards," she says. "But I think they’ll be useless unless they’re backed up by legislation that addresses funding, accountability, ownership and access issues. Otherwise, they’re just nice principles on paper.
"I don’t have many quarrels with the standards themselves – although I think there are some things that could be there that aren’t – but the real issue is that we need legislation and funding to back it up. And that means the feds, provinces and territories."
They also have to be enforceable, she says, there has to be some way of ensuring that accountability happens in a very public way.
Key elements of HSO’s revised standard
- Providing evidence-informed resident-centred care practices that value compassion, respect, dignity, trust, and a meaningful quality of life.
- Working in a team-based way to deliver high-quality care that is culturally safe and appropriate to the diverse needs of residents, the workforce, and the broader team involved in the life of a LTC home.
- Enabling a healthy, competent, and resilient workforce and healthy working conditions.
- Upholding strong governance practices and operations and a culture that is outcome-focused and committed to continuous learning and quality improvement.
Source: HSO
Armstrong has been researching LTC for decades. Her interest started years ago when she was doing her thesis, which was focused on women’s work. A classic area of women’s work, she started looking into hospitals – around 80 per cent of those working in health care are women.
While the focus on LTC as a result of the pandemic is welcome, the sector has been plagued with issues for years – putting the wellbeing of both staff and residents at risk.
“I think the pandemic maybe exaggerated and exposed the things that have been there for a long time, especially here in Canada and certainly more so in the United States,” says Armstrong.
Worker safety
While there are a number of elements at play, the central issue – and one perhaps not extensively addressed by these new standards – is staffing. This has been an issue for decades, the sector has long been plagued by low staffing levels, high turnover rates and high workplace injury rates.
Armstrong says that in a survey conducted 15 years ago, comparing Canada to the Nordic countries, staff in Canada were more than six times as likely to say they faced violence on a daily basis as those in the Nordic countries.
Fingers were pointed towards the residents, but Armstrong says “the difference wasn’t in the residents’ population between the Nordic countries and Canada. The difference was in the staffing levels and the extent of autonomy that the staff had in the Nordic countries compared to those in Canada".
By this she means that workers in those Nordic countries were more able to use their own training and knowledge to handle the residents, partly because they had more time.
To help with staffing issues, there have been calls to speed up the processing of Permanent Residency (PR) applications for Internationally Educated Nurses (IENs).
These nurses should not be assigned to lesser roles, and bringing them on board should not be an excuse for not improving working conditions, says Armstrong. We need to bring foreign labour on board and improve pay and working conditions.
