September 14, 2023

Care Watch is a non-profit, non-partisan organization run by volunteers and led by older adults. We advocate for homecare and community services to enable older adults to live independently and avoid institutionalization. We also advocate for measures that support and improve the broader system of care for older adults – a system that includes long-term care facilities and public hospitals in addition to homecare.

We believe that the Safe Long-term Care Act should:

• Support the provision of safe, high-quality, accessible long-term care in all parts of Canada including in rural and remote communities
• Embody the principles contained in the national standards developed by the Health Standards Organization (HSO) and by the Canadian Standards Association (CSA)
• Require that long-term care be resident-centred, culturally safe, and trauma informed
• Provide for a stable, capable, long-term care work force through equitable compensation and ongoing access to training opportunities and to education that includes palliative care
• Ensure that all long-term care workers have the appropriate educational preparation to meet the high intensity care needs of residents. Nearly 70% of all long-term care residents are living with dementia. Staff must have the knowledge and practical experience to meet their more complex care needs
• Require ongoing participation in facility design, facility operation, and care decisions by residents, essential care-givers, families, and long-term care staff
• Establish a national reporting system to monitor the state of long-term care in Canada. This system would require provinces to set ambitious performance targets for achieving improvements in meeting the national standards set out by the HSO and CSA. Performance targets should address: (a) the quality of care; (b) governance; (c) building design; (d) building operations; (e) a healthy and competent work force; and (f) infection prevention and control. Provincial governments should be required to track and report on their results in regular reports on the State of Long-term Care in Canada issued by the federal government, and funding should be contingent on performance. Making these reports publicly available will draw attention to any provincial government shortcomings. Public attention to quality of care will create pressure on provincial governments to take more aggressive actions. It will foster greater accountability and drive changes and improvements
• Ensure mechanisms are developed to enable the identification and sharing of best practices in long-term care delivery, as well as in facility operation and facility design 
• Be accompanied by significantly expanded federal funding for long-term care. The Parliamentary Budgetary Officer estimates that the annual cost of an effective long-term care reform plan is 13.7 billion dollars. This additional funding is necessary to leverage provincial co-operation in adopting and implementing national standards and participating fully in a national reporting system. It is also needed to give provinces and territories financial support in such areas as improving work force compensation and working conditions, which will be critical in meeting higher standards for quality of care.

Care Watch also strongly believes that comparable federal action is urgently needed with regard to homecare and community services. National standards for homecare and community services should be established and enforced as soon as possible. Along with standards, federal funding for homecare and community service needs to be significantly increased so that high quality home and community services can be made available on an accessible, inclusive, and equitable basis across Canada. We recommend that the federal government aim at achieving a national level of funding for homecare and community services that will put Canada in the top five OECD countries.

These bold federal actions on homecare and community services are needed for five main reasons:

• Homecare is a complementary and essential element of the broader system of care for older adults – a system that also includes long-term care and hospitals. Well resourced homecare services are critical to avoid unnecessary pressure on long-term care and hospitals and to enable them to play their intended roles more effectively in providing appropriate levels of care for older adults.
• Homecare supports the dignity of older adults by giving them flexibility, choice, and more control over their lives. Surveys have shown that more than 90% of older adults prefer homecare, when it is available, over other care options.
• Homecare is essential to implementing the principle of ageing in place because it enables older adults to receive support, remain in their preferred living environment, and maintain a high degree of independence and autonomy as long as possible. Accessible, good quality homecare is one of the most important requirements necessary to achieving an age inclusive community in which older adults can remain active and healthy.
• Homecare prevents or delays institutionalization with its associated loss of personal autonomy and increased governmental cost. When homecare is available, older adults can avoid the need to transition to a higher level of care until it becomes medically necessary. Moreover, because homecare involves ongoing client assessment and case planning, if transitions to a higher level of care become necessary, these transitions can be planned for and carried out more efficiently.
• Homecare is highly cost-effective. The operating and capital costs of homecare are a fraction of those of long-term care and an even smaller fraction of the operating and capital costs of hospital care. Funding for homecare needs to be increased sufficiently to make homecare accessible as a first option for those whose support needs it can meet. Substituting homecare for more expensive hospital and long-term care for older adults will reduce the overall costs of the system. This reduction in system costs will help free up additional financial resources that we know, based on current demographic trends, will be required to address expanding needs for long-term care and hospital services in the coming years.

Care Watch strongly supports the need to adopt national long-term care standards and to increase funding for long-term care in Canada. This is an important first step. However, we also believe that it is equally important to adopt national standards for homecare and community services and to significantly increase funding for these services. It is only through federal government action in both long-term care and homecare that it will be possible to achieve a national system of care for older adults that: (a) is highly responsive to the needs and preferences of older adults; (b) operates smoothly and effectively; and (c) is sustainable on a long-term basis.  

Yours Truly,

Fiona Green, Chair, Care Watch Ontario Board of Directors and John Bagnall, Project Lead and Director, Care Watch Ontario Board of Directors