How to fix a national embarrassment

COVID-19 has proven highly contagious and cruelly lethal for elderly patients−characteristics that seem specifically engineered to wreak havoc on nursing homes, as attested by worldwide mortality figures. Yet Canada’s experience has been “uniquely bad,” laments Michael Nicin, executive director of the National Institute on Ageing (NIA) at Toronto’s Ryerson University. “With 82 per cent of all COVID deaths in Canada occurring in long-term care homes, we are unfortunately leading the world in this regard.” So how do we fix this national embarrassment?

The scathing report by the Canadian Armed Forces into conditions at five Ontario nursing homes, where soldiers provided emergency support, has been a clarion call for change, and point to significant issues, both urgent and heartbreaking, in working conditions and preparedness. Many of the homes were overwhelmed and understaffed as a result of the coronavirus, and a key transmission mechanism for the virus has been workers with jobs at multiple homes. British Columbia’s early move requiring personal service workers to commit to a single worksite may explain the dramatic difference between the nursing home death toll in B.C. and those in Ontario and Quebec.

Long before the coronavirus hit, the cost of providing care for Canadian seniors beyond regular health care had been going up. Annual public spending on long-term care facilities and home care currently stands at $22 billion a year, and the NIA projects this will hit $71 billion by 2050 as demographics shift. Add the value of unpaid family care, and the total could hit nearly $100 billion.

READ: A long-term care disaster that everyone saw coming

Fixing problems in nursing homes now means we can expect the overall price of long-term care to grow substantially above those estimates, accompanied by newer costs such as those associated with “hero pay” bonuses and a rising global demand for health-care employees. Coping with these new costs will be made more difficult by massive federal and provincial deficits in the wake of the economic lockdown. But we must be pragmatic. Demands to nationalize for-profit long-term care are impractical; private businesses currently comprise more than half the sector in many provinces, and it’s impossible to contemplate taxpayers assuming such a huge burden. It also appears that a reliance on multi-bed wards, not ownership or ideology, has been driving the shocking death rates in Canada’s nursing homes; and converting these units into private or semi-private rooms will require even more funding and capacity.

One solution is to ask Canadians to do more to save for their own future needs through a mandatory scheme similar to the Canada Pension Plan (CPP). In Germany, for example, workers face a long-term care insurance payroll tax of 2.55 per cent, with an additional fee for childless adults. While an interesting concept, such a charge would be on top of the current CPP rate of 5.25 per cent; that’s a steep bill, and shifts much of the burden onto future generations. (In Japan, this insurance is only paid by those over 40.)

Alternatively there’s Denmark, which seeks to keep nursing home costs down by allowing seniors to live at home for as long as possible. Danish seniors are encouraged to age in place through a wide range of in-home care services, including mandatory visits by health-care professionals after age 75. Not only does this provide dignity and choice, it has allowed Denmark to keep a lid on capital expenses—Nicin notes the country didn’t build a new nursing home for nearly 20 years. But high-touch home care isn’t cheap either. Denmark spends 50 per cent more, as a share of GDP, on caring for its elderly than Canada. Whatever the solution, taxpayers should prepare for a bigger seniors bill.

Finally, any comprehensive solution will have to navigate the complications of Canadian federalism. But, despite all the obstacles, Nicin sees reason for optimism. “There’s been a political awakening that we can’t keep going down the same path,” he says. “It is no longer acceptable to spend the bare minimum protecting our elderly. We will have to do better.”

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This article appears in print in the July 2020 issue of Maclean’s magazine with the headline, “Urgent care.” Subscribe to the monthly print magazine here.