There has been growing public pressure to ensure that long-term care services meet the needs of Canada’s population effectively and sustainably. While the demand for LTC services in Canada is only expected to grow due to the ageing population, whose care needs are becoming increasingly complex, the reliable delivery of high-quality, safe, resident-centred care continues to be compromised by a complex and vulnerable system. Reports have underscored the need for system-wide improvements—a need that became painfully obvious during the first wave of the COVID-19 pandemic, when 80% of Canada’s deaths occurred in LTC homes, a rate twice the OECD average. In Canada, LTC is neither publicly guaranteed nor insured under the universal health coverage model. Further, LTC services are governed by provincial and territorial legislation, so there is variation across the country in what services are offered, how care is assessed, what costs are covered, and how facilities are governed. The administrative and funding variations in LTC have also contributed to notably lower wages in LTC as compared to other sectors, which has left LTC homes understaffed without the skill mix required to provide the quality of care residents need and deserve. HSO had a previous standard for long-term care, first developed in 2011. With the national call for new measures, funding, and commitments to improve the overall system, HSO saw the opportunity to create a new national standard that reflects where Canada needs to move in the provision of LTC.

Older people in general, Older people with chronic health conditions or disability, Older people with vulnerabilities, Both older and younger people

Health, Long-term care

Government, Civil Society Organization, Older People's Association, Academia, Health Care, Social Care, Private Sector

Older people were part of the process at multiple or all stages

The Standards Council of Canada (SCC), a federal Crown corporation that oversees the development of standards in Canada, selected HSO and the Canadian Standards Association (CSA Group) to develop two new complementary standards for LTC. HSO’s standard addresses the delivery of LTC services, and CSA Group’s standard addresses how LTC homes are built and operated. The two organizations worked together throughout the development of the standards to ensure the standards were aligned and did not overlap, both following the standards development process established by the SCC. HSO and CSA Group also worked collaboratively to keep federal and provincial/territorial governments informed throughout the development of the standards through a Government Advisory Table that met bimonthly. HSO also worked with the National Institute on Ageing (NIA), who analyzed the feedback gathered through the public engagement activities in the development of the standard to create three What We Heard Reports to accompany the standard. The NIA also conducted 45 evidence reviews that informed the standard. HSO worked with the Canadian Institute for Health Information (CIHI) to ensure that the standard aligns with data indicators currently gathered and analyzed by LTC homes across the country through CIHI. And HSO is working with Healthcare Excellence Canada (HEC), an organization funded by Health Canada, to align their quality improvement initiatives for LTC homes with the standard. Finally, many organizations contributed to the development of the standard by providing their feedback through participating in public engagement activities.

Currently, 68% of Canada’s LTC homes are accredited by Accreditation Canada, and will be transitioning to using this new standard. The standard is also being provided to the public at no fee, meaning that every LTC home, whether or not they are participating in Accreditation Canada’s program, can use the standard as a guide and benchmarking tool to improve their provision of resident-centred, high-quality care. The standard is also a resource for residents, their care partners, and members of the public, especially older people who might be moving into an LTC home in the future, to understand what is expected in an LTC home and enable them to advocate for the care they deserve. Written in plain language and supported with evidence and rationale, the standard can also support advocacy efforts for more funding, enhanced jurisdictional requirements and professional regulations, and other enablers for high-quality long-term care. In addition, the standard serves as an educational tool for the workforce and those training to join the LTC sector, providing them with a comprehensive overview of the standard of excellence all LTC homes should aim to meet. Additionally, HSO’s three What We Heard Reports have been made available to the public for free. The reports summarize the feedback heard from over 18,800 Canadians on what LTC should look like, providing the results in plain language to make the information accessible to all readers and support advocacy efforts for improved LTC.

The standard was developed during the COVID-19 pandemic, and therefore HSO had to exercise particular care in gathering feedback from the public, especially from the target population of older persons and LTC home residents. To address this concern, HSO used virtual public engagement methods, however engaging groups such as older persons, LTC home residents, and persons with disabilities was challenging to do virtually. To address this challenge, a variety of engagement methods were used. For example, HSO hosted town halls to gather feedback verbally from those who might not be able to provide written feedback easily. HSO also released consultation workbooks that could be printed by LTC home staff, care partners, or others and then distributed and completed by those who might not have easy access to technology. In addition, HSO hosted virtual one-to-one visits with LTC residents to gather feedback in a non-structured, conversational format that was more adapted to the needs of this group. HSO’s technical committees are typically comprised of 16-20 members; however, the technical committee for the national Long-Term Care Services standard was comprised of 32 members to ensure as many perspectives and experiences were represented as possible. Drafting a document such as a standard with this many experts was challenging at times, and this was addressed by splitting the technical committee into three working groups to tackle specific topics, and by hosting bi-weekly virtual meetings to move the work forward.

Providing excellent long-term care requires the careful balance of multiple forces, including the reality of the LTC home environment as both a home and a workplace, the rights and choices of individual residents and the need to protect the well-being and safety of the collective, and approaches to providing care that ensure consistency and continuity through the use of standards while respecting individualization. Appropriate staffing levels based on the needs of the residents in the LTC home are essential to providing high-quality, resident-centred care. In addition to appropriate staffing levels, offering more full-time permanent employment can help ensure consistency in staff, which can improve the quality of care and quality of life of residents. The provision of care within LTC homes needs to be transformed and understood as a highly sought after, competitive, and specialized career. The public, the health care system, and governments need to understand the significant aptitudes and level of specialization members of the LTC workforce require to provide care. This is particularly relevant given that the LTC workforce is often paid less than they would be in equivalent positions in other settings such as hospitals.

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