Color & Control:

Excellence in LTC

A careful balancing act

By Dr. Ashley Flanagan and Dr. Samir Sinha

The pandemic has amplified long-standing and pervasive issues and challenges within Canada’s long-term care (LTC) settings. In response to the federal government’s commitment to improve, the Standards Council of Canada (SCC), Health Standards Organization (HSO), and Canadian Standards Association (CSA Group) have come together to develop two new complementary National Standards for LTC focused on the both the design and operation of homes and the delivery of care and services within homes by the end of 2022.

The National Standard being developed by HSO will focus on the provision of resident-centred care practices that value the importance of respect, dignity, trust, and quality of life; safe, reliable and high-quality care based on evidence-informed practices; and a healthy, safe and competent workforce to ensure sustainable, team-based, compassionate care. At the core of this work for the HSO LTC Services Standard Technical Committee—the group tasked with leading the development of its new National Standard—has been continually engaging with thousands of Canadians for over a year on what matters most to them when it comes to the delivery of long-term care.

This commitment to hearing the diverse needs and voices of Canada’s LTC home residents, families, workforce, and members of the general public has guided HSO’s approach to public engagement efforts. To date, HSO has already heard from over 18,400 people through its 2021 Inaugural National Survey on LTC (Phase I), Consultation Workbooks and Town Halls (Phase II), and Public Review. In Phase I, we heard that “ensuring the provision of high-quality care” in Canada’s LTC homes is a top priority. Building on the feedback from HSO’s Phase I engagement activities, HSO aimed to facilitate deeper engagement in Phase II, welcoming additional perspectives on what an optimal future state of LTC ought to look like in Canada.

During Phase II, we were honoured to have received 392 Consultation Workbook submissions (total of Individual and Roundtable workbook submissions), from 1,805 people, including:
• 44% of individual workbook respondents self-identified as being part of the LTC workforce;
• 42% self-identified as a Family Member, Friend, or Unpaid Caregiver to a LTC Home Resident
• 4% self-identified as being a LTC Home Resident.
• 22% of roundtable workbook respondents self-identified as being part of the LTC workforce;
16% self-identified as a Family Member, Friend, or Unpaid Caregiver to a LTC Home Resident
• 8% self-identified as being a LTC Home Resident. 

We also spoke to 179 people from across the country through virtual Town Halls–designed to gather additional input. When asked what the future of LTC should look and feel like, individuals who shared their perspectives felt that high-quality care is the outcome of providing safe, reliable, and compassionate care. In other words,

Safety + Reliability + Compassion = High-quality Care

Building upon the key findings from Phase I, Phase II engagement participants also noted that the key contributing factors differ depending on one’s relationship to LTC. 

For residents: Home and Individualization. When it comes to home, many engagement participants felt that an important component of high-quality care is acknowledging and respecting that the LTC home is, in fact, a resident’s home. Hand in hand with emphasizing the “home” in “LTC home” is the importance of being able to receive individualized care and support. For engagement participants, individualization is at the heart of high-quality care as it places the residents’ wants, needs, and desires at the centre of care. 

For families: Transparency and Trust. Transparency, for engagement participants, looked like open channels of communication between families and care teams (including leadership) with respect to the care of their loved one(s). Beyond direct communication, transparency also refers to public reporting by LTC homes/organizations. Alongside transparency, engagement participants also felt that a key component of high-quality care is trust. In particular, families should be able to trust that their loved one(s) are safe and being supported. 

For the LTC workforce: Having Time to Provide Care and Feeling Valued and Supported. According to engagement participants, individuals who are part of the LTC workforce require more time to provide safe, compassionate, and resident-centred care. An additional key component in the provision of high-quality care is ensuring that the LTC workforce feels valued and supported through equitable salaries and benefits, employee appreciation initiatives, and opportunities for career advancement.

The way that perceptions of the key factors that contribute to high-quality care differ depending on one’s relationship to the provision of long-term care demonstrates that ensuring safe, reliable, compassionate, and high-quality care in a LTC home is a careful balancing act.

As we consider the future of long-term care in Canada, specifically how to best balance the key considerations, we offer some ideas and insights that consider pathways to immediate change and a reimagined future of resident-centred care:
• Evidence-based practices
• Staffing
• Funding
• Accountability

Beyond the considerations for enabling the balancing act of LTC for facilitating the transformation include:
1) Addressing the stigma associated with both ageing and long-term care will help to rebuild trust in the provision of long-term care within Canada.
2) Building collaborative networks of care between all care sectors, where care provided in LTC homes is one possibility in an array of options for providing the right care in the
right place at the right time (i.e., a true continuum of care).
3) Acting on the criteria included in HSO’s new National LTC Services Standard will help to move the dial from small tweaks (with minimal impact) towards system transformation.

Dr. Ashley Flanagan is Research Fellow at the National Institute on Ageing. 

Dr. Samir Sinha is Director of Geriatrics, Sinai Health and University Health Network in Toronto, and Chair of HSO’s National Long-Term Care (LTC) Services Technical Committee.

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