Long-term-care standards must be mandatory

If Justin Trudeau’s Liberals want it, they have been given a chance to fix long-term care.

The chance comes in the form of a just-released report making recommendations for voluntary changes to a system that has been in crisis for decades.

At the best of times, long-term care was viewed as the weak sister of the health-care system. But it took the COVID-19 pandemic to reveal its true fragility. Nursing homes were devastated by COVID. They became horror stories — places where, in effect, residents were expected to die.

In Ontario and Quebec, the army was called in to deal with the sheer squalor of the system. Residents weren’t bathed. In some nursing homes they weren’t even fed. They were kept from seeing family members.

Ostensibly, this was to protect residents from the COVID virus. But the real effect was to ensure the total isolation of long-term-care residents. To be given a bed in the long-term system was like being handed a sentence of death.

If a nursing home patient required medical services — such as an X-ray — the request was typically denied.

Nursing homes were begrudged anything that might give them an edge in the ongoing war against the virus. Death rates soared for those over 80.

In Ontario, nursing homes were technically subject to government regulation and inspection.

But in reality they did as they wished, secure in the knowledge that government inspectors would never have the time to check up on them.

All of these weaknesses were well-known even before the pandemic struck. But COVID revealed the contradictions of the system in a way that was impossible to ignore.

People felt guilty about the way the virus had treated the elderly. For a brief period, politicians vied with one another to determine who was most sympathetic to the elderly.

This was the context in which the Trudeau Liberals promised to come up with national standards for long-term care.

Those proposed standards were revealed this week. They are not radical.

More to the point, they are not mandatory. That is to say they can be easily ignored by both the long-term-care industry and the country’s provincial governments.

But what if the federal government threw a curveball into the package and made them mandatory?

It could do so by wrapping a long-term-care package into its current plan to increase healthcare spending.

That plan consists of two parts: a core spending portion to cover Ottawa’s share of medicare proper; and bilateral plans to negotiate ancillary spending schemes with individual provinces.

The federal government could present its long-term-care proposal as one of these ancillary schemes whose payment is contingent on provinces meeting national standards.

So Ontario, for instance, might be eligible for two payments: one to cover Ottawa’s share of core medicare spending; and one to cover Ontario’s commitment to set and enforce national standards for long-term care.

These standards may not even be that onerous initially. The point would be to commit the federal government to the idea of a new national social program.

That wouldn’t be such a bad thing. People might even vote for it.