Devora Greenspon, 88, a resident at a long-term care facility in Toronto, in her room on Feb. 26, 2021.TARA WALTON/The New York Times News Service
The elder care systems in Canada and Australia are remarkably similar in both their structures and failings.
The two countries share another dubious distinction: In both jurisdictions elders have disproportionately suffered the most during the COVID-19 pandemic.
Almost 80 per cent of Canada’s pandemic deaths have occurred in institutional settings such as nursing homes and retirement homes; in Australia, it’s about 70 per cent.
(Mind you, the scale is different; as of Monday, Canada’s population of 37.7 million had registered 22,859 deaths, while Australia, a country of 25.7 million, had only 909 COVID-19 deaths.)
The other trait the two distant Commonwealth countries share is a love of inquiries and royal commissions.
You can bet that Canada will soon have more public inquiries than you can shake a stick at examining the pandemic response, and the disaster in long-term care in particular.
But before we go too far down that bureaucratic road, we should turn our attention to the findings of the Australian Royal Commission Into Aged Care Quality and Safety.
The commission, which began its deliberations in 2018, well before the pandemic hit, has recently published its final report, titled Care, Dignity and Respect.
The conclusion of the massive 2,800-page, eight-volume opus can be summarized in a single sentence from the introduction: “People receiving aged care deserve better.”
How better can be achieved is spelled out in the report’s 148 recommendations, almost every one of which should be adopted by Canada.
The overarching change the commissioners call for is a philosophical one, shifting to a rights-based approach from a ration-driven one.
In both Australia and Canada, hospital and physician care are fully covered by medicare, but long-term care and home care are not. The result is ration and inequity: There are long wait lists for subsidized care, and people who can pay get better access.
The approach proposed by the Australian commission is legislative, creating an Aged Care Act that enshrines the right to universal access to care. The equivalent in Canada would be making long-term care and home care “medically necessary” services under the terms of the Canada Health Act.
The major themes tackled in the Australian commission recommendations are the same ones now at the top of the Canadian health policy agenda – standards of care, staffing and funding.
In Australia, the impetus for reform was damning media exposés about abuse and neglect, while in Canada it was the massive number of elders felled by the pandemic.
In long-term care, the commission recommends mandating a minimum of 200 minutes of one-on-one care daily, including 40 from a registered nurse. (In Canada, the push is for 240 minutes, with 48 minutes from an RN.)
Employees look on from the windows as frontline long-term care workers from Toronto's Sienna St. George and their union, SEIU Healthcare, protest to demand that Sienna, a for-profit long-term care corporation, invest more into resident care in Toronto on Jan. 7, 2021.CARLOS OSORIO/Reuters
There are calls for better training of personal care workers (known as care aides and personal support workers in Canada), as well as improved pay and benefits.
The commission says long-term care should shift from large prison-like institutions to a “small household model of accommodation.” (Both Australia’s and Canada’s systems have their roots in the penal system, not the health system.)
The Australian report repeats an oft-heard cry to shift way more resources to home care. Australia has a wait list of more than 100,000 people for home care; Canada doesn’t even bother counting, but the number is likely as high. Those on wait lists for home care end up being funnelled to long-term care homes or even hospitals, and rarely return home.
So how do we pay for all this?
In Australia, the two commissioners were divided on this contentious issue. One said there should be a separate tax; Australians pay a medicare levy of 1 per cent to 1.5 per cent of income. The aged-care levy would be another 1 per cent. The other commissioner suggested a “productivity commission” be established to determine adequate funding. The committee would determine how much money is needed to provide the legislated standard of care.
What they did agree on is that, after years of neglect, more funding is required from the state and, when individuals do have to contribute, the rules for means-testing have to be “simpler and fairer.”
The same is true in Canada and so, too, is the need for transparency, making clear what services are available to whom at what cost.
That about sums it up.
So, instead of appointing yet another commission to recommend what we already know, Canada would do well to download a few copies of Care, Dignity and Respect and, instead of more pondering, start with some actual implementation of reforms.
Dignified, respectful care is needed now. Our elders can’t afford to wait any longer.