Regulation isn't a panacea for everything. It's part of the solution.
One of the things that has happened to us in residential care is that the population has changed quite dramatically over the last decade or decade and a half, but the provision of care has changed hardly at all. People used to come to a nursing home and often stay for eight or ten years.
When we started our study five years ago, they stayed an average of 18 months. Four years later, they were staying an average of 12 months, so we're being quite successful in the community, but they're coming in very late in the trajectory so they're more complex, and we haven't changed the model. As a matter of fact, if anything, the model has become worse in many ways in terms of staffing, because the retention issue has become very big in nursing homes.
In Alberta, where I'm from, when the economy is as hot as a pistol it's very difficult to staff these environments compared to when it slows down, so it's very cyclical. The providers are doing the best they can, but we also have a mixed model of provider in long-term care that we don't have in the publicly funded acute care system. We have private for-profit, public, and voluntary faith-based organizations, so we have a number of models also mixed into this.
We think that if we could even count the unregulated workers, that would be a beginning. If we could look at minimum educational standards, minimum training standards, and if we could look at some kind of minimal re-certification standards or something analogous to that in the industry, it would help. It wouldn't solve everything, but it's a beginning.
If we could look at the sorts of standards that ought to be in place around.... We haven't really addressed end-of-life care in these organizations, which is a bit different from palliative care. A palliative care model can be very expensive, but nursing homes are end-of-life care environments now, and we haven't really addressed how that looks different from what we used to do for mom and pop 20 years ago in a nursing home.
There are a lot of things we can do without regulating ourselves and painting ourselves into a corner from which we can't escape. I mean, we have to be cautious about regulation.