Thank you for the opportunity to speak to the committee this evening.
The Canadian Association for Long Term Care is the leading voice for quality care in Canada. Our members deliver publicly funded health care services to seniors right across the country.
I will start by acknowledging the seniors who have died of COVID-19. Our hearts are with those families. I'm sure that you all join me in extending deepest condolences to them.
I'll also take this opportunity to thank our front-line health care providers, who have worked tirelessly and with great compassion to deliver the care that has been required.
As we reflect on COVID-19, we will take the time to understand what could have been done differently, but we believe the impact of COVID-19 on long-term care homes could have been mitigated if governments had been proactive in supporting the sector prior to this outbreak.
Some of the challenges I will be discussing today have been exacerbated by COVID-19 but really represent systemic issues our members have been raising for many years. I want to be clear that all types of homes have been affected by COVID-19 and each have had a different type of experience. This has been an extraordinarily difficult and painful time for everyone involved, including residents and families, the front-line staff, but those who operate long-term care homes as well. We just ask that the efforts of the nation continue to focus on rallying and supporting those who are in long-term care homes.
The differences in experience with the virus have been based on a range of factors. These factors have included infrastructure, the staffing situation in the homes both pre-outbreak and during, and how rapidly the homes have been able to access personal protective equipment and staffing support when they really needed that assistance.
In the early days of the pandemic, testing, the ability to cohort their residents, and infection control measures were focused on seniors and caregivers who showed symptoms. Infection control experts and public health scientists now understand that asymptomatic carriers are highly contagious and that the incubation period for COVID-19 is far longer than for other viruses. As a result, homes that were affected early by the virus seem to have been hit the hardest.
I'd also like to clarify some misconceptions. Any and all care that is provided in long-term care homes, whether that care is provided by a doctor, a nurse or another type of health care provider, is covered by provincial governments. Each province regulates long-term care a bit differently, but generally the homes receive a funding envelope for care, programming and staffing.
In Ontario, for example, the government funds all long-term care homes with highly prescriptive expenditures, which are audited through the government departments that oversee them, and the findings of those audits are always reported back to government. With every dollar that is allotted to nursing, to personal care and to food budgets that are specifically earmarked, if there are any dollars left over in those envelopes, they have to be returned to the provincial government; there is no profit on any of these funding envelopes.
In other areas of operation, the staffing levels are highly prescribed and the funding model is extremely complex. It's highly prescriptive, tightly regulated and monitored on a regular basis by each provincial government.
I will now speak to some of the systemic issues we have noted that we feel have been an exacerbating factor with COVID-19.
The first one is infrastructure. Many older long-term care homes have three- and four-bed wards. They do not have private rooms, and it makes it a challenge to implement cohorting and isolation measures. They generally have narrower hallways and there's only one centralized dining room in the majority of homes, which makes it much harder to socially distance residents appropriately.
The Public Health Agency of Canada released an interim guidance document on infection control for long-term care homes, and some of the guidelines such as restrictions to certain work zones and the use of single rooms for certain types of care are almost impossible for homes to implement across the board, especially in these older facilities. Any existing outbreak management plan that these older homes have, including the isolation of asymptomatic residents, is really hindered by inadequate space and the layout availability, and we can see just how devastating shared rooms can be in an outbreak.
We know that there are at least 400 long-term care homes across the country that require updating and some form of modernization. It is imperative that the federal government support this sector by providing access to existing federal infrastructure funding, and there are many ways this could be administered. We have also noted that Minister McKenna recently spoke about financial support for shovel-ready projects in the post-pandemic stimulus package. These projects, indeed, are shovel ready and we certainly could move forward quickly with federal support.
The other systemic issue that I would like to raise is with regard to health and human resources. This is a challenge that is facing this sector and is ongoing almost at a crisis level across the country. Attracting and retaining individuals for a career in senior care has become increasingly challenging, especially when preparing for the aging demographic transition that we're experiencing right across the country. We're caring for individuals who have multiple and complex conditions much more than we have seen in the past.
We are asking for a health and human resources strategy for the long-term care sector. This is desperately needed and it should focus on the right number, the right mix, the geographic distribution of providers, as well as an appropriate setting for providers to deliver the care in. Through the leadership of the federal government, there must be collaboration with the provinces, the territories and the long-term care sector to develop and implement a pan-Canadian health and human resources strategy.
In closing, there are systematic challenges that the sector has been grappling with for many years, which we have identified. This has been fully exacerbated by the event of COVID-19. We have asked before, and we are asking again, that the federal government provide assistance to the sector to ensure that seniors have the housing and the care they need, not just in a time of crisis, but every day.
I thank you for giving me this opportunity to speak, and I certainly look forward to questions.