Canada failed to protect elderly in first wave of COVID-19 — will the same mistakes be made again?

Long-term care facilities bore the brunt of the first wave of the pandemic in Canada, with more than 70 per cent of deaths from COVID-19 occurring in those aged over 80, about twice the average of rates from other developed countries.

“That is one of the most damning failures that’s taken place through the pandemic,” said Dr. Andrew Boozary, executive director of health and social policy for Toronto’s University Health Network. 

“If we were going to be judged by how we protected our most susceptible and people who are structurally vulnerable — we failed them.” 

Dozens of COVID-19 outbreaks have recently been reported in nursing homes in Ontario, B.C., Alberta and Quebec as the second wave arrives in much of Canada.

WATCH | Trudeau discusses the federal government’s role in long-term care:

In his address to the nation Wednesday night, Prime Minister Justin Trudeau said the situations experienced by “too many elders” in long-term care homes is “unacceptable.”

“That has to change and it will change,” he said. “We will be working with the provinces and territories to set new national standards on long-term care.”

But Canada’s systemic failures in long-term care are nothing new, and neither are the calls for action. 

Long-term care deficiencies a longstanding issue

A July report from the Royal Society of Canada, an association that includes some of Canada’s top scientists and scholars, described COVID-19 as “a shock wave that cracked wide all the fractures in our nursing home system.” It called on the federal government to act “immediately” on creating national standards of care.

Months later, no concrete action has yet been taken, and the second wave of COVID-19 infections is well underway in previously hard-hit provinces, such as Ontario, B.C. and Quebec.

On Friday, Trudeau conceded during a press conference that problems in long-term care facilities “existed long before COVID-19.”

“The systems that we had were inadequate all across the country,” he said. “They were not up to the task of protecting our seniors appropriately.”

But experts question why the process of fixing those systemic issues has only now just begun.

“The writing is on the wall that this had to happen yesterday,” said Boozary. 

“To not ensure that every measure, every resource is in place to protect these families and their loved ones — to me is just damning, it’s egregious.” 

The prime minister was quick to point out that long-term care is “very clearly a provincial jurisdiction,” adding that the federal government was busy helping the provinces “get the situation under control” early in the pandemic. 

“Whether it was sending in the military or the Red Cross or sending extra financial support to vulnerable health care workers, the federal government was busy acting,” he said.  

But Trudeau also said the need for national standards of long-term care only became clear to his government after “conversations with Canadians and the provinces” following the devastation caused in the first wave of the pandemic. 

Long-term care facilities unprepared for second wave

A group of major stakeholders in Ontario’s long-term care system sent a 60-page letter to Ontario Premier Doug Ford and the ministers of both Health and Long-Term Care this week calling for “immediate action” to protect the health of residents, staff and family members.

“In the absence of these measures and support from government, Ontario’s long-term care homes are not currently ready to manage a second wave of COVID-19,” said the letter, which was first reported on by the Globe and Mail.

WATCH | Canada’s prime minister on the country’s second wave of COVID-19:

“The recent surge in cases in Ontario and other provinces is a warning that we have little time to waste,” it stated. “We need decisive action now.”

Dr. Anna Banerji, an infectious disease expert and faculty lead for Indigenous and refugee health at the University of Toronto, said she’s not convinced Canadian long-term care homes have made the necessary changes to protect elderly residents in the second wave.  

“We don’t want to see the same kind of disasters that we were seeing in the spring where we had all these people dying and the people that were living were basically living in squalor,” she said. “If that occurs again, it’s a real failure.” 

Banerji said nursing homes need to ensure they have no more than one resident per room with individual access to their own bathroom, while staff should have adequate personal protective equipment and infection control training — something they lacked in the first wave. 

Dr. Aisha Lofters, a family physician and researcher at Women’s College Hospital in Toronto, said nursing homes also need to ensure staff aren’t putting residents at unnecessary risk. 

“In the early days, we saw a lot of people who were working in multiple long-term care homes, working part-time and casual, having to move from home to home to home,” she said.

“We saw the devastating effects of that.”

National standards of long-term care need enforcement

Dr. Naheed Dosani, a physician and health-justice advocate in Toronto, welcomes the creation of national standards for long-term care, but hopes those homes in violation of them will face serious consequences. 

“One of the things that we need to be aware of is that at least in Ontario, it was shown that for-profit homes especially had a higher proportion of deaths,” he said. 

Dosani said he wants the national standards to create a baseline for where care needs to be in nursing homes across Canada, so that seniors aren’t left to suffer the consequences. 

“They already suffered in the first wave. My hope is that they don’t have to suffer and less people have to die in the second wave,” he said. 

“Why would we allow this to happen in the second wave? The federal government has the ability to set that bar where it needs to be so that standard of care is met so that doesn’t have to happen again.” 

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