It would be hard to imagine a more policy-applicable report produced at a more optimal time. Ever. With funding from the Social Science and Humanities Research Council, Professor Pat Armstrong has co-authored a report for The Canadian Centre for Policy Alternatives (CCPA): “Re-imagining Long-term Residential Care in the COVID-19 Crisis.”

With this publication, Armstrong and her co-authors bring their expertise to build new tools and strategies to address the historic crises we are currently facing.

“A major gap in our Canadian universal system is long-term residential care or what are more commonly called nursing homes. In our report, we draw on the lessons for the pandemic, from the research done by us and others, to suggest what we can do and should not do now, and what we should plan for in the future. The importance of universal, publicly funded, accessible health services has never been clearer,” Armstrong emphasizes in the report.

A Distinguished Research Professor in Sociology, Fellow of the Royal Society of Canada and a driving force for positive change, Armstrong is a York University treasure. For more than three decades, she has produced exceptional books and articles on the Canadian healthcare system, shining a bold light on systemic weak spots. Her work focuses on the fields of social policy, women, work and the health and social services; and makes the relationship between paid and unpaid work central to the analysis.

Armstrong has published widely, co-authoring and co-editing such influential books as Wasting Away: The Undermining of Canadian Health Care (Oxford University Press/OUP, 2010); “Heal Thyself:” Managing Health Care Reform (Garamond Press, 2000); and Unhealthy Times: Political Economy Perspectives on Health and Care in Canada (OUP, 2001).

Publication sought to find “ideas worth sharing”

This latest publication, co-authored with Hugh Armstrong, Emeritus, Carleton University; Jacqueline Choiniere, Faculty of Health, York; Ruth Lowndes, Research Associate, York; and James Struthers, Emeritus, Trent University, had a clear goal: “to identify promising practices for treating both residents and care providers with dignity and respect and for allowing them not only to stay safe but also to flourish.”

The researchers wanted to unearth “ideas worth sharing, ideas that could help make nursing homes a positive option rather than the last and least attractive one,” the report states. The researchers spoke of promising rather than best practices to allow for flexibility because what works well in one jurisdiction may not be effective in another area or for another group.

Researchers started with five key assumptions

The research team began this work with an important set of assumptions, gleaned from existing research, much of it their own. This truly helps to establish context.

1. The conditions of work are the conditions of care. Armstrong explains: “Staff can’t focus on residents if the conditions don’t now allow them the resources, the structures, the support, the time, and the capacity to do so.”
2. The social determinants of health – that is, housekeeping, dietary, laundry, clerical and recreation services – are essential components in care.
3. The labour in nursing homes includes paid and unpaid work undertaken not only by staff, families and volunteers but also by paid staff who assume unpaid work.
4. The majority of this labour is carried out by women, many of whom are racialized and/or new to this country.
5. Care work is skilled work, and those doing the work require ongoing education and training for the nursing home environment.

Concrete, pan-Canadian recommendations for both short- and long-term

After a fulsome analysis of existing research, the team identified many promising practices and some principles that could apply across the country. The researchers brought forward short-term recommendations, including:

• Make all staff permanent and limit their work to one nursing home;
• Raise staff wages and benefits, in particular sick leave;
• Provide COVID-19 testing for all those living, working or visiting in homes;
• Deliver hands-on training for all those entering nursing homes;
• Guarantee access to protective equipment; and
• Limit transfers from hospitals.

In the long term, Armstrong’s team has concrete suggestions for policy-makers. They should:

• Stop privatization and work towards removing profit of long-term care facilities in Canada;
• Better integrate long-term residential care into the broader public health care system, through legislation like the Canada Health Act, with the goal of developing a universal public long-term care plan that is sufficiently funded and accessible to all;
• Ensure that protective equipment is stockpiled for the future;
• Build surge capacity – this refers to the ability to evaluate and care for a markedly increased volume of patients – into labour force planning and the physical structure of facilities; and
• Establish and enforce minimum staffing levels and regulations.

Findings profile on the current state of regulation

More than anything, this work brings to the fore the glaring faults in the regulatory system. “Regulations should promote good care, prevent problems before they may occur and protect residents and staff,” Armstrong points out. “However, the pandemic has exposed the lack of regulations which would prevent putting profit over resident and staff care.”

Report underscores a sense of urgency

This comprehensive report contains a sense of urgency. “The COVID-19 crisis calls for extraordinary and immediate measures. Some of the most vulnerable live in what are commonly called nursing homes where people require 24-hour care. Those providing paid and unpaid care are particularly vulnerable as well.”

She hopes that policy-makers and government stakeholders take note. Their how-to plan has arrived.

To read the CCPA report, go here. The CCPA is an independent, non-partisan research institute concerned with issues of social, economic and environmental justice. It is one of Canada’s leading progressive voices in public policy debates.

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By Megan Mueller, senior manager, Research Communications, Office of the Vice-President Research & Innovation, York University, muellerm@yorku.ca