It’s not elective!

Few of us have been left untouched by the tragedy of unnecessary COVID-19 related deaths in long-term care settings which have touched Ontario and Québec especially hard in the past weeks.  This tragedy was preventable.  Canadians who have or have had a loved one in a long-term care facility know that the system is broken. 

Atul Gawande in his brilliant book Being Mortal: Medicine and What Matters in the End reminds us of the untold suffering Western models of medicine and health have unleashed in the institutions which are designed to provide care for the frail elderly.

I am hopeful this crisis will lead us to demand real solutions to this problem.  But how should we frame this problem?

Does it matter whether the organization delivering long-term care is a profit-seeking firm, a nonprofit, or a public one? 

Does the responsibility for this crisis lie with the weak provincial and territorial regulatory frameworks and problems of system-wide governance?

Yes, those things do matter.  And, yes, we need urgent changes to system-wide governance and regulation.  But, without more funding, the problem will not be fixed.

Without more funding, good pay and adequate levels of staffing will not be possible.  And, facilities designed to meet today’s expectations for isolation when required, for privacy, and for spouses requiring different levels of care to live under one roof also need urgent investment.

I was inspired by a CBC Radio Interview on April 27 with Colleen Flood of the University of Ottawa’s Centre for Health Law, Policy and Ethics.  She discussed the Scandinavian model of a mandatory insurance scheme for long-term care which provides a good basic level of funding for everyone needing care at home or in institutional settings.  A separate mandatory public insurance scheme would ensure resources are not co-mingled with the broader consolidated tax revenues and may thus broaden the appeal of such an approach.

I am hopeful that this crisis will inspire us to dream big in fixing a broken system of long-term care.