Lawrie McFarlane: Federal quality standards for long-term care homes are a pipe dream

Researchers at the Canadian Centre for Policy Alternatives, a left-leaning think tank, are calling on the federal government to impose quality standards on long-term care facilities.

They are, in effect, demanding the government do as it promised in its September throne speech. On that occasion, Ottawa undertook “to work with provinces and territories to set new, national standards for long-term care.”

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Specifically, the researchers want to see minimum staffing levels established, wait times for admission reduced, and a guarantee that 70 per cent of staff will be permanent employees.

There’s a lot more where that came from, but it can be summarized as follows: Ain’t never gonna happen.

The first problem is that the federal government has no constitutional power to force such an obligation on the provinces.

The researchers attempt to get around this by arguing that Ottawa has the right to set standards for any health-care program it funds. That’s effectively what happened in the case of hospital and physician care.

But on that occasion, the federal government had already negotiated an arrangement with the provinces to the effect that if they undertook to deliver universal health care, Ottawa would pay for half.

That is to say, the project wasn’t imposed by fiat. The provinces agreed voluntarily to become involved in exchange for federal funding.

The second problem is that Ottawa didn’t keep its word. Federal funding for medicare today is less than half what was pledged.

Every premier in the country knows this. can promise the sun and the moon, but no one’s going to buy it.

The third problem is that there are hugely different systems of long term care across the country. While some of this is accidental, most of it reflects important differences in the way various regions manage social services.

Sorting this tangle out would take years.

Lastly, and this is true of nearly every social program, the availability of government funding varies greatly between regions.

Characteristically, the Atlantic provinces, ever strapped for cash, cannot afford the kind of infrastructure you find in the more affluent provinces. A simple illustration: Nationwide, the standardized death rate per hospital is three per cent better than the average among western countries.

But in New Brunswick it is 15 per cent worse, in Newfoundland 16 per cent worse, and in Nova Scotia, 20 per cent worse. Some of that is caused by unhealthy lifestyles.

But unavoidably some of it is due to less sophisticated treatment facilities.

Supposing the other problems could be sorted out, trying to fix this last one is well-nigh impossible.

It would be necessary to top up subsidies to the poorer regions, such that each could meet the national standard. But there would be a huge food fight over who gets what, and who pays for it.

The reality is that Canada is a federation of 10 largely independent provinces, each conscious of its own unique identity, and answerable not to a national audience, but a local one.

Anything Alberta agrees to, Quebec will not. Anything Ontario can afford, Newfoundland cannot.

Add the fact that every government in Canada is facing massive COVID-related deficits, and the sad truth is that 2050 will arrive before the country can afford another major social safety net program, vague and airy promises notwithstanding.

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