The federal government is headed for a showdown with some of the big provinces over the idea of national standards for long-term care.

Amid devastation in the country’s long-term care homes — where the bulk of Canada’s COVID-19-related deaths have taken place and where the armed forces had to be brought in to assist — advocates, union leaders and researchers are urging Ottawa to make some funding to the provinces contingent on compliance with a set of national standards for care.

The increasing calls come as Prime Minister meets with provincial and territorial premiers Thursday to discuss health care and vaccine logistics.

The federal government signalled in its September throne speech that it would work with the provinces and territories on national standards for long-term care and reiterated that commitment in last week’s fiscal update.

But some provincial leaders have shown little enthusiasm for the idea, while others have been explicit in their opposition, seeing Ottawa’s potential involvement as an unnecessary encroachment in an area of provincial jurisdiction.

The premiers have been publicly pushing for increases to the Canada Health Transfer payments, money that Ottawa gives the provinces to help cover health care costs.

“Premier François Legault has always been categorical: the federal government should not be involved in the management” of the province’s long-term care homes, Ewan Sauves, a spokesman for Quebec’s premier, wrote in French in an email to the Star.

“If Mr. Trudeau wants to do his part regarding health, he should respect the autonomy of the provinces to make their own choices by increasing the health transfers.”

Ontario Premier Doug Ford has said what is needed to improve long-term care is an increase in funding.

“National standards won’t fix decades of underinvestment in our long-term care homes,” said Ford’s spokesperson, Ivana Yelich.

“The premier will continue calling on the federal government to ensure any commitment to increase the Canada Health Transfer takes into account these necessary long-term investments to support our most vulnerable seniors and those who care for them.”

It was a similar message this week from Saskatchewan Premier Scott Moe, who said in a statement to the Star his province already has “robust standards” for long-term care and is committed to hiring hundreds more staff.

“We should be given the flexibility to fulfil our priorities through the (Canada Health Transfer), not be bound by additional red tape and tedious reporting requirements above and beyond those already contained in the agreement,” Moe said.

The details of what national standards could look like depend on who you ask, but some overarching goals include improving recruitment and retention of qualified staff with better wages and benefits, ensuring that each resident gets a minimum amount of hours of care, and better data collection to assess the performance of each long-term-care home.

“We need to all start working together on improving a very broken system and it’s very disheartening when you see provincial governments pushing back like that,” said Sharleen Stewart, president of SEIU Healthcare, an Ontario union representing more than 60,000 front-line health-care workers.

Some premiers have been more open to the concept, including those of Nova Scotia, Nunavut and the Northwest Territories.

“If the federal government is going to provide funding for long-term care, it would make sense that they should know how it’s being spent,” said Nova Scotia Premier Stephen McNeil in a statement.

The Registered Nurses’ Association of Ontario has argued for standards to be modelled on what it calls its nursing home basic care guarantee — a staffing formula that would provide at least four hours of direct care per resident, per day. The Ontario government announced last month it would adopt such a staffing standard, but doesn’t expect to achieve it until 2024.

“This is a message for my premier and any other premier: stop the excuses that this is a provincial jurisdiction. It is, but we have all failed collectively, so now it’s time for national standards so this tragedy never happens again,” said RNAO chief executive Doris Grinspun.

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There may be provincial opposition, but the federal government is in a good position as it likely has a huge chunk of the public on its side in this debate, said Dr. Samir Sinha, director of health policy research at the National Institute on Ageing. He said the COVID-19 pandemic laid bare the chronic and dire situation in many of the country’s long-term care homes.

“This isn’t somehow a dirty little secret now,” Sinha said.

“If a province like Saskatchewan or Quebec says, ‘We are not going to join this national agenda, we want to do it on our own,’ then fine,” he said. “But I think a lot of citizens will say, ‘Wait a minute, you’re not doing a good job, so either you pony up the money or you take the federal government’s money.’”

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