Time to free Canada’s long-term care system from its backward history

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The COVID-19 pandemic has exposed the failure of Canada’s long-term care (LTC) facilities. A review of history, however, suggests that our response to senior care has needed improvement for a long, long time.

For centuries, families traditionally took care of their elders. For families unable to do so, and for elders without the means to care for themselves, the historical alternative was the almshouse or poorhouse (both now thankfully obsolete).

Introduced to North America in the 17th century by English settlers, the function of these houses was to provide shelter for those who couldn’t support themselves, suffered mental illness, or were orphaned or elderly. Living conditions were often substandard, being financed by local communities with little to no regulation. It wasn’t until the Municipal Institutions Act, enacted in Upper Canada in 1866, that municipalities and provinces were required to inspect and regulate these institutions.

Operating alongside the almshouses of the late 18th and 19th centuries were privately supported boarding houses for the elderly. In her 1977 paper “A History of Long-Term Care Facilities for the Elderly in Canada,” Barbara Emodi described a two-tiered system of public almshouses and privately owned “boarding houses” for seniors. Wealthier families would keep elders at home, often soliciting outside care support. If that was impossible, a family could make arrangements for care to be provided in a private boarding house. Poorer elders and families relied upon public institutions. This is not unlike the current system of private and public LTC facilities.

Eventually the boarding houses evolved into private hospitals, which sprang up all over the country in the 1920s and 1930s—the grandparents of today’s nursing homes and LTC facilities. Being under the jurisdiction of provincial governments, standards varied from province to province. Even today, provision of LTC falls to provincial and territorial governments; a current bone of contention.

Advocacy groups, including the Council of Canadians and the Canadian Labour Congress, are petitioning the federal government to bring LTC under the scope of the Canada Health Act. Spurred by the thousands of deaths related to COVID-19 in Canadian LTC facilities, these groups are asking the federal government to work with the provinces and territories to create strategies and standards of care to protect seniors in LTC and the staff members who work with them. But requests like this one are not a new development.

Throughout the 20th century, the federal government provided few guidelines and little to no funding for LTC. In 1966, the report of a Senate special committee on aging noted that Canada’s health policy was preoccupied with parent and child healthcare to the exclusion of other age groups, particularly the elderly. With just 3 percent of the population then over 75, senior care was not a politically urgent or advantageous issue for the federal government at the time.