Update: ARPA Canada also provided a written submission on the importance of resident-focused care to the Ontario Standing Committee on the Legislative Assembly. You can find that submission here.

The Ontario government has introduced a massive bill it hopes will address some of the issues with long-term care in the province. Many of the weaknesses in the system were longstanding, and advocacy groups have long been calling for change and improvement. But after the staggering number of deaths and horror stories coming out of long-term care homes during the pandemic, it seems the time is finally right for a change. Bill 37 seeks to make those changes by repealing and replacing the existing long-term care homes act and amending various existing acts to better protect the rights of residents and families served by long-term care.

All the major parties in Ontario have called for improvements to the long-term care system. Although some are happy to see changes, others are calling for even greater improvements. There are several policies included in Bill 37 that mirror recommendations made in our Elder Care policy report, though there are a couple of additional suggestions that we would have liked to see included.

Things to support

The best part of Bill 37 is a strong Residents’ Bill of Rights. A new addition to these rights is the “right to be provided with care and services based on a palliative care philosophy” (p. 9, Bill of Rights #25). This focus on helping people live well contrasts directly with the euthanasia mindset of helping people die. As we laid out in our policy report on Palliative Care, the palliative care approach is to deal with total pain – all aspects of suffering, so that a person can live as well as possible while neither prolonging their life nor expediting their death. This is a resident-focused approach, and a positive policy to support.

The Residents’ Bill of Rights also starts with a strong statement that every resident has “the right to be treated with courtesy and respect and in a way that fully recognizes the resident’s inherent dignity, worth and individuality, regardless of their race, ancestry, place of origin, colour, ethnic origin, citizenship, creed, sex, sexual orientation, gender identity, gender expression, age, marital status, family status, or disability” (p. 8, Bill of Rights #1). This statement supports the truth that everyone is made in God’s image, and equally worthy of respect and care. Dignity, contrary to what euthanasia supporters believe, is not something that can be lost.

Residents’ Right #6 clarifies that every resident has the right to “receive visitors of their choice,” and #26 adds that anyone who is dying or very ill has “the right to have family and friends present 24 hours per day.” (p. 9) This rightly recognizes that relationships are vital to health and well-being.

Additional recommendations set goals on staffing levels and hours of care, seeking to increase staffing ratios and the number of daily direct care hours for all long-term care residents. Given the complex care needed in these homes, these changes are much needed and it is good to see clear targets with a concrete timeline.

This bill also continues to support private long-term care. Though some groups call for the elimination of privately run long-term care facilities as an answer to issues in long-term care, the fact is that non-profit, for-profit, and government-run care homes can all offer excellent care. The government is right to ignore calls to eliminate private care and takeover with a single government-run approach. As we discuss in our Elder Care policy report, governments should respect and support the value of choice in long-term care, particularly care homes that meet the unique spiritual and cultural needs of citizens.

Things that could be added

Despite the hefty size of Bill 37, there was a notable absence of a plan to protect the rights of residents in extreme circumstances, such as a pandemic. Policies like allowing family caregivers access to their loved ones in such a time are not well laid out. Family needs to be recognized as an integral part of the long-term care system, and their presence should be prioritized in any visitor access plan. The “More Than a Visitor Act” introduced in the previous session by MPP Lisa Gretzky (and reintroduced in the current session) prioritizes access for family caregivers. The new government bill would benefit from borrowing language from Gretzky’s bill.

This lack of clarity also applies to the statement that residents are entitled to have any visitor they want. In the case of vaccine mandates, many visitors have been barred from visiting their loved one, even if the resident is fully capable of giving informed consent to the visit.

It is inconsistencies like these that keep long-term care homes from truly feeling like home for many seniors. Residents’ rights are rightly limited by the fact that they live in a unique community and must act in ways that show love to their vulnerable neighbours. However, they should also be allowed to take measured risks, as physical safety is not the only priority to be considered.

The way forward

Bill 37 has now passed 2^nd reading and been referred to the Standing Committee on the Legislative Assembly for further study and review. We hope to get involved at the committee stage, encouraging the addition of amendments that protect the right to choice in long-term care and better protect family caregivers as an essential part of long-term care.

This bill does a good job of trying to put residents first and notably mentions the need to prioritize social, emotional, and spiritual support. Yet there is no evidence that this holistic approach will be able to withstand pressure from another pandemic or similar situation. We need to ensure that safety is not the only priority, but that meaning and purpose are prioritized as well. As always when discussing elder care, we need to consider how we would like to be treated in the same situation.