For nearly 20 years, Carole Estabrooks’ 'patient' has been the elderly care system in Canada, particularly in nursing homes and other long-term care facilities.
A nursing professor at the University of Alberta in Edmonton, Estabrooks is considered a leading researcher into elderly care in the country. She received appointment as a Member of the Order of Canada in 2016, and is scientific director of the nationally focused Translating Research in Elder Care program.
While problems in Canadian long-term care go back decades, Estabrooks makes no secret of the fact she was alarmed at the appalling state of care offered to the elderly with the onset of the COVID-19 pandemic, which exacerbated the grim situation.
“It (long-term care) was bleeding for decades; COVID just caused it to start hemorrhaging,” she said.
While seniors in other countries were hit hard by the pandemic, Estabrooks says Canada fared poorly compared to other developed countries, particularly in the initial months when a devastating 81 per cent of all deaths occurred in Canadian long-term care residences.
Care facilities accounted for a somewhat lower portion of deaths as the pandemic wore on and vaccines became available. But military had to be called in to assist some residences where outbreaks were deemed out of control.
“Canada had one of the worst performances of any G-20 country,” Estabrooks said. “It’s shameful.”
Estabrooks cites a series of factors plaguing the system, many pre-dating the pandemic, including a lack of preparedness. Others include low daily care hours for residents, flawed infection control, poor funding and resources, inconsistent inspections and inadequate integration of health and hospital services.
She is still haunted by images of nursing home seniors kept in lockdown for months, apart from families during the pandemic. She blames the “insanity” of too severe restrictions that weren’t applied equally to those in care.
But workforce training and recruitment remain her key concern, especially with “severe shortages” of care workers, some who were working two or three jobs when the pandemic hit due to low pay and benefits. Even so, Alberta care workers are paid substantially higher wages than in the Atlantic provinces.
“In my mind it is still the number one issue,” Estabrooks said. “We have to stabilize the workforce, and we’ve got to address recruitment. Because we can’t have a healthy workplace and have good care if you can’t have good, healthy staff in enough numbers.”
Estabrooks is cautiously optimistic some headway is being made to improve long-term care. While it remains under provincial jurisdiction, Ottawa released new updated long-term care standards in January, which she hopes will eventually be adopted by provinces even though they aren’t mandatory.
In July, the Trudeau government announced it is seeking public input into a new Safe Long-Term Care Act, which could add teeth to the standards. Estabrooks says the new Alberta health minister’s mandate letter from Premier Danielle Smith is encouraging too, directing Adriana LaGrange to continue implementing recommendations from a facilities-based continuing care report that pegs 4.5 hours as a goal for daily care per resident.
But there’s no quick fix, warns Estabrooks, noting hundreds of millions of dollars will be required, likely billions in the long term.
“We’re moving but long-term care was in such a deficit that it is going to take more than a day to fix it,” she said. “I would say if we worked really hard on it, and kept our focus and resources on long-term care, it will take a decade to really put it where it should be.”
Estabrooks recommends keeping public pressure on politicians to make sure progress is made, through advocacy and letter writing.
“Many of us are worried now that COVID is becoming endemic, and we don’t hear about it every day, the government is going to ease up,” she said.
“I think people have to be more vocal.”
