With the launch of its Strategic Plan 2021-2026, the Canadian Institutes of Health Research - Institute of Health Services Policy Research (IHSPR) has embarked on a formidable quest to secure healthcare's holy grail: hea...With the launch of its Strategic Plan 2021-2026, the Canadian Institutes of Health Research - Institute of Health Services Policy Research (IHSPR) has embarked on a formidable quest to secure healthcare's holy grail: health system transformation, health equity and the vaunted pillars of the Quadruple Aim (Bodenheimer and Sinsky 2014; CIHR IHSPR 2021).
To date, 35% of coronavirus disease 2019 (COVID-19) deaths in the United States have occurred among nursing home populations (https://jamanetwork.com/journals/jama-health-forum/fullarticle/2763666), compared with 14% in...To date, 35% of coronavirus disease 2019 (COVID-19) deaths in the United States have occurred among nursing home populations (https://jamanetwork.com/journals/jama-health-forum/fullarticle/2763666), compared with 14% in Japan (Werner et al. 2020). How did Japan manage such a low proportion of COVID-19 deaths in nursing homes? The similarity in case-fatality rates among patients with COVID-19 in nursing homes in the two countries (both approximately 16%) suggests that the infection rate in nursing homes in Japan was much lower than in the United States. Therefore, the pandemic unmasked long-standing problems with the quality and financing of US long-term care (LTC) services (Grabowski 2020; Werner et al. 2020). We compare differences between the LTC systems of Japan and the United States, focusing on the measures adopted to protect against COVID-19 in Japan.
The dominant narrative through the pandemic focused on the perils associated with the transmission of COVID-19. This led to restrictive policies in long-term care that prevented family caregivers from being physically pr...The dominant narrative through the pandemic focused on the perils associated with the transmission of COVID-19. This led to restrictive policies in long-term care that prevented family caregivers from being physically present to participate in their loved ones' care. There is growing evidence that such policies resulted in harm to residents, family members and staff. The path forward highlights the need for balanced policies and practices to ensure that compassionate, person-centred and partnered care is not lost, whether in times of calm or crisis.
For decades, there have been calls for innovative care solutions to address the growing numbers of people living with complex health and social needs, including dementia. In 2020-2021, the toll of the COVID-19 pandemic o...For decades, there have been calls for innovative care solutions to address the growing numbers of people living with complex health and social needs, including dementia. In 2020-2021, the toll of the COVID-19 pandemic on vulnerable populations exposed many of the same issues and spurred renewed calls for transformative change. As we look forward, it is imperative to consider options not just for improving residential long-term care but also for integrating it into broader continuums of health and social care, where people can receive supports and services in the most appropriate setting. This commentary spotlights campuses of care as one homegrown solution to address individuals' and system needs and contexts.
Increasing attention is being placed on the role of the built environment in promoting and sustaining health in long-term care home settings. Work that reconsiders the physical and work designs of the long-term care sect...Increasing attention is being placed on the role of the built environment in promoting and sustaining health in long-term care home settings. Work that reconsiders the physical and work designs of the long-term care sector in the future is expected. In light of that, we urge full and reflective consideration of the tensions and complexities that have been brought to light through the pandemic and attending to what is known and knowable about the influences of the built environment on long-term care home residents and staff who provide their care.
A coherent workforce strategy and consensus on essential staffing requirements are needed to ensure quality in long-term care (LTC) homes. We have neither in Canada. No Canadian studies, investigator driven or commission...A coherent workforce strategy and consensus on essential staffing requirements are needed to ensure quality in long-term care (LTC) homes. We have neither in Canada. No Canadian studies, investigator driven or commissioned, exist to guide us. We generally rely on 20-year-old US recommendations, although we have never actually implemented them. During, and in the wake of the COVID-19 pandemic, it is clear that an insufficient workforce was at the root of much of the failure in LTC to manage the pandemic. This commentary frames research on staffing and LTC homes and the impact of COVID-19. It then outlines key ingredients, such as knowledge of residents, the workforce and the care environment, that are needed in order to estimate staffing needs. Recommendations for decision makers are provided.
For-profit ownership of long-term care (LTC) homes for the elderly is linked to worse outcomes for residents. In Canada, there has been an increase in financialized ownership in which seniors' housing (LTC homes and reti...For-profit ownership of long-term care (LTC) homes for the elderly is linked to worse outcomes for residents. In Canada, there has been an increase in financialized ownership in which seniors' housing (LTC homes and retirement residences) is run as products for investors. The top 10 firms have doubled their holdings from 2003 to 2020, and currently 33% of seniors' housing (including 22% of LTCs and 42% of retirement homes) is owned by private equity, institutions or other financial firms. The business strategies of these firms drive profits not only from real estate but also from domestic and care operations. During the COVID-19 pandemic, for-profit and financialized operators in Ontario have stood out for having higher death rates in their LTC homes. A radical remaking of the sector is necessary to take the profit out of care.
The COVID-19 pandemic has driven home the serious vulnerabilities plaguing Canada's long-term care system. We argue for significant new federal investments tied to clear, enforceable quality standards (particularly aroun...The COVID-19 pandemic has driven home the serious vulnerabilities plaguing Canada's long-term care system. We argue for significant new federal investments tied to clear, enforceable quality standards (particularly around staffing); new investments in home care so that more people can "age in place"; and additional support for informal care providers, including respite programs and cash benefits. We explore how to achieve these reforms within the framework of Canadian federalism and call for the creation of a national governance framework - overseen by experts independent of federal and provincial governments - tasked with establishing evidence-based standards for the quality, safety and timeliness of long-term care services.
The experience of the COVID-19 pandemic has fuelled demands for national threshold standards of quality for long-term care in Canada. The federal government, however, lacks jurisdiction for and experience with the provis...The experience of the COVID-19 pandemic has fuelled demands for national threshold standards of quality for long-term care in Canada. The federal government, however, lacks jurisdiction for and experience with the provision of long-term care, which rests constitutionally with the provinces. A creative approach to providing new funding and effective regulatory standard setting would seize the potential of an area of jurisdiction shared by federal and provincial governments - old age security - to establish a long-term care insurance program administered by the federal government and jointly governed by federal and provincial governments.
A system of facilities and services to support and care for Canada's elderly people is essential and must be sustained, but long-term care (LTC), as we now know it, is not it. It is not sustainable financially either by...A system of facilities and services to support and care for Canada's elderly people is essential and must be sustained, but long-term care (LTC), as we now know it, is not it. It is not sustainable financially either by our governments or its current and future recipients. On the upside, the policy direction should easily be changed given that those recipients' strong preference is to age in place in their own homes and communities, not in institutional care homes.
Given our diversity, it is risky to talk about "Canadian values," but this examination of care for older people does reveal some prominent values evident in how we provide care for this population. Identifying eight of t...Given our diversity, it is risky to talk about "Canadian values," but this examination of care for older people does reveal some prominent values evident in how we provide care for this population. Identifying eight of these values, this paper argues that these values are being challenged in the wake of the COVID-19 pandemic.
Across Canada, the long-term care sector has received increased attention since the devastating impact of the COVID-19 pandemic. The now often-cited statistic - 80% of deaths in the first wave occurred among individuals...Across Canada, the long-term care sector has received increased attention since the devastating impact of the COVID-19 pandemic. The now often-cited statistic - 80% of deaths in the first wave occurred among individuals residing in institutional long-term care - is tragic enough and is only compounded by the fact that the number of deaths in long-term care were still higher in the second wave in all but two provinces. Many have argued that the impact of the pandemic was amplified in the institutional long-term care sector because of a number of long-standing shortfalls in funding, space, staffing and infrastructure. For example, Canadian provinces had lower average direct hours of care (three hours per day) provided to residents in long-term care facilities than even the average of four hours per day provided in the United States (Hsu et al. 2016).
Healthc Pap
· 2020 Oct · PMID 33337308
·
Publisher ↗
We are fortunate to have the reflections and wisdom of experts from multiple disciplines in this issue's discussion of healthcare sustainability. In the lead paper of this issue of Healthcare Papers, we issued a call to...We are fortunate to have the reflections and wisdom of experts from multiple disciplines in this issue's discussion of healthcare sustainability. In the lead paper of this issue of Healthcare Papers, we issued a call to action drawing on the capacity of the Canadian health sector to address climate change (Miller and Xie 2020). Our colleagues agree on the need to deliver sustainable care and raise important questions about how such an aim can be achieved. In this response, we consider and revisit three themes: feasibility of a sustainable healthcare system, theories of change that support our recommendations and capacities that enable change.
Grundy Q, Krasik O, Meleca N
… +3 more, Mills N, Nour S, Whalen E
Healthc Pap
· 2020 Oct · PMID 33337307
·
Publisher ↗
The health system is a major contributor to Canada's greenhouse gas emissions, largely arising from the ways that care is organized and delivered. Nurses, representing the largest group of regulated healthcare profession...The health system is a major contributor to Canada's greenhouse gas emissions, largely arising from the ways that care is organized and delivered. Nurses, representing the largest group of regulated healthcare professionals, are experts in the organization and delivery of care, and are uniquely and critically positioned to witness and address the harmful effects of climate crisis. Thus, sustainable health systems cannot be achieved without nurses. Yet, nurses' capacity to lead on issues of climate crisis and sustainability remains underdeveloped. We argue that the nursing profession needs to widely embrace climate crisis as a priority nursing problem and to take visible leadership on this issue. To enable the transformation of the health system toward sustainable and equitable delivery of care, health systems should incorporate a sustainability lens into strategic decision making, and implement and scale up nurse-led models of care. It is time to move beyond "engaging" or even "empowering" nurses to participate in sustainability initiatives. It is time for nurses to lead.
Andermann A, Tcholakov Y, Tomatuk R
… +1 more, Buchman S
Healthc Pap
· 2020 Oct · PMID 33337306
·
Publisher ↗
The impacts of climate change can already be seen among many of the patients in our clinics and emergency rooms, and as with all disasters, the most impoverished and marginalized members of society are the hardest hit. T...The impacts of climate change can already be seen among many of the patients in our clinics and emergency rooms, and as with all disasters, the most impoverished and marginalized members of society are the hardest hit. The health system has a social accountability role to anticipate and respond to the evolving health needs of our society. We are the stewards of this planet, steering the course through current and future challenges. What we do now will determine what the world will be like for our children and grandchildren. At times like this, more than ever before, health workers around the world must unite and engage in contributing to shaping future policy directions and monitoring progress to create a post-COVID world where social accountability and sustainable development go hand in hand.
Healthc Pap
· 2020 Oct · PMID 33337305
·
Publisher ↗
Building on the article by Miller and Xie (2020) that raises a call to action for environmentally sustainable healthcare in Canada, this commentary posits that there is a responsibility to place that action in light of h...Building on the article by Miller and Xie (2020) that raises a call to action for environmentally sustainable healthcare in Canada, this commentary posits that there is a responsibility to place that action in light of health equity. It also identifies an opportunity to build on an existing approach to health system improvement, that is spreading across Canada, by adding an additional aim around environmental sustainability and placing the outcomes for health systems firmly in health equity. By doing this in a clear, anti-racist and anti-colonial setting, sustainability can build on Canada's Indigenous knowledge and principles of sustainability to align health system sustainability with reconciliation and equity.
Healthc Pap
· 2020 Oct · PMID 33337304
·
Publisher ↗
The current pandemic is a stark reminder that crises bring to light society's vulnerabilities. In the lead paper of this issue of Healthcare Papers, Miller and Xie (2020) argue that the same is - and will be - true for c...The current pandemic is a stark reminder that crises bring to light society's vulnerabilities. In the lead paper of this issue of Healthcare Papers, Miller and Xie (2020) argue that the same is - and will be - true for climate change. They make a compelling and urgent case for its importance to health and healthcare in Canada and around the world. Opportunities to advance the multiple interrelated dimensions of sustainability in the health sector include understanding and mitigating the health implications of climate change; preparing the health sector for climate change; and accelerating the health sector's contribution to society-wide net-zero targets. High-performing, resilient health systems with their capacity to deeply engage with communities, and to respond dynamically to changing circumstances, will be key to proactively addressing climate change, just as they are proving to be in pandemic preparedness and response.
Healthc Pap
· 2020 Oct · PMID 33337303
·
Publisher ↗
Miller and Xie (2020) raise a call to action on creating a sustainable Canadian healthcare system as part of a more just and sustainable economic model. This commentary explores the economic dimensions of this call to ac...Miller and Xie (2020) raise a call to action on creating a sustainable Canadian healthcare system as part of a more just and sustainable economic model. This commentary explores the economic dimensions of this call to action. It provides a brief overview of relevant concepts and insights from emerging schools of economic thinking, and contemplates challenges and opportunities for health system sustainability as the economic consequences of COVID-19 play out in coming years.
Healthc Pap
· 2020 Oct · PMID 33337302
·
Publisher ↗
Climate change concerns have gained traction with many Canadians and impacted their individual choices. However, as a country, we have repeatedly failed to meet international emission-reduction targets. Setting an ambiti...Climate change concerns have gained traction with many Canadians and impacted their individual choices. However, as a country, we have repeatedly failed to meet international emission-reduction targets. Setting an ambitious goal of net zero in healthcare may continue the discouraging pattern of missing the mark. This commentary proposes a new approach - identifying practical solutions and measuring their beneficial impact for both health and the environment. A few options are suggested, some likely to benefit from near-term government investments. Making tangible progress where opportunities present themselves will create positive health and environmental benefits and a solid foundation for future achievements.
Healthc Pap
· 2020 Oct · PMID 33337301
·
Publisher ↗
Miller and Xie (2020) issue a compelling and wide-ranging call to action for how healthcare systems, leaders and decision makers can and should mobilize to address the climate crisis. Issues of sustainability and the cli...Miller and Xie (2020) issue a compelling and wide-ranging call to action for how healthcare systems, leaders and decision makers can and should mobilize to address the climate crisis. Issues of sustainability and the climate crisis are complex, wicked problems with no simple solutions. Sustainability considerations and the imperative to use healthcare system resources wisely are a motivator of the Choosing Wisely Canada campaign. These considerations are increasingly urgent in the context of fiscal and resource deficits due to the COVID-19 pandemic. The experience of Choosing Wisely campaigns can offer potential strategies for driving increased awareness and action from healthcare stakeholders on the climate crisis. This commentary explores some of the factors that have contributed to the spread of Choosing Wisely campaigns and the levers that have fostered campaign uptake. It will also consider the challenges faced by, and lessons learned, from Choosing Wisely campaigns, and how these could inform healthcare systems and individual clinicians in increasing awareness and taking leadership on the climate crisis.