IRPP study proposes a new approach to measuring the performance of long-term care in Canada

Montreal – The COVID-19 pandemic has had a devastating effect on residents of Canada’s long-term care homes. Major changes to the system are needed — but how can we be sure that the planned improvements will be the right ones? While governments consider serious reforms to improve long-term care, a study from the Institute for Research on Public Policy proposes a new approach to evaluate the success of such institutions.

In their IRPP study, co-authors Michel Grignon and Harneet Hothi argue that the commonly used performance measure — COVID-related long-term care deaths as a proportion of total COVID-related deaths — is not the best metric. Instead, they propose comparing deaths in long-term care institutions with deaths in similar age groups living in the community during the pandemic and during a nonpandemic year. They find that the pandemic doubled the risk of dying among residents of long-term care institutions.  However, only part of the difference in mortality in institutions can be attributed to the way institutions are organized and funded.

At the same time, Grignon and Hothi caution governments against enforcing a rigid form of care based solely on preventing death, as this could ultimately lower the quality of life of residents. Instead, they call on governments to focus on three areas when implementing long-term care reform:

• Develop clear guidance for long-term care institutions on the appropriate balance between preventing death and supporting quality of life
• Improve the efficiency of long-term care by increasing the use of home care and allowing institutional specialization
• Estimate costs associated with long-term care in the coming decades, including home care, and identify ways to finance those costs

“Governments should use the pandemic experience to create a better model of care that focuses on the needs and interests of recipients,” says Grignon. “A resident-centred model may require a looser form of guidance for institutions — one that provides greater flexibility as well as more human and financial resources. Ultimately, Canadians will need to have a broader conversation about how much we are willing to pay to provide quality care, and how these costs should be shared between individuals and governments,” he says.

Life and Death in Long-Term Care: Are We Learning the Wrong Lessons from COVID-19? can be downloaded from the IRPP’s website (irpp.org).