Nurses say throne speech advances A Just Recovery for All

Wednesday’s federal Throne Speech was an important policy moment in Canada. Please see below RNAO’s press release issued after the Speech. RNAO was successful in achieving two major asks in our Vision for A Just Recovery for All: 1) the federal government will work with the provinces and territories to set National Standards for Long-Term Care (LTC) so that seniors get the best support possible, with funding attached to those standards, and 2) strengthening the National Housing Strategy announced in 2017 by increasing investments to rapid housing in the short term, and partnering with not-for-profits and co-ops in the mid- to long-term. The commitment is to end chronic homelessness.

Why is RNAO insisting that the federal government set National Standards for LTC homes in Canada and tie federal funding to upholding jurisdictions to deliver those standards? In short, we’ve lost trust that the Ontario government will act in any substantive way in the absence of external pressure. In Ontario alone, more than 35 reports on LTC have been issued in 21 years, and although during this period we’ve had a number of different governments, not much has been done to improve the lives of LTC residents, their families and the hard-working staff that serve them.

Following the tragedy in nursing homes during the first wave of the pandemic, Premier Ford made heartfelt commitments to fix a “broken system.” For the first time in many years, we were hopeful with a premier who appeared genuine and determined to bring substantial positive change. Premier Ford reiterated these commitments many times, including when the report of the armed forces became public.

While we were relieved when the government moved to reunite residents with their loved ones, following RNAO’s report and the pressuring of others, many families tell us that they continue to face barriers normalizing the frequency and length of their visits.

In the area of health human resources, despite the insistence of RNAO that government provide a directive and funding for nursing homes to hire additional staff in the summer, so that they would be ready for the second wave in the fall, not much has happen. To our tremendous disappointment and anguish we have had no answers to our call to action issued on May 28 immediately following the Canadian Armed Forces report. Nor have we heard reactions to our Nursing Home Basic Care Guarantee, formally submitted on June 10th to Minister Fullerton. My personal plea to our Premier, Ministers and the Collaborative Table have been “noted.” As a result, our media presence and pressure remains constant.  

When on July 30, Minister Fullerton released the LTC Staffing Study, but took no action, we at RNAO knew the second wave will bring more tragedy. This is why in August, facing the reality that our provincial government does not have serious intention to invest in LTC staffing ahead of the second wave, we decided to shift gears and ask the federal government to intervene. We issued a letter to Prime Minister Trudeau urging him to set National Standards for LTC homes, and proposed our Basic Care Guarantee.   

Colleagues, you have read and heard RNAO saying on numerous occasions that Ontario is not ready for the next wave of the pandemic; we are not alone on this. In particular, you have heard us speak about the gravity of the situation in Ontario’s LTC homes. Thousands of you signed action alerts asking the Premier and Minister Fullerton to mandate and fund nursing homes to hire NPs, RNs, RPNs and PSWs during the summer. The disregard for our and others’ advice pains us all, as we see the impending human tragedy that will ensue with the confluence of flu and COVID-19 – the so-called “twindemic.”  These are issues we have shared in previous blogs.

Now that the federal government has committed to National Standards for LTC homes, RNAO will again ask you to lend your voice in support. This is one-in-a-generation chance to make a difference for Canada’s seniors. Be prepared to witness lots of bickering and rhetoric about “health being a jurisdictional matter.” You will hear premiers, including our own, saying “give us the funding without strings attached.”  At RNAO, we agree that the federal government must increase its health transfer payments, and we know that most healthcare delivery is a jurisdictional responsibility. However, nurses and other health professionals also know that when it comes to LTC, unless we establish a Basic Care Guarantee, not much will change for LTC residents, their families and staff.

Canada has had many successful experiences with federal, provincial and territorial partnerships to advance the health and health-care system of Canadians. For example, in September 2000, Canada's First Ministers agreed that improvements to primary health care (PHC) were crucial to the modernization of the health care system. As part of their 2000 Health Accord – a Primary Health Care Transition Fund – was signed for the period of 2000 to 2006. The federal government, provinces and territories agreed to work together, and in concert with health professionals to improve team-based PHC and its linkages with other parts of the health care system. This was an initiative where federal, provincial and territorial governments participated with a huge degree of success. The results are clear in Ontario where we formed family health teams, family health networks, expanded community health centres and aboriginal health centres, as well as launched 26 NP-led clinics. The entire country made substantive progress in moving from primarily solo practices to team-based care.

This is the type of collaborative success that the country needs now. The tragedy and trauma that residents in nursing homes have experienced; the suffering of the families; and the post-traumatic stress and ill-health of staff can no longer be tolerated. We must now stand up in unison and say: No more, because this is, indeed, our last chance.

This has been, and continues to be, a horrific and preventable tragedy caused by 20 years of misguided policies and funding neglect – and recent inaction. If governments in Canada, including our own government in Ontario, are allowed to keep a blind eye now, no future government will feel compelled to take action. This is why RNAO is insisting on the need to establish National Standards of Care in LTC and tying federal funding to meeting those standards. RNAO will be – as always – working with the Ontario government and others to ensure we deliver on those standards. Together, we could have done much better for residents in nursing homes. Now, we owe them a brighter future.

Here is the press release issued on Wednesday:

During an unprecedented fight against an insidious virus, nurses say they are being heard by the federal government. Wednesday’s Speech from the Throne addresses policy imperatives RNAO outlined in a letter and call to action sent to Prime Minister Justin Trudeau demanding that vulnerable people not be left behind as a result of COVID-19. 

A Just Recovery for All, a global movement endorsed by RNAO, shines a light on the actions needed to build a better and more inclusive society, and to seal the cracks of inequity exposed during the pandemic.

More than 2,000 people, including nurses, other health professionals and members of the public, gave voice to RNAO’s call for the federal government to implement measures focused on two priority groups hit hardest by the virus: the elderly, especially those living in long-term care (LTC) homes, and people who experience homelessness.    

RNAO applauds the government’s announcement to create national standards for LTC and urges Prime Minister Justin Trudeau to provide funding – with strings attached – to improve staffing. This is vital given the long-standing systemic failures in this sector and will honour the more than 5,300 men and women who have succumbed to COVID-19 in Canada. Indeed, more than 80 per cent of those who died from COVID-19 across the country were residents in LTC, which is double the LTC death share of countries in the Organization for Economic Co-operation and Development. Nurses urge the prime minister to move swiftly with both national standards and the related funding to avert a second major tragedy, which is already in the making.

Such national standards should be modelled on RNAO’s Nursing Home Basic Care Guarantee, which has been on the table in Ontario for several months. The guarantee ensures that:

1. Each LTC home provides a minimum of four (4) worked hours of direct nursing and personal care for each resident per 24 hours, according to the following staff mix formula:

• a minimum of 48 minutes of worked hours of RN direct care
• a minimum of 60 minutes of RPN/LPN direct care
• a minimum of 132 minutes of PSW direct care

2. Each LTC home employs a full-time equivalent (FTE) nurse practitioner (NP) per 120 residents, as attending NP. In regions where there is a shortage of NPs, employ a clinical nurse specialist (CNS).  
3. Each LTC home employs an FTE nursing staff member (preferably an RN) to support the functions of infection prevention and control, quality improvement, staff education, onboarding and orientation. 
4. Each LTC home implements the following mandated human resources standards:

• mandate that LTC staff (RN, RPN/LPN, PSW) only work in one LTC home
• ensure nursing and personal care salaries in LTC are commensurate with those paid to health workers in other sectors, such as hospitals
• ensure full‐time employment with benefits is offered to staff who want full‐time work, enabling continuity of care for residents, and improved staff retention

5. Each LTC home has a complement of interprofessional staff, including: physiotherapy, rehabilitation therapy, speech therapy, social work, dietary and dental care.

RNAO’s CEO Dr. Doris Grinspun says a Nursing Home Basic Care Guarantee will honour the over 1,800 lives lost in Ontario’s LTC homes due to the pandemic. Grinspun says the association also supports “the government’s intention to amend the Criminal Code so those who neglect seniors under their care are penalized. This move rightly takes aims at long-term care operators who put profits ahead of residents.” 

The pandemic also highlighted another public policy failure: The number of people who experience homelessness and are left to fend for themselves. Nurses say the government’s pledge to eliminate chronic homelessness addresses a long-standing promise to develop a national housing strategy. Grinspun says “the 250,000 people across the country who have no place to call home have been waiting for far too long. COVID-19 has shown that those without a permanent home are at greater risk of illness and disease and that the best treatment is housing. We are particularly pleased with the focus on rapid housing in the short-term and the partnering with not-for-profit and co-ops in the mid- to long-term. Nurses will also hold the government’s feet to the fire on its explicit intent to support Indigenous Peoples and northern communities,” adds Grinspun.

Ensuring A Just Recovery for All also means that nurses – who make up the largest segment of health workers fighting the pandemic – must be recognized for their knowledge and expertise. “Our contribution to clinical care and health system decision-making has always been critical and never been more visible,” says Grinspun. “This is why we ask government to reinstate the role of the National Chief Nursing Officer (CNO). Having someone in this position will result in better human resources and deployment planning, movement on expanded scope of practice for RNs and NPs, and help root our health system in primary care – all essential priorities as we deal with the second wave and build back a stronger Canada,” says Grinspun. “The position of the National CNO ended under the previous government of Stephen Harper and there is no better time to reinstate this role than now, 2020, a year designated by the World Health Organization as the Year of the Nurse in honour of Florence Nightingale, the founder of modern nursing, to recognize all nurses fighting the pandemic.”    

RNAO is heartened to hear the government remains committed to bring in a national pharmacare plan. Such a program covering all essential prescription drugs has been a key demand of RNAO for years. “Not only is our current system unsustainable, it means that in a country as rich as ours, one in five Canadians either lacks sufficient drug coverage or knows someone who does,” says RNAO President Morgan Hoffarth. “It forces people to make hard choices, in some cases, rationing prescription medications or going without. Not only is this plain wrong, it’s bad for health and extremely costly,” Hoffarth adds.

Among those feeling the weight of the pandemic are families, especially working parents.  RNAO is applauding a commitment to improve child care as a key plank in the government’s agenda. “This is an issue where many promises have been made and yet, little concrete action is taken. Today’s announcement to create a national early learning and child care system is a promising start,” says Hoffarth.

Other measures announced in the throne speech that nurses support include:

• ongoing efforts to address the opioid crisis
• addressing food insecurity and clean water, especially in Indigenous communities
• environmental initiatives including promises to exceed Canada’s current 2030 climate goals, achieving net zero emissions by 2050, retrofitting homes, money for transit and active transportation, pollution pricing and investments to combat climate disasters.

RNAO says no recovery from COVID-19 is possible if those who are most vulnerable are left out. The association says it will continue its advocacy on behalf of its members and other health professionals fighting the pandemic. “The health and well-being of all Canadians depend on a committed voice that will remain loud and clear as we fight this pandemic with every ounce of our collective strength,” says Hoffarth.    

“COVID-19 has confronted us with a global crisis we’ve not experienced in generations,” concludes Hoffarth. “It is no surprise that some may want to use the crisis to advance extraneous agendas. As nurses we reject arguments claiming we should not advance social and environmental agendas because we are incurring fiscal debts. The real crushing debts Canadians face are growing inequality, social injustice and ecological devastation – all causing ill health. As nurses we say: now is the perfect time to strengthen our Canada and the real future of our children,” Hoffarth insists.