Re-imagining Long-term Residential Care in Canada

April 24, 2020

TORONTO –– The COVID-19 crisis offers an opportunity to create a new, better normal at Canadian long-term residential care facilities, according to a new background report released today by the Canadian Centre for Policy Alternatives (CCPA).

Evidence collected over more than a decade suggests there are a number of short- and medium-term interventions at hand that would improve conditions for residents and the workers who support them.

“With long-term care facilities on the frontlines of the COVID-19 crisis, the importance of universal, publicly funded, accessible health services has never been clearer,” said report co-author Pat Armstrong, distinguished research professor in sociology at York University and CCPA research associate.

“That the largest proportion of COVID-19 deaths in Canada are in nursing homes attests not only to the vulnerability of residents, but also to residents’ high health care needs and our failure as a country to implement policy changes that have been supported by evidence for over a decade.”

Re-imagining Long-term Residential Care in the COVID-19 Crisis––authored by Pat Armstrong, Hugh Armstrong, Jacqueline Choiniere, Ruth Lowndes and James Struthers––reviews existing research on solutions for reforming long-term residential care, which shows that care homes run on a for-profit basis tend to have lower staffing levels, more verified complaints, more transfers to hospitals and higher rates for both ulcers and morbidity 

What’s more, managerial practices taken from the business sector are designed for making a profit, rather than for providing good care. These include paying the lowest wages possible, and hiring part-time, casual and those defined as self employed in order to avoid paying benefits or providing other protections. Contracting out services such as cleaning, laundry, food and security can also increase risk by bringing more people into homes on a daily basis.

The report’s short-term recommendations include: making all staff permanent and limiting their work to one nursing home; raising staff wages and benefits, especially sick leave; rapidly providing testing for all those living, working or visiting in homes; ensuring access to protective equipment immediately; and severely limiting transfers from hospitals.

In the long term, evidence suggests policymakers should more effectively integrate long-term residential care into the the public health care system, through federal legislation similar to the Canada Health Act, in order to develop a universal public long-term care plan that is accessible and adequately funded; stop privatization and promote non-profit ownership; ensure protective equipment is stockpiled for the future; build surge capacity into labour force planning and the physical structure of facilities; and establish and enforce minimum staffing levels and regulations.

“This crisis allows us to reimagine nursing homes that are rewarding places to work, where life is worth living for residents and where visitors feel comforted about the care. There is no going back, but there are ways forward,” adds Armstrong.

A full list of evidence-based recommendations can be found in the report, available online at


For media interviews please contact: Alyssa O’Dell, CCPA Media and Public Relations Officer, at [email protected] or 343-998-7575.