Long-Term Care in Canada: Three-quarters say significant change is needed; only one-in-five believe it will happen
55 per cent of Canadians say they would accept a tax increase to fund improvements in LTC
July 26, 2021 – The gradual lifting of restrictions at long-term care facilities across Canada is offering opportunities for families whose loved ones survived the stress, uncertainty, grief and tragedy of COVID-19 to reconnect and regain some sense of normalcy.
But this moment of light in what has been among the darkest periods of the pandemic cannot mask a coming reckoning over how to prevent the devastating losses of life and persistent isolation residents of LTC facilities experienced as the pandemic wore on.
Indeed, the future of Canada’s long-term care industry is an issue that will continue to dominate conversations among policy makers, and family members, for months and years to come.
New data from the non-profit Angus Reid Institute finds four-in-five Canadians saying the pandemic fundamentally altered the way they view the industry.
Further, half of Canadians (47%) now say they will do everything in their power to avoid entering LTC themselves, and to keep close family members out. One-in-five (22%) say they’ll start saving for such a plan, while more than twice that number say they “dread” the thought of living in long-term care (44%).
If the industry is to be improved, three-quarters of Canadians say either significant changes (45%) or a total overhaul (31%) is necessary. For some, this means more federal government involvement. At least three-in-five residents in British Columbia, Manitoba, Ontario, and Atlantic Canada say that the federal government should be directly involved in creating standards for the industry. That said, in Alberta, Saskatchewan and Quebec, the same number disagree, and say it should be solely up to the provinces.
More Key Findings: 
- Three-in-five say private care should be minimized or phased out, rising to two-thirds among those 55 years of age and older. That said, two-in-five say that private care can still be a part of the solution to the problems facing the industry
- Seven-in-ten (72%) say Canada should invest more in homecare, and a full majority (55%) say they would be willing to pay more in taxes to accomplish it in their own province
- B.C. and Ontario residents are most willing to pay extra to fund long-term care. In each case, three-in-five say they would be amenable to paying two per cent more in personal taxes. The rest of the country is divided nearly fifty-fifty on that proposal
- In terms of top priorities for the industry, two-in-five say more enforcement of standards is needed (43%). Further, a similar number would increase the minimum number of staff per facility (39%) and raise their pay (38%) in order to recruit and retain quality employees
About ARI
The Angus Reid Institute (ARI) was founded in October 2014 by pollster and sociologist, Dr. Angus Reid. ARI is a national, not-for-profit, non-partisan public opinion research foundation established to advance education by commissioning, conducting and disseminating to the public accessible and impartial statistical data, research and policy analysis on economics, political science, philanthropy, public administration, domestic and international affairs and other socio-economic issues of importance to Canada and its world.
INDEX:
Part One: Assessing the LTC situation
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Pandemic shifts perspectives considerably against living in LTC
Part Two: What needs to change?
Part Three: Big appetite for big change
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Three-quarters support subsuming long-term care within public health
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Two-in-five still say private care can work
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Homecare is preferred, most Canadians willing to pay up
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Federal involvement preferred but many are opposed
Part Four: Despite desire for change, few expect action
Part One: Assessing the LTC situation
The Angus Reid Institute’s first foray into experiences in long-term care, accessible here, found both positive and negative elements. While most – especially those personally and directly affected by the LTC experience during the pandemic – said long-term care facilities did the best they could during the first months of the pandemic, there is a broader sense among Canadians – including those with loved ones in care – that significant change within the industry is needed.
Related: For those with family in LTC facilities during COVID-19 pandemic, size mattered
Pandemic shifts perspectives considerably against living in LTC
The immediate impacts of the pandemic on long-term care have altered how Canadians intend to plan for their own futures. Today, only 18 per cent of Canadians say what happened in LTC facilities during the pandemic had no impact on how they intend to plan for their own or a loved one’s future health and living needs.
For the rest: more than two-in-five Canadians (44%) say they now “dread” the thought of having to live in LTC or to have to place a loved one there. This proportion rises to half among women of all ages. Further, half (47%) now say they will do everything they can to avoid living in a LTC facility.
One-in-five Canadians, and fully 39 per cent of younger women, say they will now try to save more money to be able to afford homecare when they enter old age.
The profundity of these sentiments is unchanged regardless of whether the respondent has had more personal exposure to long-term care. Both those with loved ones in care and those without are equally likely to say they have changed their views of LTC over the past year.
Part Two: What needs to change?
Tackling change within a system as large, complex, and diffuse (each province is responsible for the oversight of long-term care) as LTC is, to put it lightly, a heavy lift. When canvassed on a number of possible areas for change, Canadians themselves prioritize greater investment in the people responsible for direct care, and more intense oversight. The top individual option chosen from a list of priorities is enforcement of standards. Notably, one-in-three Canadians say every option on the list should be addressed in some way:
Particularly notable in this instance are the views of those with loved ones in care, as compared to those in the general population. Both groups choose each priority at near-identical rates, suggesting that awareness of the need of each priority is largely evident to Canadians, whether or not they are close to the LTC industry:
Ontario residents are most concerned about the enforcement of existing standards, and alongside Quebecers, are highly concerned about both the pay of staff and the level of staffing in their province:
Part Three: Big appetite for big change
When it comes to the intensity of change the LTC needs, more than half (55%) in every region of the country say significant improvements are necessary, if not a complete overhaul. This sentiment is near-unanimous in Quebec, where 75 per cent of all deaths related to COVID-19 in the province happened in LTC facilities:
Those who have had loved ones in care, or currently do, are similarly resolute in their assessments. Notably, this loud call for major change has little to do with whether their loved one lives or had lived in a either a government-run or private facility:
*small sample size, interpret with caution
Three-quarters support subsuming long-term care within public health
Some Canadians would go even further than establishing standards and infusing more funds into long-term care. Asked if they would make long-term care a fully integrated part of the public health system, which would be taxpayer funded and accessible to all, three-quarters say they would support such a fundamental change. Enthusiasm for this type of standardization and expansion rises among older Canadians, but is the majority view across all age demographics:
Again, in this issue, the views of Canadians with personal experience of the LTC system differ little from those with none:
Two-in-five say private care can work
If no transformative change is made to move LTC under federal jurisdiction, two-in-five who have had a family member in care are confident that with the proper level of investment, private care can provide a good quality alternative to government-run facilities. These opinions are identical to those with no experience (see detailed tables) but most notably, those who have had a loved one in private care are most optimistic about the potential:
*small sample size, interpret with caution
On this question, there is a consistent divide among Canadians between the ages of 25 and 54, while older Canadians tend to disagree and would phase out private ownership:
Conservative leaning provinces Alberta and Saskatchewan are most supportive of private ownership, while at least three-in-five in all other regions say that Canada should try to phase out private companies within this field:
Homecare is preferred, most Canadians willing to pay up
Another dominant refrain from those close to the LTC universe is the importance of aging in place, or in-home care. Indeed, in previous research from the Angus Reid Institute, Canadians profess a clear preference for this type of arrangement for their future.
Perhaps due to this preference, seven-in-ten Canadians (72%) say that Canada should invest in at-home care and the percentage of those holding this view rises with age:
Notably, the preference for investment in at-home care is the majority view in every region, however, a significant minority in Alberta, Saskatchewan, Manitoba, and Atlantic Canada feel that this is likely a fruitless pursuit and that funds should be invested in LTC facilities instead:
Respondents who have a closer relationship with LTC through their family have similar views to those who do not and prefer a focus on funding at-home care:
There is general consensus among policy experts in the space that any improvement in service will come with a substantial price tag. More than half (55%) of Canadians say they are willing to contribute, while the most willing are found in B.C. and Ontario. The rest of the country, however, is close to evenly divided.
Further, those who have a closer connection to LTC voice a higher willingness to contribute toward amending and improving the industry in Canada:
While there is, perhaps surprisingly, little difference of opinion by level of income (see detailed tables), political divisions are pronounced. While majorities of past Liberal, NDP and Bloc Quebecois voters say they would be willing to see their personal tax rate jump two per cent to better fund the LTC system in their province, two-thirds of past CPC voters disagree:
Federal involvement preferred but many are opposed
Some observers have suggested that the federal government must become more involved in the long-term care industry. National standards have been called for by organizations involved in care and in response, the Liberal government announced in May that it would be investing $3 billion in establishing new standards, which would take nearly two years to study and implement.
Canadians are generally supportive of federal involvement with long-term care. Indeed, 58 per cent say this is a positive development; similar levels of enthusiasm exist in the general population as well as among those with more proximity to LTC:
Regional views about the elevation of the federal government in this field are by no means uniform, however. In Alberta, Saskatchewan, and Quebec, majorities say it should be left to the provinces alone to manage LTC standards in their respective jurisdictions. In Ontario and Atlantic Canada, however, seven-in-ten say that the federal government should help establish standards for care and be more involved. The federal government has stated that in order to be eligible for long-term care funds, the provinces will have to agree to implement national standards. Quebec Premier Francois Legault has decried the lack of federal funds in recent years but also rejects answering to Ottawa:
Part Four: Despite desire for change, few expect action
Nonetheless, while Canadians have a desire for fundamental change in the long-term care industry, the sentiment among both the general public and those with more proximity to the issue is divided. Just three-in-ten expect the change that most say is necessary:
Older residents have slightly more faith than younger generations that the needed alterations will be made, indeed, one-in-three say that they will. This group is also most likely to say that change must happen (see detailed tables). Regionally, however, residents of Quebec are far more confident their government will improve LTC in the coming years:
Survey Methodology
The Angus Reid Institute conducted an online survey from March 15 – 18, 2021 among a representative randomized sample of 1,503 Canadian adults who are members of Angus Reid Forum. For comparison purposes only, a probability sample of this size would carry a margin of error of +/- 2.5 percentage points, 19 times out of 20. From this sample, the Institute derived a sub-sample of 403 respondents who have had a family member or close friend live in a long-term care residence within the past year, which for the purposes of analysis was then boosted by an additional 413 cases to bring that group to a total of 816. A probability sample of those who have had a loved one in long-term care (816) would carry a margin of error of +/- 3.5 percentage points, 19 times out of 20. Discrepancies in or between totals are due to rounding. The survey was self-commissioned and paid for by ARI. Detailed tables are found at the end of this release.
For detailed results by age, gender, region, education, and other demographics, click here.
For detailed results by whether or not the respondent had a loved one in long-term care, click here.
For detailed results by the type of long-term care facility, click here.
To read the full report, including detailed tables and methodology, click here.
To read the questionnaire, click here.
Image – Georg Arthur Pflueger/Unsplash
MEDIA CONTACT:
Shachi Kurl, President: 604.908.1693 shachi.kurl@angusreid.org @shachikurl
Dave Korzinski, Research Director: 250.899.0821 dave.korzinski@angusreid.org
