Submission to the Consultation on Safe Long-Term Care Act
The Canadian Association of Social Workers (CASW) is pleased to submit to the consultation to inform the development of a Safe Long-Term Care Act. We are encouraged by this initiative from government and hope to see it improve the long-term care sector in Canada.
As background, the CASW is the national voice for social work in Canada with a dual mission to promote the profession and advance social justice. As a profession founded on principles of social justice, CASW advocates for the inherent dignity, worth and agency of all persons.
Social workers provide a critical role in long-term care (LTC). Throughout the COVID-19 pandemic, we saw devastating impacts in LTC across Canada. Unfortunately, many of the problems predate the pandemic and demonstrate the need for drastic change to achieve improvement.
LTC must take a holistic approach to address the full range of resident’s needs — physical, nutritional, psychosocial, cultural, spiritual and recreational — to properly support mental and physical health and enrich quality of life. As social workers in a LTC setting, the scope of practice is broad and involves proactively addressing the social determinants of health for each, individual resident. Social workers have the unique ability to recognize and honour the individual and to consider all aspects of their care and circumstances to achieve optimal quality of life.
LTC requires a fully integrated interprofessional team that meets the full scope of residents’ needs. Within LTC settings, social workers practice collaboratively with allied professionals on a fully integrated interprofessional team. , Using their knowledge and skillset as the largest regulated provider of mental health supports in Canada, social workers are key to enhancing resident quality of life and well-being. Based on this model of care, the need for more social workers in LTC is clear.
The recommendations below outline the changes and initiatives that the federal government should include in the Safe Long-Term Care Act. We thank Health Canada for their work to date and for considering the recommendations and comments below.
Optimize the Social Work Role in Long-Term Care
Staffing in LTC is one of the main factors that will determine the quality of the resident experience. The COVID-19 pandemic has exposed the ongoing staffing shortages in the LTC sector to a point that it can no longer be ignored. Real solutions are needed now to change the trajectory of homes across the country and to put residents first. It was found in the Ontario Long-Term Care Staffing Study, that staffing levels and training have not kept up with the expansion and demand of long-term care in the province, leading to unsafe work and living conditions for both staff and residents. This is true for all LTC homes in every province and territory.
To provide residents with the care they need and deserve we suggest that LTC homes offer the services of at least one social worker that is fully integrated into the care team within each LTC home. Social workers provide a wide variety of care and services, which makes them adept at working in a LTC home. Social workers are there for residents and families to take care of their mental health and well-being while also helping them navigate the health care system.
Social workers are highly skilled mental health professionals and the primary provider of psychosocial care (inclusive of mental health supports) within LTC. This includes but is not limited to conducting psychosocial assessments, providing individual and group counselling, addressing responsive behaviours of residents through non-pharmacological means, managing caregiver distress, and participating in the delivery of person-centred palliative and end-of-life care.
Additionally, in an interdisciplinary team of specialists that work within the LTC home, social workers are experts in system navigation and can refer residents to the point of care they need at the time, which streamlines the process and gets residents the help they need earlier. Social workers advocate for what is best for the resident while building an environment that is supportive and honours the dignity of the resident.
Increasing social work staffing levels on the interdisciplinary care team has been shown to enhance resident quality of life, reduce resident responsive behaviours and the use of antipsychotic medications, and has been found to be the most cost-effective health human resource investment to improve quality of care.
Despite this, social workers are underutilized in LTC and where they are present, they face heavy workloads due to understaffing and a reliance on social workers to conduct tasks that fall outside of their role, impacting the delivery of proactive psychosocial and mental health care to residents and their caregivers. Ensuring adequate social work presence in the LTC staffing model within LTC homes and allowing social workers to practice to their full scope of practice within these settings is key to optimizing their role and improving the quality of care for residents.
Develop a Health Workforce Study and Incentivize Work in Long -Term Care
To have a full understanding of the workforce in the LTC setting, we urge the government to develop and fund a comprehensive health workforce data study which includes social workers and LTC home information. The goal of the study would be to determine the number of social workers working across different settings in Canada and to help estimate the number of social workers that would be needed in health care teams within LTC settings to achieve the goal of one social worker in every LTC home.
The pandemic dampened the sectoral reputation for LTC, leaving many potential employees cautious about working in a home. To remedy this, we encourage the government to incentivize work in LTC homes for social workers and those across the care continuum. It is also of utmost importance that the workplace environment is inclusive, safe, offers mental health and well-being supports and learning and development opportunities. To provide a good working environment, we recommend the government invest in LTC homes across Canada and provide the resources they need to implement and follow the guidelines made in Long-Term Care Services standards from the Health Standards Organization.
Data in Long-Term Care
While data collection in LTC may seem like a “nice-to-have,” leveraging data has very real, tangible impacts that can be used to improve the system and the care of residents. By sharing health data, LTC homes can help to identify health inequities, provide health care teams with complete resident health information and determine which practices are most effective. Data must be comprehensive, standardized, and measures the needs, strengths and preferences of residents living in LTC settings.
We are pleased to see progress on the bilateral agreements between the federal, provincial and territorial governments concerning standardized health data and digital tools. We hope to see further investments made in health data infrastructure as we see the approval from health care providers of the sharing of electronic health information, however, there is low uptake in practice.
Working Together on Indigenous Long-Term Care Needs
The Assembly of First Nations (AFN) has advocated for funds for First Nations to “establish and operate long-term care facilities.” As AFN states: “Many of the current generation of First Nations seniors were forced to leave their communities and to attend Indian Residential Schools. Forcing First Nations seniors to leave their communities again for palliative, end of life or long-term care at the end of their lives is unacceptably cruel.”
We urge the government to co-create a new Framework for Indigenous Long-term Care as promised in the 2021 Liberal Party of Canada election platform that meets the needs of Indigenous people and communities in Canada. This framework must also include resources to support Indigenous people to live and age in place, wherever they may reside.
CASW is pleased to participate in this consultation of the Safe Long Term-Care Act. We are encouraged by the collaboration between the federal-provincial-territorial governments to improve the quality, safety, equity and availability of LTC.
This legislation could be a positive step forward for Canadians. To improve the LTC sector, CASW would like to see the federal government bring social workers to the table. Social workers hold a unique position as they can act as stewards of care, directing residents to the care they need at the time and minimizing unnecessary and complicated steps getting there. For this to happen, there needs to be resources available to social workers so they feel compelled to work in the LTC space and encourage others to join.
It will also be important for the legislation to outline the proposed funding and how it will be divided between the priority areas in LTC. CASW looks forward to the tabling of the Safe Long-Term Care Act in Parliament.
 Canadian Institute for Health Information. (2021). COVID-19’s impact on long-term care. Retrieved from the Canadian Institute for Health Information website: https://www.cihi.ca/en/covid-19-resources/impact-of-covid-19-on-canadas-health-care-systems/long-term-care
 Canadian Institute for Health Information. (2022). Health Workforce in Canada, 2017 to 2021: Overview — Data Tables. Retrieved from https://www.cihi.ca/en/health-workforce-in-canada-overview
 Ontario Ministry of Long-Term Care. (2020). Long Term Care Staffing Study. Retrieved from the Ontario Government website: https://files.ontario.ca/mltc-long-term-care-staffing-study-en-2020-07-31.pdf
 Restorick Roberts, A., Smith, A.C. & Bowblis. J.R. (2019). Impact of social service staffing on nursing home quality and resident outcomes. Retrieved from https://sc.lib.miamioh.edu/bitstream/handle/2374.MIA/6299/Roberts-Impact-Social-Service-Staffing-%2001-2019%20.pdf?sequence=4&isAllowed=y
 Health Standards Organization. (2023). Long-Term Care Services. Retrieved from the Health Standards Organization website: https://healthstandards.org/standard/long-term-care-services-can-hso21001-2023-e/
 Canadian Institute for Health Information. (2023). Taking the pulse: A snapshot of Canadian health care, 2023. Retrieved from the Canadian Institute for Health Information website: https://www.cihi.ca/en/taking-the-pulse-a-snapshot-of-canadian-health-care-2023
 Assembly of First Nations. (2017). The First Nations Health Transformation Agenda. Retrieved from the Southern Chiefs’ Organization website: https://scoinc.mb.ca/wp-content/uploads/2021/06/FNHTA-AFN-wcag.pdf