The long-term care sector has been hit very hard by the COVID-19 pandemic in Canada and abroad. Long-term care homes (also known as nursing homes, continuing-care facilities, or residential-care homes) provide 24/7 access to nursing and personal care to residents. This generally includes more care than can be safely met through supportive housing or a retirement home, but not so much care that they require admission to a hospital unit.

Throughout the pandemic, the focus has been on improving the prevention and management of COVID-19 outbreaks in long-term care homes. But many policymakers and stakeholders are now turning their attention to renewing the long-term care sector and exploring alternatives to long-term care homes.

What the research tells us

A recent review examined what is known from research evidence about supporting renewal in long-term care homes in light of the COVID-19 pandemic. They also examined what was done in Canada and in eight other countries (Australia, France, Finland, Germany, Netherlands, New Zealand, United Kingdom, United States). These countries were selected because they are advanced in their approaches and delivery of long-term care or are good comparators to Canada.

The review identified 204 highly relevant documents that could inform renewal in long-term care homes. Three themes were found that could contribute to the renewal of long-term care:
- making public investments in long-term care (particularly in light of the pandemic as population needs are high and a significant burden of care has been placed on caregivers over the past 18-months);
- ensuring models of care include dementia care and mobility services for residents; and
- addressing outdated physical infrastructure (for example, older designs of rooms and common spaces, poor ventilation, multi-bed rooms, and larger homes), which contributed to a higher incidence rate of COVID-19 and poorer resident satisfaction with care.

Reflections are also ongoing about improving supports for residents and staff, notably:
- significant staffing shortages since the pandemic, with many workers having left due to unsafe working conditions and burnout;
- public-image campaigns alongside financial support for training and guaranteed job entry could support recruitment of new workers in long-term care;
- increases in wages, availability of full-time work (as opposed to part-time positions), and providing equitable benefits, such as paid sick leave can improve recruitment and retention of workers;
psycho-social supports including counselling, therapy and psycho-educational training to identify signs of burnout can help retention of staff;
- enforcing safety standards such as mandatory staff-ratios (how many staff needed for each resident), frequent inspections, and mandatory reporting of quality indicators can improve the safety and quality of the work environment for staff as well as living environment for residents;
- shared decision-making with residents and their families or caregivers was found to have positive outcomes for residents (but it requires an investment in staff training to ensure it is delivered effectively); and
- interoperable electronic health records may enhance quality of care as well as the improved management of clinical documentation (but some long-term care homes have been slow to adopt them and to put in place training and processes to support their use).

Lastly, three themes emerged about promoting alternatives to long-term care homes:
- providing additional supports in the community (for example, enhancing the use of technologies at home and expanding at-home palliative-care services) can help older adults to remain at home longer and empower older adults and their families to choose if and when to enter long-term care;
- expanding benefits for home-care clients, including increasing the number of hours for personal care (for example, bathing, cleaning, preparing meals) and flexibility in working time and temporary absences for caregivers can help to make home care a more viable alternative to long-term care; and
- greater coordination between home-care supports and primary-care providers can support older adults to age in place.

The reflections and debates concerning the renewal of long-term care are not something new. It remains to be seen whether the sense of urgency created by the pandemic will be sufficient to keep this issue on top of the governmental agenda and bring about sustainable change.