Long-term care homes (LTCHs) face unique challenges that have been exacerbated by the COVID-19 outbreak. The public and media have been alarmed by high infection rates and the number of deaths in LTCHs over the course of the pandemic. In response, CSA Group (Canada's largest standards development organization), supported by funding from the Standards Council of Canada (SCC), is spearheading the development of a standard dedicated to the needs of LTCHs. This initiative has included stakeholder surveys and information-gathering sessions with a variety of interested parties (including LTCH residents, family members, caregivers, and LTCH management) coupled with CSA Group's accredited standards development process. The standard is scheduled to be published in December 2022.

The COVID-19 pandemic illustrated the vulnerability of, and challenges confronted by, LTCHs in Canada. As of May 2020, 840 outbreaks had been reported at LTCHs and retirement home facilities, which accounted for approximately 80% of all COVID-19 related deaths during the first pandemic wave.1 Currently, there are 2,000-plus LTCHs with more than 250,000 residents in Canada. The Conference Board of Canada estimates the need for an additional 199,000 long-term care beds by 2035 to keep pace with the aging population.2 

LTCH residents are often older, with pre-existing medical conditions. These residents also tend to be more prone to infections due to shared space and supplies, frequent transportation between medical institutions, and insufficient and varying practice standards within the homes.

“This past year has brought to the forefront significant issues within our long-term care homes,” says Dr. Alex Mihailidis, chair of CSA Group's technical subcommittee for the LTCH standard. “In response, we need to do all that we can to help ensure that these facilities are places where everyone feels cared for in a safe and compassionate way.”3 

LTCHs have been at the center of COVID-19 media coverage. Infection prevention and control was one of the major challenges in LTCHs during the pandemic, and Canada was identified as having the worst infection rates and deaths in LTCHs of any Western country, as highlighted by CBC News.4 Also, a publication by the Canadian Centre for Policy Alternatives (CCPA) recommended developing national standards in areas such as LTCHs.5 

To address some of the challenges faced by LTCHs, CSA Group and the Health Standards Organization (HSO) are collaborating with the SCC to develop two new complementary standards. HSO is an accredited standards development organization in Canada, and HSO's standard, CAN/HSO 21001:2022 Long-Term Care Services, will mainly focus on the quality of direct care, such as staffing and residents’ rights. CSA Group's standard, CAN/CSA Z8004 operation and infection prevention and control of long-term care homes, will address safe operating practices and infection prevention and control in LTCHs. This standard will also help provide a safe long-term care home setting that is needed to support the quality of care for residents.

“In terms of our standard, we deal with the nuts and bolts of what LTCH facilities need to consider, such as infection prevention and control, PPE, etc.,” says Doug Morton, vice president of government relations at CSA Group.6 

Multiple areas are covered or referenced in the CSA Group standard, such as heating-ventilation-air conditioning (HVAC), plumbing, medical gas systems, and the use of technology.

“CSA's standard is covering the infrastructure that is required to keep LTCH residents, staff, and visitors safe with respect to infection prevention control,” says Dr. Mihailidis. “More specifically, the National Standard of Canada for Operation and Infection Prevention and Control of Long-Term Care Homes (CSA Z8004) will cover a lot of the typical things: the engineering systems, ventilation, and things like that, but we are also looking at design aspects as well that will support these operational requirements to keep all the residents and staff safe within these LTCHs.”7 

In a typical standards development process, standards are established by technical committees of external experts and stakeholders, and the drafts are then presented for public review. Canadians are encouraged to comment and recommend changes to the draft over a 60-day period.

“The public review process not only represents a significant project milestone, but one of the most consequential in the standards development process,” says Mary Cianchetti, president of standards at CSA Group.8 

In developing the LTCH standard, CSA Group extended this approach to include enhanced public engagement, which exceeded the accredited standards development process. Together with other collaborating organizations, CSA Group hosted six targeted consultation sessions and three national surveys to engage technical experts and other stakeholders. The consultations took place in June and August 2021 and targeted specific groups, including frontline workers, Indigenous communities, older adults, the LGBTQ community, and operational staff.

More than 225 individuals participated in these consultation sessions, and the surveys received 776 responses from across Canada, representing 12 provinces and territories. The survey participants comprised LTCH residents, their caregivers and families, frontline staff, LTCH management and administrators, government regulators, and research and advocacy organizations.

CSA Group published a “What We Heard” report summarizing insights from the public engagement sessions. These insights outlined principles that help inform all aspects of operations, infection prevention and control, policies and procedures, and the design of LTCHs. Based on findings during the consultations, three principles were identified: people-centered care; equity, diversity, and inclusion; and gender and sexual inclusivity.9 The report also discussed the themes that emerged from the consultation process, including COVID-19 policies and procedures, equity, diversity and inclusion, training and education, food and nutrition, infection prevention and control, HVAC, and environmental design.

The CSA Group technical subcommittee for the LTCH standard used the valuable insights from the enhanced public engagement process to inform the development of the standard draft, and the 60-day public review took place from February to April 2022. CSA Group also applied the enhanced public engagement approach during the review period, organizing several information sessions to help stakeholders and the public actively participate. The information sessions provided an overview of the standard draft, emphasizing its key aspects, and helped participants understand how to share their comments and input with CSA Group. Currently, the technical subcommittee is reviewing all submitted comments. The final version of the CSA Z8004 standard is expected to be published in December 2022.

In addition to investments in LTCH standards, the federal government has indicated its intent to create a new Safe Long-Term Care Act, which would set national standards of care. In Canada, health care falls under provincial and territorial control, and it's ultimately their decision to implement the standards.

“As thorough as CSA Group's new standard will be, its adoption will be voluntary unless it's incorporated by governments, regulators, or best-practice guidelines,” says Doug Morton. "We're having discussions with federal and provincial governments, and we have members from government on the technical committee, so we're very hopeful.”10 

1.
Canadian Institute for Health Information.
2020
.
“Pandemic experience in the long-term care sector: How does Canada compare with other countries?”
Ottawa, Ontario
:
CIHI
, June.
2.
Gibbard,
Robyn.
2017
.
“Sizing up the challenge: Meeting the demand for long-term care in Canada. ”
Ottawa, Ontario
: The Conference Board of Canada, 27 November.
3.
CSA Group.
2021
. “
New national long-term care standards to provide safer environment and high-quality care
. ”
CSA Group
, 2 April.
4.
Canadian Broadcasting Corporation.
2020
. “
National standards critical to saving lives in long-term care, report says. ”
CBC News
, 24 November.
5.
Armstrong,
Pat,
and
Cohen
Marcy.
2020
. “
A higher standard: Setting federal standards in long-term care and continuing care
. ” Ottawa, Ontario: Canadian Centre for Policy Alternatives, 23 November.
6.
Foulis,
Maia.
2022
. “
CSA Group building new standard to protect long-term care staff
. ” Canadian Occupational Safety, 26 January.
7.
Foulis.
2022
.
8.
Health Standards Organization.
2022
.
“CSA Group and HSO release new national long-term care standards for public review. ”
Ottawa, Ontario
:
HSO
, 11 February.
9.
CSA Group.
2022
. “
What we heard, final report
. ”
Toronto, Ontario
:
CSA Group
, January.
10.
Swift,
Diana.
n.d. “
Reimagining long-term care with lessons from the pandemic
. ”
Hospital News
.

Pantea Niksirat is manager of regulatory impact assessments at CSA Group. She holds two MSc degrees in chemistry, a master's in public policy, and a risk management certificate from the University of Toronto.

Pantea Niksirat is manager of regulatory impact assessments at CSA Group. She holds two MSc degrees in chemistry, a master's in public policy, and a risk management certificate from the University of Toronto.

Close modal