LTCcovid Country Profiles

Responses to 4.09. Reforms to improve care homes, including new standards and building regulations

Ontario (Canada)

The Fixing Long-Term Care Act, announced in 2021, would permit the Minister of Long-Term Care to develop a policy outlining how many beds are needed in the province and where these beds are most needed (source: Bill 37, Providing More Care, Protecting Seniors, and Building More Beds Act, 2021).

Last updated: December 10th, 2021

Finland

The Finnish government is currently proposing reforms to the Social Welfare Act that aim to promote diverse and flexible housing and care solutions, including communal housing and housing with 24-hour care. The communal housing would offer accessible and safe homes where people can live in apartments where they can participate in activities have support with any care needs. Both communal housing and housing with 24-hour care would be provided in the same building complex, also including ordinary apartments, with the aim that clients can get the services they need at home without having to move when their care needs change.

Long-term institutional care for older people is to be abolished by the end 2027, with a transition period to introduce and adapt the services.

Last updated: December 10th, 2021

France

Improving infrastructure for older people, and in particular the social care sector, was a key pillar of the French government’s?plan?to “relaunch the economy and make it more resilient” and intends to build a resilient care sector over a journey of 20-25 years. For care homes, 2.1 billion euros have been allocated over 5 years to invest in the transformation, renovation works, and digital upgrading of care and nursing homes. Examples of how this will be used include the renovation of 65,000 care home beds to adapt estates to the futures: buildings allowing for smaller structures with more convivial living opportunities, more rooms adapted to cognitive impairments, and future-proofing estates against climate change. The funds will also build new care homes. 

1.5 billion?euros have been allocated over 4 years to transform models of care homes as part of the Ségur de la santé, into more human, locally connected and medicalised settings. In addition, 125 million euros have been allocated to finance daily needs, such as buying new equipment, small changes and construction works. 

In January 2022, significant media attention was given to the care quality and infrastructure in private residential and nursing homes following the publication a journalist’s inquiry revealing rationing food and hygiene products, with high levels of turnover leading to inappropriate staffing levels. A CICTAR report in February 2022 further highlighted the financially opaque and ‘leaky’ practices within these large private-equity backed care home groups.  The growing media attention suggests the quality and financing of residential and nursing homes, and wider questions around care provision for both older and disabled people, could be a key question in upcoming presidential debates.  

Other measures to improve quality of care and integration of care homes with the health sector include: 

• Doubling financing for mobile geriatrician teams which support residential and nursing homes to €8m per year, which has supported the creation of 177 mobile teams, alongside the development of mobile hygienist teams to build up a culture of Infection Prevention and Control (IPC) more systematically; 

• Strengthening home hospitalisation (akin to virtual wards). The number of residents in care and nursing homes increased by 79% between 2019 and 2020 supported through a relaxing of regulatory conditions to scale and spread models. The long-term financing of home hospitalisation in a wider range of residential care settings is currently being investigated;  

• Establishing geriatric on-call and palliative care for to now cover all care and nursing homes, financed by an end-of-life care plan 2021-2024 and supported with the necessary regulatory changes and support from mobile teams; 

• Development of care and nursing homes and domiciliary care services as territorial resource centres for older people, with responsibilities that include: 

• Providing training for staff, administrative and logistical support, access to geriatric and gerontologic competencies and resources, and facilitating access to specialist infrastructure; 

• Access to more intensive home care support;  

• Strengthening medical support in care and nursing homes, through a budget of €52,2m in 2022 to increase coverage and attractiveness of these roles. Measures include increasing the minimal time of coordinating doctors must spend in care and nursing homes to a minimum of 2 days per week, regardless of the size of the provider, and a monthly bonus for coordinating doctors to €517; 

• Ensuring continuity of overnight care through the scale and spread of night nurses to all care and nursing homes in 2023, with discretion given to regional health authorities around implementation; 

Developing a greater number of specialist settings for care for people with dementia and other neurodegenerative diseases, with additional financing for multidisciplinary teams. (source) 

Last updated: October 23rd, 2024   Contributors: Camille Oung  |  Alis Sopadzhiyan  |