Public Notice of Intent

Long-Term Care Services, 11.020.10

Designation Number: CAN/HSO 21001:2022

Standards notification on a: New Development

Type of Standard: Integrated Health Service, Health Service Provider, Organizational Competency, Health Professional Competency

Status: Open for comment (15 days)

Responsible Technical Committee: TC008 – Long-Term Care Services

Scope: Health Standards Organization (HSO) is developing a National Standard of Canada (NSC) for the co-design and delivery of integrated, resident-and-family-centred long-term care (LTC) services across Canada. The HSO National Long-Term Care Services Standard (CAN/HSO 21001:2022— Long-Term Care Services) is a revision of the HSO 21001:2020 – Long-Term Care Services standard and will provide LTC homes across Canada with evidence-informed practices that define how LTC homes and LTC teams can work collaboratively to keep people safe, provide safe, reliable, and high-quality care, and demonstrate positive, outcomes-focused change.

The new standard will focus on:  

• Resident-and-family-centred care practices that value the importance of respect, dignity, trust, and quality of life,  
• Safe, reliable, and high quality care based on evidence-informed practices,   
• A healthy and competent workforce to ensure sustainable, team-based, compassionate care, and,  
• An organizational culture that is outcome focused and strives towards the safety and well-being of residents, families, and the LTC workforce

The CAN/HSO 21001:2022 – Long-Term Care Services standard will also: 

• Adopt a “whole person,” holistic approach to the provision of LTC services that are delivered collaboratively with residents and families by LTC care providers in a licensed, congregate care setting; 
• Present how LTC homes and LTC teams can improve quality of care and quality of life for residents and families by moving towards an integrated, resident-and-family-centred delivery of care model that enables LTC services to be delivered at the right time, by the right people and in the right setting; 
• Present the requirements for the coordinated delivery of resident-and-family-centred LTC services, as defined by the needs of residents and their families; 
• Determine how LTC services can be coordinated across the health system, and particularly integration at the level of local community services (e.g., timely access to primary and acute health services); 
• Provide clear, standardized, evidence-informed practices to deliver direct care and services expected for a vulnerable population of Canadians with complex care needs; 
• Outline how LTC homes can support and maintain a healthy LTC workforce, ensuring that staff receive the training they require, that they are provided with decent and safe working conditions, and that they are supported in their day-to-day interactions so they are able to provide the highest quality of mindful and purposeful LTC services to residents and families; 
• Adopt a culturally safe, culturally appropriate and mindful approach to care and service delivery across all LTC interactions;
• Adopt a health equity lens and abide by the principles of equity, diversity and inclusion, advocating for the needs of all residents and families, particularly those relevant to underserved, racialized and/or marginalized communities such as 2SLGBTQ+ peoples, Black, Indigenous, and other People of Colour (BIPOC), refugee, immigrant and other ethno-cultural communities;
• Promote a higher quality of life for residents and their families by developing safe and age-friendly environments that foster autonomy and engagement while valuing the importance of respect, dignity and trust; and, 
• Provide guidance to leadership and policy-makers about how they can support safe, reliable, and high quality LTC services through, for example, policy, regulation and legislation that are informed by the needs of people and communities.

For the purposes of this standard, LTC homes are defined as a facility formally recognized by jurisdiction (i.e., are licensed and/or permitted to formally operate as such) that provide a wide range of personal (e.g., assistance with everyday activities) and medical services 24 hours, 7 days a week. The LTC home is considered the person’s formal ‘home’ address.

Overarching principles of both resident-and-family-centred care as well as integrated LTC service delivery as a continuum of care are foundational to the development of this standard. While the standard will focus exclusively on the delivery of evidence-informed, resident-and-family-centred LTC services within the context of formal LTC homes, principles of high quality, resident-and-family-centred LTC service delivery transcend setting and space and can be applied in any care environment where LTC services are delivered and received. 

Out of scope in this revision is content related to the planning, designing and construction of LTC homes, as well as content related to infection prevention and control (IPAC) best practices used when planning, designing and building LTC homes. 

The standard is not intended to duplicate or replicate existing HSO National Standards of Canada, but rather to supplement and complement current standards, guidelines and recommendations used across HSO’s suite of services. 

Project Need: The COVID-19 pandemic has exposed significant gaps in the quality and safety of care within Canada’s Long-Term Care (LTC) and retirement homes, which house close to half a million mostly older Canadians. The Canadian Institute for Health Information (CIHI) reported that, during the first few months of the global pandemic, 81% of Canada’s known COVID-19 deaths were in its LTC and retirement homes, nearly double the average for Organization for Economic Co-operation and Development (OECD) countries. Furthermore, the risk of dying from COVID-19 was found to be 73.7 times greater amongst older Canadians living in LTC and retirement homes than in their own private dwellings in the community.^1,2,3,4    

In reacting to this report, the Prime Minister made the following statement: “We will continue to work with the Premiers on ensuring that our long-term care centres are properly supported, whether that’s by  bringing in national standards,  whether that’s by extra funding,  [or] whether that’s by  looking at the Canada Health Act.”⁵

The provision of LTC is not publicly guaranteed nor insured under the Canada Health Act; rather, it is governed by provincial and territorial legislation resulting in different jurisdictions across Canada offering a variable range of services, eligibility, cost coverage and quality assurance mechanisms for LTC services across the country.  

Given that over 40% of Canada’s LTC and retirement homes have sustained COVID-19 outbreaks and over 12,000 resident and 20 staff deaths to date, there has been significant public attention and continued calls to improve the provision of LTC services for all Canadians. A recent Ipsos Survey of 2,005 Canadians aged 18+ in late 2020 found that 86% said they were concerned about the challenges being faced by Canada’s LTC system, with only 26% agreeing that prior to the pandemic, LTC homes were safe and operating at high standards. In fact, 62% of Canadians agree that challenges to the LTC system are primarily due to a lack of national standards for the sector.⁶  

On September 23rd, 2020, via its Speech from the Throne, the Federal Government committed to “work with the provinces and territories to set new national standards for long-term care,” presenting an opportunity  to provide a greater level of harmonization in the provision of high quality LTC services across Canada.  

HSO, Canada’s only Standards Development Organization (SDO) solely dedicated to health and social services, consequently submitted a proposal to the Standards Council of Canada (SCC) supporting the development of CAN/HSO 21001:2022 – Long-Term Care Services, a National Standard of Canada (NSC) that could enable the federal government’s commitment to set new national standards for long-term care, as informed by the needs of residents and families across Canada. The current iteration of HSO’s Long-Term Care Services standard (HSO 21001:2020 – Long-Term Care Services) is now in use by Accreditation Canada to accredit 58% of Canada’s LTC homes. There are still a number of LTC homes that are not accredited. Considering the established need and desire to develop new national standards for LTC, SCC accepted the HSO proposal and has agreed to fund the revision of this standard.

The Canadian Standards Association (CSA) Group is simultaneously developing a new national standard focused on the operation and infection prevention and control of LTC care homes. As a result, HSO and the CSA Group have agreed to work collaboratively throughout the length of their development processes to ensure they provide a comprehensive and unified solution for Canadian LTC homes, and that they develop updated and complementary standards and assessment programs that achieve current goals.

To that end, HSO is convening a Long-Term Care Services Technical Committee to lead the development of its newly proposed CAN/HSO 21001:2022 – Long-Term Care Services. The Long-Term Care Services Technical Committee (TC008) will take an evidence-informed, systematic approach to developing standards that assess best practices for providing safe, high quality and reliable care in LTC homes and/or residential homes for Canadians, their families and caregivers, and the supporting workforce. The Technical Committee will collaboratively work with residents and families to provide clear, standardized, evidence-informed practices that enable the delivery of resident-and-family-centred care and services that are mindful and purposeful for all Canadians. 

[1] https://www.theglobeandmail.com/canada/article-new-data-show-canada-ranks-among-worlds-worst-for-ltc-deaths/
[2] https://www.cbc.ca/news/health/coronavirus-canada-long-term-care-deaths-study-1.5626751
[3] https://www.cbc.ca/news/canada/nursing-home-covid-19-deaths-1.5641266
[4] https://www.jamda.com/article/S1525-8610(20)30791-X/abstract
[5] https://www.cbc.ca/news/politics/long-%20term%20%20-care%20%20-challenge%20-1.5626841
[6] https://www.ipsos.com/en-ca/news-polls/safer-at-home-eight-in-ten-canadians-vow-to-do-all-they-can-to-avoid-going-into-long-term-care

Proposed Timeline: January 2021 to September 2022

Posted on: March 16, 2021

Contact Information: Organizations interested in supporting the development of this standard or wanting to be consulted as a stakeholder during the development process and individuals, including patients, providers, health leaders and the members of the public can provide comments by contacting us at publications@healthstandards.org.

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