AnnouncerYou’re listening to From the Burgundy Chairs, a podcast for health system leaders created by Santis Health.

Danielle FlielerWhen federal, provincial and territorial health ministers convene each fall, the agenda is understandably packed. Immediate crisis management, funding frameworks and national strategies take up most of the room. A resilient health system also depends on the fundamental building blocks of patient care, and those are the issues that rarely reach the headlines, even though they shape the experience of millions of Canadians every day. Many of the most consequential conversations in health care are left off the agenda, and they never receive the pan-Canadian attention they warrant.

My name is Danielle Flieler, Manager of Federal Government Affairs at Santis Health. In this episode of From the Burgundy Chairs, we are stepping outside the formal agenda of the October Health Ministers meeting to examine the priorities that will not make the official list, but that will determine whether the rest of the system holds together. Over the next half hour, I speak with three leaders about the sectors they represent, what they need ministers to understand, and what they want to see change over the next five years. We begin with long-term care.

Jodi Hall is the Chief Executive Officer of the Canadian Association for Long Term Care, the national voice for long-term care in Canada. CALTC represents provincial and territorial associations and providers delivering publicly funded care to seniors across the country, and Jodi has led the organization as its inaugural Chief Executive Officer since 2021. Jodi, thank you for joining me.

Jodi HallThank you, Danielle, it’s great to be here.

Danielle FlielerSo Jodi, before we get into policy, set the scene for people who do not work in this sector. What does the current state of long-term care in Canada look like?

Jodi HallI think it’s helpful if I provide some context for how this looks across the country. Right now there are approximately 200,000 Canadians who live in long-term care homes, within about 2,100 homes. They employ 250,000 individuals in a range of roles, both in care but also in dietary and other environmental departments, and there are also physicians, nurse practitioners, and a range of allied health professionals like rehab, OT and social work.

The other side of long-term care is that homes are also important to the local community, because many of them serve as a community hub. It’s where our residents live, it’s truly their home, and there are a lot of connections that occur with intergenerational programming with local children and schools. Residents benefit greatly from the contributions of volunteers and family caregivers who really enrich their daily life. So long-term care homes truly are this crossroads between health and social programming and policy.

Long-term care is not under the Canada Health Act, and it falls under the jurisdiction of the provinces to legislate, set standards, regulate, licence and oversee the work of the homes through regular inspections. In addition, provincial governments provide public funding based on a formula that considers daily care and living needs as well as accommodations. Many residents can also pay a fee to live in long-term care, depending on that province’s financial assessment model.

I can say that the demand for long-term care spaces right across the country far exceeds the capacity or supply that we have at this time. Every province in Canada is at a record high waitlist for individuals waiting to move into a long-term care home. We have the most extreme example in Ontario, where they have over 48,000 people on the wait list, but every province right now has a record number of people waiting to move into a long-term care home.

We can point to some significant investments that provincial governments as well as the federal government have made over the last several years, certainly noting with the federal government that it’s the Aging with Dignity bilateral agreements that have come into play. Some provincial governments have made great investments in the sector, but it’s important to point out that that varies between one province and the other.

So to pull it all together, we have an aging population with demand for long-term care spaces that surpasses supply. We have capital development costs for home construction that have increased significantly, and some provinces have introduced capital programs to support development and others have not as much. We’ve also seen that people are receiving more services in the community, so when residents come to a long-term care home, we’re seeing more complex needs and higher levels of acuity. Some provinces have invested in hours of care and have gotten to four hours of care, and others have not.

Although the workforce needs of the sector have improved, where we’re seeing that somewhat stabilized, there still is a significant need for a sustainable workforce plan right across the country — especially when we consider changes that have been made to immigration policy. It’s a critical point that we need to think about. Some provinces have relied more heavily on the Temporary Foreign Worker Program, which has contributed to improvements, but with recent policy changes that staffing situation really is quite fragile as we see those work permits coming to an end over the next couple of years.

Danielle FlielerBuilding on something that you touched on, and the immense pressure facing long-term care homes with an aging population and people arriving with more complex needs — can you describe the distance between what the sector is being asked to deliver and what it is currently funded to deliver?

Jodi HallFirst I just want to re-emphasize that quality of life and quality of care is still the top priority for every home across the country, and staff do amazing work to try and meet every need of the residents in every jurisdiction. But with that said, there is concern about the unequal investment that we see happening. I think it raises questions that we have to ask around equity, and whether residents in every province are having the same experiences with long-term care as others.

That’s flowing through provincial investments into the sector, but also how federal dollars are being used that are directed to the provinces for support through agreements like the Aging with Dignity bilateral agreements. I think there is a lot of opportunity for us to address some of those gaps that are starting to look really different in different jurisdictions for workforce, for infrastructure, and for IT modernization. Right now we see investments being made, but it’s been uneven, and I think there is a lot of opportunity to fill the gap if we could find a more unified effort across the country — respecting jurisdiction — to make those targeted investments.

Danielle FlielerAcute care usually takes centre stage at ministerial meetings, despite the critical needs of long-term care. What is the one long-term care priority that has to stay top of mind for ministers this October?

Jodi HallFor me it’s always helpful to think about the big picture to paint the story, and I want to start by saying that there are public policy solutions to the challenges that we face in long-term care, and that we’re not powerless to address some of the things that we’re facing. I’m not suggesting that these are not complex matters, because they absolutely are. But if we approach public policy from a systems viewpoint, we can see that the health care ecosystem is not just about the hospital or just about the long-term care home — there are actually many more components, and they’re all interconnected. When care is happening in a community with informal caregivers and home care providers, and then we also think about long-term care homes — and of course I emphasize the word homes, because it is where people live their daily lives — sometimes the solutions that we seek for acute care actually reside elsewhere in that health care ecosystem.

To move specifically to the long-term care home sector and discussions at the ministerial table, it’s really challenging to identify just one priority that should be discussed, so I’ve thought about it more from the perspective of what can be done in the short term. In the short term, I think that workforce development and specifically immigration policy is a key area where there is opportunity. There must be a carve-out in immigration policy that prioritizes individuals who come to Canada to work in the long-term care sector, both in programs like the Provincial Nominee Program and the Temporary Foreign Worker Program, just to name a few.

But we also have to think about not just recruitment, we have to think about retention. Prioritization of work permit renewals for people coming through immigration programming, and creating more permanent residency pathways, really need to be prioritized. The immigration policy reforms that have been introduced have started to have a deep impact on long-term care homes, not just for care staff but for a range of positions in the homes, and I think it’s really important to emphasize that there’s not an existing Canadian cohort to fill all of these roles. So it’s essential that we continue to see immigration as part of the workforce strategy that we need for long-term care.

At this health ministers meeting, this is something that the provinces could seek from the federal government that would lift immediate pressure that homes are facing across the country. Of course there are always many other opportunities for this table to take action for long-term care in Canada. I’ve mentioned a few times the renewal of the Aging with Dignity bilateral agreements, and we would love to see specific investments that flow directly to long-term care homes that could support IT modernization and prepare for what inevitably will be changes the sector will be facing as AI advances.

Danielle FlielerIf we sat down again five years from now, what would need to have changed for you to say long-term care is on a sustainable footing, or a more sustainable footing?

Jodi HallFirst, Canadians should be able to access the care that they need when they need it. We shouldn’t have people waiting unnecessarily in hospitals, or families struggling to find the appropriate place for their loved ones. Access to long-term care should be available, and I’d love to see that stabilized in five years.

Second, we need to have a much more stable and sustainable workforce. We need to address recruitment, retention and training domestically with a national strategy — we’re certainly an advocate for that — but also immigration policy, as I’ve already mentioned, that specifically recognizes the need in long-term care homes and develops policies so that homes can reliably staff to meet the needs of their residents through long-term planning.

Third, we need to have more significant progress on infrastructure. We can’t meet the demographic reality of the next decade with today’s capacity. Much more is needed to mobilize home construction, and there is a need for renewal of many existing homes that don’t currently meet a modern design standard.

Fourth, we need to find the right balance between IT modernization and artificial intelligence that supports the work of staff and resident care in a way that’s meaningful — not just implementing it for the sake of doing so, but so that it actually enhances outcomes for residents and provides a streamlined workflow for staff and leaders.

Danielle FlielerMy last question, which I am asking each of my guests: if a health minister remembers only one thing from this episode, what should it be?

Jodi HallThat some of the solutions they seek for acute care can actually be found elsewhere in the ecosystem. It’s not something that you can solve one piece at a time — you really need to invest in other areas, in community, but also in long-term care homes. There is real opportunity there with targeted investment and resources, not only for us to become sustainable but for us to become global leaders right around the world.

Danielle FlielerJodi, thank you for that. Workforce pressure, capacity, and the connection between long-term care and the rest of the system come back repeatedly as pain points within the health system. Pressure inside long-term care does not stay inside long-term care, and the same is true of the issue I want to turn to next. Mental health care touches almost every file ministers will discuss in October, and it continues to be treated as a conversation of its own.

Diana Vincze is the Associate National Executive Director of the Mood Disorders Society of Canada, one of the country’s most connected mental health organizations, working nationally on advocacy, peer support and public education for people living with mood disorders. Diana, thank you for sitting down with me.

Diana VinczeThank you for having me.

Danielle FlielerFor listeners who follow health policy but not mental health specifically, where does the system stand today? What does a Canadian looking for mental health support actually encounter?

Diana VinczeDanielle, I think it’s really important to draw the full picture. For most Canadians, if you need mental health support, the first step is usually to see your family physician. And if you don’t have a family physician, which is the reality for many Canadians, you may end up going to a walk-in clinic. Typically you leave that appointment with a prescription and a referral.

If you’re referred to a psychiatrist, that service is generally covered through the provincial health system. But if you’re referred to a psychologist, that’s a different story. Psychological services generally aren’t covered by provincial health insurance unless you’re accessing them through a specific publicly funded program. So this is the point where you find out you’re going to be waiting, and in many cases people can wait up to six months to a year or even longer to access the care they’ve been referred to.

Danielle FlielerSo what do people do in the meantime while they’re waiting? Because that’s a really long time, and we obviously know that in certain circumstances mental health issues can be quite acute. What resources are there, or what is the solution at the moment for people in the meantime?

Diana VinczeIt does create a huge gap, you’re absolutely correct. You’ve identified that you need help, you’ve gone to see a health professional, you’ve received the referral, but now you’re essentially waiting and trying to figure out what to do in the meantime. For people who have employer benefits, there may be another option. But even there the coverage is often limited. It’s common to see annual psychological service coverage in the range of $500 to $1,000, which can disappear very quickly when you consider the cost of private care. From our perspective, coverage should be at least about $2,000 annually, which would provide people with a more meaningful opportunity to actually access ongoing support.

And then there’s the question of geography. Somebody living in a large urban centre may have more options than someone living in a rural, remote or northern community. So when we talk about access to mental health in Canada, I think we need to be very clear about what the experience actually looks like for the individual. It’s not simply about whether a service exists, it’s about whether you can access it when you need it, whether you can afford it, and whether you can navigate the system while you’re already struggling. The struggle doesn’t take a pause during this gap and wait period.

This is where we need to do better. A referral is not the same thing as access to care, and a waiting list is not a treatment plan. The issue is not that Canada doesn’t have mental health services, it’s that access to those services is inconsistent, fragmented, and too often dependent on circumstances that have nothing to do with the person’s need for care.

Danielle FlielerAbsolutely. And on that note, mental health is discussed constantly, and it still sits outside primary and physical health policy. So as ministers gather in October, what has to change for mental health to receive the equal policy priority that I think you’re alluding to?

Diana VinczeThis is a great question, Danielle. I think the biggest change is that we have to stop treating mental health as something that sits beside the health system rather than being part of the health system. When a mental illness emerges, it doesn’t necessarily operate on the same timeline as our health system. It doesn’t wait for a referral appointment to become available, for a waitlist to move, or for a program to reopen. It has its own timeline, and that can mean that by the time somebody finally gets access to care, their situation has become much more difficult.

If someone is living with depression, anxiety or another mood disorder, their mental health is going to affect their physical health, their ability to work, their relationships, and their ability to navigate the health system overall. These things aren’t happening in separate compartments. That’s why we at MDSC fully support the Mental Health Parity Act, Bill C-280, as proposed by MP Gord Johns — the principle that mental health should be treated as an essential part of health, with access to care reflected accordingly in our health system and policies.

We also need to look at what happens after that initial referral. A referral shouldn’t be the end of the journey; for many people it’s actually where the journey becomes more complicated. They’re given a list of numbers, they’re put on a waitlist, and they’re left to figure out what comes next. I think there are concrete things the government can do: improving data collection, establishing meaningful national measures for mental health access and outcomes, strengthening community-based services, and really ensuring that mental health is reflected in health funding and accountability. We don’t need to reinvent the entire system overnight. But we do need to start treating mental health as an essential part of health.

Danielle FlielerSo if we revisited this conversation five years from now, what would need to have changed for mental health care in Canada?

Diana VinczeFive years from now I would hope that we could look back and say that needing mental health care no longer automatically meant entering a completely different system. I would want mental health to be measured alongside physical health, not as an afterthought, but as a core part of how we evaluate the health of Canadians.

And I think we need to recognize where people actually spend their lives. We spend roughly a quarter of our time in the workplace, so mental health cannot be separated from the workplace either. A report published in April 2026 by the CSA Public Policy Centre estimates that Canada’s mental health crisis costs the economy $180 billion annually across health care, emergency services, the criminal justice system and homelessness supports. That tells us this is not just a health issue — it’s a workplace issue, an economic issue, and ultimately a human issue.

I would also like to see much more consistency in access to psychological services. Your ability to receive care shouldn’t depend so heavily on your employer’s benefits package or the province or community you happen to live in.

Danielle FlielerThat’s an incredible number. And unequal access is something that we see across many different sectors in different ways. So thinking about that: if a health minister remembers only one thing from this episode, what should it be?

Diana VinczeMental health is health. And access to mental health care should not depend on your postal code, your income, your employer, or your ability to navigate a complicated system. If someone is reaching out for help, that’s a moment when the system has the opportunity to support them. We need to make sure that reaching out actually leads somewhere.

If there is one thing I would want a health minister to remember, it’s that we don’t have to build everything from scratch. We need to better understand, recognize and use the valuable resources that already exist within community mental health organizations. There are organizations across the country that have been created specifically to support people living with mental health conditions and their families, along with the caregivers who support them. They have built programs, resources, peer support networks and practical tools based on years of experience, and importantly, lived experience, which is something that we stand for at the Mood Disorders Society of Canada.

I think there is a real opportunity to bridge the gap between the clinical health care system and the community. We need to bring clinical expertise together with lived experience expertise, because both are essential. A clinician will bring one perspective, but people who have lived through the system, and the organizations that support them, bring a different kind of expertise that you cannot replicate in the clinical setting.

Danielle FlielerThank you, Diana. The theme running underneath that conversation is prevention, and what it costs the system when prevention is deferred. That brings me to my final guest. Chronic conditions account for a significant share of health system costs and pressure, and proactive management is routinely set aside for the urgent case in front of us.

Carrie Thibodeau is the National Director of Programs and Public Policy at The Kidney Foundation of Canada. For more than 60 years, the Foundation has delivered advocacy, research and support for Canadians living with kidney disease. Carrie, thank you so much for joining me today.

Carrie ThibodeauThank you for having me, it’s a pleasure.

Danielle FlielerSo let’s start with the patient. What does the journey look like for someone diagnosed with kidney disease today, from the first indication that something is wrong through to ongoing treatment?

Carrie ThibodeauKidney disease is often called a silent disease. People can lose a significant amount of kidney function without any symptoms at all. For a lot of patients, the first indication that something is really wrong is a serious health event, frequently resulting in an emergency room visit where they learn that their kidneys are already failing. At this point, the options are severely limited. When your kidneys fail, you require dialysis or a transplant to survive.

Dialysis is a gruelling treatment. Hemodialysis, the most common form, typically involves visiting a clinic or hospital three times a week for at least four hours per session. It takes a massive toll physically and mentally. Beyond the time spent connected to the machine, the recovery period after each session can wipe out the rest of the day. This makes maintaining regular employment incredibly difficult for many patients, leading to severe financial strain on patients and their families. It’s also important to note the geographic disparities. If you live in a rural or remote area, accessing a dialysis centre might involve hundreds of kilometres of travel, or even relocation.

Danielle FlielerSo those are some of the implications of dialysis. Zooming out to look at the health system generally, why does chronic disease need elevated national attention right now?

Carrie ThibodeauChronic disease needs much greater national attention because our health care systems are increasingly focused on acute crisis management, often at the expense of early intervention and proactive care. We know that chronic diseases, including chronic kidney disease, are a leading driver of health care costs and hospitalizations. For kidney disease specifically, an estimated four million Canadians have chronic kidney disease, and many don’t know it. The cost of treating end-stage kidney disease, particularly through in-centre hemodialysis, is enormous, estimated to be upwards of $100,000 per patient per year. This is not a sustainable trajectory for our health care system.

When we invest in early screening, particularly for high-risk populations like those with diabetes or hypertension, we can detect kidney disease much earlier. With early detection, we can implement medical management and lifestyle interventions that can significantly slow or even halt the progression of the disease. This prevents the need for dialysis, reduces cardiovascular events which are closely linked to kidney disease, and improves the quality of life for the patient. It also means that patients are more likely to stay employed, and they can be engaged in their families and communities.

Danielle FlielerIf we were to revisit a conversation like this in the next five years, what changes would you like to see made to support chronic disease care for Canadians?

Carrie ThibodeauI’d like to see chronic diseases, and that includes kidney disease, treated as preventable and manageable rather than inevitable. I want to see standardized risk-based screening implemented across primary care so that kidney disease is caught in its earliest stages. In five years, I would hope that access to early testing — such as the simple blood and urine tests required to detect kidney disease — is widely available and consistently utilized.

I would also like to see greater support for home dialysis options. While it’s not suitable for everyone, home dialysis can offer a better quality of life, greater flexibility, and it’s often more cost-effective for the health system. We need to remove the barriers to home dialysis, whether those are educational, logistical or financial, such as the utility costs associated with running equipment at home.

Furthermore, a national strategy to increase organ donation and transplantation is critical. A transplant is the best treatment for end-stage kidney failure, offering the best outcomes and the lowest long-term costs, yet wait times remain unacceptably long. We need coordinated efforts to maximize both living and deceased donation rates across the country. Ultimately, a shift towards proactive chronic disease management will not only improve the lives of millions of Canadians but also have a meaningful impact on long-term costs to the health care system.

Danielle FlielerYou’ve given us a lot to think about. My last question, which I’ve asked everyone today: if a health minister remembers only one thing from this episode, what should it be?

Carrie ThibodeauThe key point to take from all of this is that earlier diagnosis fundamentally changes the journey. Catching chronic kidney disease early allows us to alter the trajectory, delay or prevent the need for dialysis, and keep people living their lives fully. It’s an investment in prevention that pays off exponentially, not just in dollars saved, but in the quality of life for Canadians.

We can’t afford to keep waiting until the kidneys fail to act. Proactive chronic disease management must be a priority if we want a sustainable health care system. We must shift the focus upstream, diagnosing early and intervening effectively, thereby mitigating the burden of those conditions on both patients and the health care system.

Danielle FlielerI want to thank Jodi, Diana and Carrie for sitting down with me to explore this conversation. Each of these guests described a different sector, and each of them described a version of the same underlying problem. The issues that do not reach the ministerial agenda are the ones that quietly determine whether everything else works.

Long-term care capacity shapes hospital flow, mental health shapes whether people are able to manage their physical health at all, and chronic disease management shapes how many acute episodes arrive at the door in the first place. As health ministers finalize their priorities for October, sustainable reform requires looking at the whole system and keeping these issues in front of decision makers rather than behind them. Thank you for joining us on From the Burgundy Chairs, we will see you next time.

AnnouncerThanks for listening. You can find this episode and more on our website at santishealth.ca, and on our Twitter at Santis Health. This has been From the Burgundy Chairs.