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Drop in home inspections left gaps; Long-term care residents were vulnerable going into pandemic, commission finds

Posted: December 6, 2020

(December 5, 2020)

By: Elizabeth Payne, Ottawa Citizen (Print Edition)

A steep drop in comprehensive inspections at long-term care homes left gaps in knowledge about infection control and emergency preparedness leading up to the pandemic, Ontario’s Long-Term Care Commission said Friday.

The commission recommended the Ministry of Long-Term Care reintroduce annual Resident Quality Inspections for all long-term care homes as part of its second set of interim recommendations. The comprehensive inspections have been cut drastically in recent years.

The commission also recommended that all reactive inspections – in response to complaints or critical incidents – include an infection prevention and control assessment and that any violations are identified whenever there is an inspection at the home during the pandemic.

Changes in the long-term care inspection process, and a lack of meaningful enforcement, have long been concerns of families and advocates who say problems aren’t being uncovered often until something dramatic occurs and that homes are not held accountable for poor care. Those concerns have heightened during the pandemic when family members weren’t inside the homes for long periods.

So-called Resident Quality Inspections (RQI) are proactive and take a holistic look at the workings of homes in order to identify systemic issues.

Between 2013 and 2017, nearly every home in the province received an RQI each year. As other inspections became backlogged, the province switched to a riskbased system, prioritizing the homes with the biggest problems for more in-depth inspections. All homes were supposed to be inspected every year.

Compared with 626 annual RQI inspections between 2013 and 2017, 329 long-term care homes received the comprehensive inspections in 2018 and just 27 homes did in 2019.

Nor did the Ministry of Long-Term Care begin proactive inspections when COVID-19 outbreaks began, the commission reported. Between March and October of 2020, the commission noted, only 11 long-term care homes in the province received a proactive, comprehensive inspection.

“This reduction in RQIs, which are intended to provide a holistic review of operations in the homes, left the ministry with an incomplete picture of the state of infection prevention and control and emergency preparedness,” wrote the commission, calling it a “key gap”.

On Friday, ministry officials argued that there are more inspections in long-term care homes than ever.

But Jane Meadus, a lawyer with the Advocacy Centre for the Elderly, said those reactive inspections – in response to specific complaints or incidents – don’t find other problems, including infection prevention and control lapses. They don’t even follow up on previous orders to fix problems, she said.

“This is a welcome report,” Meadus said. “I think it is clear that the commission is really taking this job seriously by putting out a second interim report so quickly. It certainly hits a lot of the very major issues we have seen during COVID.”

The commission also recommended that the province improve enforcement of problem homes.

“We are concerned about the apparent lack of enforcement and followup verification of compliance with orders issued by the ministry.”

The commission found that infection prevention and control rarely made it into the areas of non-compliance identified during complaint inspections – “showing that it was rarely a focus of any inspections.”

The commission also noted that fines or prosecution are rarely applied “which may feed into the lack of urgency illustrated by LTC operators to come into compliance.”

Meadus said enforcement is weak, with no fines and no one charged under the provincial offences act.

“What does it take? At what point is a home in non-compliance so long that they are charged? If this isn’t it, I don’t know what is.”

Natalie Mehra, executive director of the Ontario Health Coalition, said the province needs to get tougher on homes that don’t comply with regulations.

“There can be no more slap on the wrist with no consequences for long-term care homes that have poor care,” she said.

Earlier this year, the province passed legislation that advocates say will make it significantly harder to hold long-term care homes responsible for illness or death from COVID-19.

The province’s Long-Term Care Commission is continuing to hear witness testimony and is expected to file a final report in the spring. It has released interim recommendations, it has said, because of the urgency of the pandemic now it its second wave.

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