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Ontario election 2022: Will the pandemic tragedy in long-term care lead to real change?

Posted: May 11, 2022

(May 9, 2022)

By: Elizabeth Payne, Ottawa Citizen

Ontario’s long-term care system was a crisis waiting to happen when the COVID-19 pandemic hit in March 2020.

Years of neglect, crowded conditions, chronic understaffing and underfunding combined with a lack of effective preparation for the long-anticipated pandemic, set the stage for disaster when COVID-19 began to spread through Ontario’s long-term care homes.

Shortages of personal protective equipment as well as practices that allowed the virus to spread among residents and prevented some from receiving treatment in hospital, added to the suffering of the province’s most vulnerable. A slow provincial response to the unfolding crisis made things worse.

Once the virus got into homes, illness and death quickly followed.

“One after another of the residents started dying,” a PSW wrote at the time in an email she sent to Prime Minister Justin Trudeau and Premier Doug Ford, among others. “I was scared to come back after a few days off, not knowing how many would be left. It is not right, so short staffed and bodies of the people I cared for piling up.”

What transpired in many long-term care homes during the pandemic shocked Ontario residents and has led to calls for dramatic changes in the way care is delivered to the elderly in the province.

Staffing, infrastructure and the role of for-profit companies in long-term care have all been the focus of study and criticism. With a provincial election called for June 2, the major parties all have long-term care in their sights.

While Premier Doug Ford’s government has focused on increasing long-term care beds and training personal support workers, among other things, both the NDP and Liberal parties are vowing to end for-profit long-term care in Ontario.

There are plenty of prescriptions out there to solve, or at least improve, delivery of long-term care in Ontario, but at least one critic fears the political will does not exist among the governing PC party for a sea change in the way care is delivered, especially when it comes to private ownership.

“There is no political will among the Conservatives to do anything that is going to get in the way of the interests of the for-profit industry,” said Natalie Mehra, executive director of the Ontario Health Coalition.

In fact, the majority of the 30,000 plus new long-term care beds announced by the Progressive Conservative government in a pre-election blitz will go to for-profit companies, including those with some of the worst track records during the pandemic. The government counters that it is doing what has been ignored for years — building beds quickly. And it will work with everyone it can to do so. New rules around accountability and more staff will make sure residents in those beds receive quality care.

In the early months of the pandemic, 70 to 80 per cent of all COVID-19 deaths in Ontario were among long-term care and retirement home residents, one of the worst records among wealthy countries globally. As of late April, around 4,500 Ontario long-term care residents had died of COVID and the real number could be significantly higher. Since the pandemic began, as many as 25,000 residents and 11,600 workers have been infected.

The situation was so dire that members of the Canadian Armed Forces’ Augmented Civilian Care Team were sent into some of Ontario’s worst-hit homes in the spring of 2020. A report written after the deployment described in shocking detail what the team found: malnutrition, cockroaches, rotten food and residents being left in soiled diapers.

Among the most damning findings was that 26 residents of a Downsview long-term care home died, not from COVID-19, but, as a result of dehydration due to lack of staff to care for them.

Ford vowed to “leave no stone unturned” to fix the crisis in long-term care, appointing a provincial commission in July.

“COVID-19 has exposed deep cracks in the long-term care system and it is now up to us to fix these problems,” Ford said at the time, adding: “This tragedy must serve as a wake-up call to our whole country.”

But even as a magnifying glass was being held up to the disaster in long-term care during the first pandemic wave, the second wave, later in 2020, was becoming more deadly. According to the National Institute on Ageing, 2,225 Ontario long-term care residents died during the second wave compared to 2,072 in the first wave.

“It is very shocking and very scary. We said we would never let this happen again,” Dr. Nathan Stall, a geriatrician and research fellow at Women’s College Research Institute in Toronto, said at the time.

The introduction of vaccines, starting in late 2020, significantly reduced rates of serious illness and death among long-term care residents, but outbreaks continue. Measures meant to improve the situation have been slow to bring any real change.

After months of testimony from experts, families, residents, operators and others, Ontario’s COVID-19 Long-Term Care Commission delivered a report in 2021 that criticized the government for its lack of a plan and slow response and called for sweeping change.

Among other things, the commission said new homes are needed to address the needs of the aging population, but they said quality care, not profits, should be the sole focus of a home’s ownership. The commission recommended that for-profit companies be contracted to build new facilities, but operations should be undertaken by “mission driven entities.”

It also called for better preparation for future outbreaks and pandemics, better infection protection and control, improved staffing levels, efforts to retain and train staff and more accountability for home operators.

The Ford government has implemented many of the recommendations, including increasing the amount of direct care long-term care residents receive to an average of four hours a day by 2025. This requires the training and hiring of thousands of PSWs and nurses, which is moving slower than expected. Critics say the increase in care hours does not go far enough to provide the kind of patient-focused care residents need.

The province has also committed to building 30,000 new long-term care beds and 28,000 upgraded beds by 2028.

The majority of those new licences for long-term care beds, though, have gone to for-profit companies, some of them private equity firms. Well over half of long-term care homes in the province are privately operated and those numbers are increasing with new licenses.

Numerous studies have found that residents of for-profit homes fared worse during the pandemic. According to the Ontario Health Coalition, for-profit residents were 60 per cent more likely to become infected with COVID-19 and 45 per cent more likely to die than residents of non-profit homes. A University of Waterloo study found that long-term care homes owned by private equity firms and large chains have the highest mortality rates.

The Ontario NDP has said it will take profit out of long-term care as part of its ambitious plan to overhaul the system if it is elected. It would also shift to small community-based centres to improve the quality of care and quality of life of residents and increase annual operating costs for the care sector to $12 billion from the current nine billion dollars.

The Ontario Liberal Party says it would adopt a home-care first approach to senior care in the province and eliminate for-profit long-term care by 2028. Leader Steven Del Duca called the pandemic a wake-up call and characterized institutionalized long-term care as “one of the great mistakes of the 20th century”.

Mehra said the Ford government has done a good job of convincing the public that it is taking decisive action to change long-term care. But in many cases “they have not done what they said they would do.”

For example, the province said it would get tough with long-term care homes that don’t follow rules. But to date, no home has lost its licence, she said.

In recent years, there have been positive examples of cultural change in some homes across the province, which have become more patient centred, improving care and quality of life. Advocates would like to see more small, patient centred homes that feel more like homes than institutions in order to improve residents’ quality of life.

That could be the most elusive form of change needed in Ontario’s long-term care system, but many think it is the most important and that it is at odds with businesses whose key motive is profit.

“The worst thing that could happen in response to the COVID-19 pandemic is that we simply add more long-term care beds by expanding current large facilities or building new ones,” wrote journalist Andre Picard in his book Neglected No More. “We don’t need more warehousing of elders, or more inadequate care. We need better care.”

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