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Pandemic should push change in long-term care; Advocates say there is no going back now that inadequacies have been highlighted

Posted: May 31, 2020

(May 30, 2020)

By: Elizabeth Payne, Ottawa Citizen

Once the novel coronavirus has been tamed or eradicated and the world returns to “normal,” what will that look like? Will COVID-19 fundamentally and permanently alter our lives? In an occasional series, this newspaper examines the potential lasting effects of the pandemic on how we live, work and play. Today: Long-term care.

The COVID-19 crisis has shone a devastating light on one of Ontario’s worst-kept secrets: The province’s system of caring for the elderly is underfunded, inadequately staffed and badly designed.

COVID-19 exploited those vulnerabilities.

Could it also be the push that changes long-term care in Ontario? Families, caregivers and others have been saying for years that the system is broken. A shocking report written by Canadian military members who were doing relief work in five Ontario homes has shone a new spotlight on those problems and pushed politicians to take action.

Ontario Premier Doug Ford called the military report – which detailed cockroaches, rotting food, rough treatment, poor infection control and more – “disgusting” and has vowed to change the system.

The province plans to launch an independent commission into long-term care beginning in September.

But critics say Ford’s own government reduced annual inspections that should have flagged some of the problems that led to the biggest COVID-19 outbreaks in long-term care homes and failed to act decisively on information it had about which homes were struggling.

Advocates say long-term care must change and there can be no going back now that COVID-19 has exposed a system that is failing Ontario’s most vulnerable.

The numbers tell the story: More than 62 per cent of all COVID-19 deaths in Ontario involved residents of long-term care homes.

In Ottawa, 193 of 238 people who have died from COVID-19 were long-term care residents.

At least 53 residents have died from COVID-19 at Carlingview Manor, at least 43 have died at Madonna Care Community, both in Ottawa, and more than 69 people have died at Pickering’s Orchard Villa, now the focus of a coroner’s investigation after the military report alleged the choking death of a resident might have resulted from negligence. The death tolls continue to climb at long-term care homes across the province, although the spread of the pandemic in longterm care has slowed down.

The impact of COVID-19 on residents of Ontario’s long-term care homes has shocked many, including politicians. But it has not surprised those who have been warning for years that the system is broken.

“Sadly, I can’t say I was hugely surprised, but maybe by the numbers,” said Jane Meadus, a lawyer with the Advocacy Centre for the Elderly, regarding the scope of the pandemic in long-term care homes.

Families, advocates for the elderly and others have long warned that staffing levels are inadequate, staff members are underpaid and homes desperately need upgrading.

About 30,000 of the province’s 78,000 long-term care beds are scheduled for redevelopment, meaning they don’t meet standards for safety and infection control.

Those include homes in which four residents share rooms, some of which were among the hardest hit by COVID-19.

The Progressive Conservative government has committed to building 15,000 new beds but, as has been the case for years, progress is slow.

Meadus said the system must be transformed. “We know a number of things that have to change.”

High on that list are more upto-date facilities to replace 30,000 beds that don’t meet standards. That should happen quickly, and with federal government help, says Lisa Levin, CEO of AdvantAge Ontario, which represents not-forprofit homes in the province.

“I just want to make sure that we are not going to sit around studying the issue and thinking about it.

We need action and we need it fast. We already know there are many shortcomings in the system that we have talked about for years, so why are we waiting?” Natalie Mehra, executive director of the Ontario Health Coalition, says there must be a discussion about who gets those redeveloped beds: the private corporations that now own the majority of long-term care homes in the province, or the not-for-profits.

Researchers and journalists from the Toronto Star have found that privately run homes – some of which have paid millions in dividends in recent years and whose top executives earn millions – have had the highest rates of COVID-19.

Levin said it is too early to assess the difference between the way not-for-profit and for-profit homes managed the pandemic, but that should be part of a review.

Previous research found that non-profit homes provide a better level of care, she said.

Staffing is another long-recognized weakness at provincial longterm care homes. Staff members are generally poorly paid and few are offered full-time hours and benefits, which makes it difficult to attract and keep people in what are difficult and sometimes dangerous jobs.

Staff members frequently work at multiple locations to earn a living, which was a factor in the spread of COVID-19 to many longterm care homes in the province.

The provincial government did not take action to temporarily ban work at more than one location until weeks into the lockdown.

But even the pre-pandemic normal in homes was inadequate, say those who have worked in and studied long-term care homes.

One former executive said she conducted a study to see how long it took a personal support worker to get a resident up, dressed and showered. The finding was 15 to 20 minutes, but most PSWs working in long-term care have five or six minutes. During the pandemic, with fewer staff and more complications due to isolation and sickness, many of the jobs workers are expected to do would be virtually impossible, many say.

Advocates have also called for more professionals, such as nurses and nurse practitioners, in longterm care homes and regulated minimum hours of care per patient, which would require higher staffing levels. There is currently a private member’s bill before the Ontario legislature calling for a minimum care standard of four hours, something long requested by families and others.

Mehra agrees that working conditions and pay have to improve for personal support workers and others in long-term care.

She wants to see a reasonable minimum wage set for the sector and a requirement that a percentage of staff have to be full-time.

She noted there has long been a consensus that something must be done to deal with staffing shortages in long-term care homes, and yet it can take workers up to a decade to get full-time hours.

Before the pandemic, the Ontario government appointed a panel to come up with a personal-support-worker staffing strategy to address chronic staff shortages. That panel is expected to produce a report in the coming weeks.

The pandemic has exposed other shortcomings in long-term care homes, including lack of access to personal protective equipment and lack of proper infection control.

Infection-control problems are at least partly related to staff shortages Critics say some of the changes needed in long-term care should begin immediately. But lessons learned from the pandemic will be crucial to further improve the system and protect long-term care residents from future outbreaks or pandemics.

Meadus said that requires an independent inquiry that includes public hearings, not just a commission that the provincial government has committed to launch.

Among other things, an inquiry could look at how personal protective equipment was distributed to long-term care homes and in what numbers; what kind of training staff had with proper use of PPE; and the impact of no-visitor rules that have kept family caretakers and privately hired personal support workers out of homes at the same time volunteers were asked to work.

Meadus said it is also crucial to better understand why some homes had small outbreaks and no deaths, while others saw COVID-19 spread like wildfire if there is to be permanent change in long-term care homes.

“We have to hear the full story of what happened and why things went better in some places and why other places didn’t do well.”

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