- by Eric Coleman
This is the second part of a series on the topic of Long Term Care (LTC) homes in Ontario, following a military report on the state of five LTC homes after deploying to support them. Read the first part here
Through April and May of 2020, 250 military personnel were deployed to five long term care homes in Ontario to aid them with Covid-19 outbreaks. On May 26, their report to the federal government was released, with a scathing indictment of the conditions in those homes. They described rooms infested with cockroaches, residents being force-fed, Covid-positive residents being allowed to freely roam the facilities, and staff fearful of using necessary PPE over concerns about cost and supply. This has served to shine a glaring spotlight on the state of long term care in Ontario, a situation that has been troubled for a very long time.
So, how did we get here? For a long time, since the inception of long term care in Ontario, in the late 40s, long term care has been largely private. Through to the 80s, efforts were made, pulling the various parts of the industry under the Ministry of Health’s regulation. With the Long Term Care Act that the NDP passed in 1994, strict new guidelines on minimum hours of nursing care, inspection requirements, and other staff minimums, things seemed to be getting under control finally. In 1995, bundled with an omnibus bill, Mike Harris’ PC government rolled back many of those regulations, and created an environment more attractive to private operations. Doug Ford’s PC government followed in his footsteps, freezing out rates at a 1% increase. Below the rate of inflation, so an effective cut to funding, as well as slashing transition funds that support LTC homes.
Funding for LTC homes, primarily, comes in two parts. The first is provincially funded, and covers the medical end of things – nursing, personal care, programs, etc. The second is resident-paid, but at regulated rates, for accommodation, with varying price points for private (1 bed), semi-private (2 bed), or ward (3+ beds) rooms. Any excess funding from the provincially-funded side of revenue is returned to the government, while any excess revenue from accommodation fees is retained by the operator. This is where profit can be derived. With inadequate staffing hours, we get situations like care workers unable to attend to residents in need, force-feeding residents as they only have a very narrow window of time to complete the task, and inadequate cleaning and sanitization.
The province has over 160 inspectors for the LTC system. What, exactly, had they been assigned to do under, first, Christine Elliott and, later, Merrilee Fullerton when inspections dropped by half in 2018 and only 9 in total in 2019? All the regulations in the world won’t make an ounce of difference if nobody is there to ensure they are being adhered to. Inspections need to be frequent, thorough, and unannounced; foreknowledge of inspection dates simply mean the facility can prepare and mask their regular operations. The Ford government has stated that many inspections were, in fact, done. They have also said that many of those were phone interviews, not in-person inspections, an utterly ineffectual means of inspection, relying on providers in violation of regulation to respond honestly, and in good faith. If the inspectors do not have the proper equipment to conduct inspections, it on the province to supply those supplies, not allow substandard inspections.
In the end, there is no easy, quick, or inexpensive way to fix the state of Ontario’s LTC homes. The government needs to enact strict, new regulations, and provide thorough, extensive screening and inspections to ensure those regulations are adhered to. That means requirements for staffing levels that ensure workers have adequate time to care for all residents adequately, it means requiring minimum standards for training staff on proper care, as well as proper use of necessary equipment. If the province doesn’t have enough inspectors to ensure those minimums are met, then we need to hire more inspectors. If that means the cost to provide care increases, then it needs to increase to a level that ensures a decent standard of care. And, if that means private LTC providers can’t afford to stay in business, then the province will need to be prepared to step in and assume control of those facilities.
These changes will not fix the systemic issues with long term care overnight, but it will start to put us on the right path, while we work on finding the right solution through a full public inquiry.
