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Commission flags poor oversight of Ontario nursing homes as COVID-19 deaths jump

Click to play video '‘Care Gone Wrong’ highlights flaws in Ontario’s long-term care and nursing homes' ‘Care Gone Wrong’ highlights flaws in Ontario’s long-term care and nursing homes
WATCH ABOVE: ‘Care Gone Wrong’ highlights flaws in Ontario’s long-term care and nursing homes – Nov 26, 2020

TORONTO — Effective inspections and management are crucial in the battle to stop the grim march of COVID-19 infections and untimely deaths in Ontario’s long-term care homes, a commission delving into the situation reported on Friday.

The interim report, which comes amid surging cases across the province, notes that 100 homes have seen an outbreak of the virus in the last six weeks, with 300 more deaths.

“Questions and concerns have been raised about the effectiveness of the province’s oversight and inspections system,” the report states. “Several issues have surfaced that the commission believes require urgent attention.”

Read more: A look at what has gone wrong in Ontario long-term care amid the coronavirus pandemic

On Friday, the province reported 1,780 new COVID-19 cases, a slight decline from a day earlier. However, the number of deaths almost doubled to 25 from the 14 reported on Thursday.

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The spread of the virus has “hit a critical point,” said Health Minister Christine Elliott, who urged people to wear masks and remain physically distant.

Among the issues the long-term care commission flagged is a provincial decision in the fall of 2018 to end comprehensive inspections implemented in 2013, and a lack of consistency in enforcement when issues are uncovered.

Only 27 homes were inspected last year, far fewer than had been the case in previous years, the report states. Inspectors looked at only 11 of the province’s 670 nursing homes proactively from March 1 to Oct. 15, after the pandemic struck.

Click to play video 'Coronavirus: Ontario working to bring rapid COVID-19 tests to long-term care homes with ‘full force’' Coronavirus: Ontario working to bring rapid COVID-19 tests to long-term care homes with ‘full force’
Coronavirus: Ontario working to bring rapid COVID-19 tests to long-term care homes with ‘full force’ – Dec 3, 2020

The result, the commission said, are wide gaps in what the government knows about infection prevention and control in long-term care homes as well as their emergency preparedness.

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The commission recommends resumption of annual resident quality inspections in all homes and more intensive follow-ups on complaints.

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Enforcement of compliance orders issued when problems were identified is another area of concern, the report says. Part of the problem is a reliance on voluntary compliance by long-term care homes with issued orders, without any mandatory verification they have actually complied.

Read more: How to prevent the spread of COVID-19 and other infections at Ontario’s long-term care homes

Inspectors issue mandatory orders only in “extreme circumstances,” the report says, noting only 21 were issued between January 2019 and August 2020.

Fines or prosecutions for failure to comply are “rarely applied,” with resulting “lack of urgency” from home operators to address violations.

The report also finds the inspection situation is handled by three different organizations that don’t necessarily communicate with one another.

Management of long-term care homes has been at best uneven, the commission concludes, saying leadership has been lacking or invisible in many cases.

Read more: How COVID-19 has changed the way families think about long-term care in Ontario

“We heard that homes where leaders were visible and provided clarity around staff roles and responsibilities fared better than those where leadership was less engaged,” the report states. “Homes with effective leaders were better prepared, had less outbreaks, and better contained outbreaks when they occurred.”

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Also Friday, the province appointed nine people to its new COVID-19 vaccine panel, headed by retired chief of national defence staff Gen. Rick Hillier. The panel will oversee distribution of the vaccine when one eventually becomes available.

Among its members are Dr. Dirk Huyer, chief coroner of Ontario, Toronto’s former police chief Mark Saunders, and Linda Hasenfratz, head of car parts giant Linamar. Also appointed were Dr. Homer Tien, a trauma surgeon, bioethicist Maxwell Smith and infectious diseases expert Dr. Isaac Bogoch.

Key panel tasks include vaccine delivery, logistics and administration, clinical guidance as well as public education and outreach.