Ahead of the highly anticipated release of Ontario’s independent COVID-19 long-term care commission’s findings, the province’s auditor general says years of ignoring systemic concerns impacted how government staff were able to respond to the pandemic.
“By late March 2020 when COVID-19 had begun its ravage of long-term-care homes, it became blatantly obvious that aggressive infection prevention, detection and patient care actions were needed— and needed quickly — to prevent staggering death rates from becoming the norm across Ontario’s entire long-term-care community,” Bonnie Lysyk wrote in a special report examining Ontario’s long-term care sector and its response to COVID-19.
Lysyk said there were many contributing factors that “negatively impacted” long-term care residents up until the end of 2020.
According to data provided by long-term facilities between mid-March and the end of August, at least 30 per cent of residents were infected at the same time and two-thirds of rooms had three or four residents inside those rooms.
The report also noted the Ministry of Long-Term Care and Local Health Integration Networks could not tell the auditor general’s office how many people were in wards and couldn’t specify when renovations would be done to respond to a recent directive that there be a maximum of two residents per space.
The report noted 761 patients — an unusually large number — were transferred from hospitals to nursing homes in March 2020, exacerbating serious crowding in homes struggling to control the spread of COVID-19.
The document also outlined how facilities have had insufficient staff and staff training for personal support workers, specifically increasing complexity in health care needs for residents. It called for potentially regulating the profession.
“The staffing shortage peaked in late April, when 36 homes — ranging from a small 56-bed home to a large 300-bed home — reported critical shortages to the ministry on the same day,” the report said.
Lysyk also noted that 13 of the 15 homes with the highest numbers of COVID-19 deaths were operated by for-profit entities. The 15 homes had only 4.4 per cent of all long-term-care home beds but accounted for 28 per cent of all resident deaths.
Lysyk’s office also said a March directive to restrict family members who acted as caregivers in an effort to control COVID-19 outbreaks eliminated a “valuable source of resident care providers.”
“This lack of contact took an emotional and physical toll on residents and their families, in many cases resulting in a deterioration in residents’ physical and mental condition,” the document said.
The report noted infection prevention and control was inconsistently practised even before the pandemic. Between January 2015 and December 2019, ministry inspections cited hundreds of incidents of non-compliance at about two-thirds of all homes.
At the same time, enforcement was “problematic,” culminating in the government scrapping comprehensive inspections in the fall of 2018. Instead, inspectors focused on the growing backlog of critical incidents and complaints by issuing more compliance orders.
“Despite this increase, the ministry still had not implemented our 2015 recommendations aimed at addressing the issue of repeated non-compliance,” the report said.
Lysyk and her office went on to emphasize despite concerns being raised for several years, even before the Ford government took office in 2018, “the public sector had not yet effectively addressed the systemic weaknesses in the delivery of long-term care in Ontario.”
She added there should be “no surprises in the content and recommendations” outlined in her findings, adding many were previously highlighted or recommended by her office or by other stakeholders.
In an effort to address the issues raised, Lysyk made 16 recommendations aimed at strengthening how long-term care homes and the Ontario government can better respond to the issues emphasized during the pandemic.
“Given the longstanding nature of these issues and the risks of severe outcomes, there is a need to keep decision-makers’ attention focused on what needs to change, even though vaccines have helped to significantly reduce COVID-19 outbreaks and deaths in long-term care homes,” the report said.
Included in Lysyk’s recommendations were calls to reassess the government’s plan to add 45,000 new and renovated long-term care beds (noting current backlogs are unlikely to meet the need), develop a long-term strategy to build up the workforce of personal support workers, overhauling infectious disease and prevention protocols, enhance inspections of long-term care inspections and strengthening punishments for operators that are continually cited by inspectors.
When asked about the report’s findings during question period Wednesday morning, Dr. Merrilee Fullerton, Ontario’s minister of long-term care, thanked the auditor general for her report but repeatedly highlighted how Lysyk cited the issues raised were present during the previous Liberal government’s tenure.
“The leader of the opposition sat in this chamber and had the opportunity for many years to address what she knew and she didn’t and neither did the government of the day,” Fullerton told Ontario NDP Leader Andrea Horwath in response to questioning about the report.
“It is our government that has taken responsibility for this sector so badly neglected for many years under the people sitting right there and I will take no lessons from you as I work to repair long-term care and support staff, residents and families while you neglected it.”
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Donna Duncan, CEO of the Ontario Long-Term Care Association, called for quick action to implement “historic commitments” to end the sector’s staffing crisis and rebuild old and overcrowded homes.
Lysyk’s report on Wednesday is the second major one looking at how the Ontario government and public sector handled responding to the pandemic.
In late November, Lysyk focused on the provincial government’s emergency management planning and bureaucracy, how it responded to the pandemic, outbreak planning and decision-making, laboratory testing, COVID-19 case management, and contact tracing.
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In that report, she cited issues with delays and confusion when it came to how decisions were being made. She also highlighted ‘confusing’ and indirect communications on COVID-19 from Ontario officials.
“Local medical officers of health informed us that they were confused by provincial politicians delivering public health advice in place of the chief medical officer of health,” the Nov. 25 report said.
“Public health units and other impacted stakeholders were not always made aware of provincial decisions that impacted their operations prior to these decisions being announced publicly. This left these parties unprepared to act in a timely manner.”
Overall, Lysyk said the Ontario government’s response to COVID-19 was “slower and more reactive” compared to other provinces, noting many issues were avoidable because the provincial government “failed to act on key lessons identified after the 2003 SARS outbreak that had not been implemented.” She also said the provincial command and response structure became too “cumbersome” with many tables.
“We recognize that decision-makers, the health-care system and the public made every effort so that Ontario’s health system would not be overrun in the first wave,” Lysyk wrote.
“As we continue into this second wave, it is still not too late to make positive changes to help further control and reduce the spread of COVID-19.”
At the time, the governing Progressive Conservatives took issue with many parts of the report. Premier Doug Ford dismissed it as “21 pages of inaccuracies” while accusing Lysyk of overstepping her authority.
“The auditor general’s job is not to be the chief medical officer, not to be the ombudsman, not to sit there and give us health advice,” he said.
“Stick with looking for value for money, stick with the job that we hired you for.”
Ford further suggested that co-operating with the audit process had siphoned government resources away from tackling the pandemic.
— With files from The Canadian Press
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