TORONTO — Ontario’s neglected long-term care sector needs sweeping reforms to protect its vulnerable residents, an independent commission has found, pointing the finger in a scathing report at governments past and present for thousands of COVID-19 deaths at the province’s nursing homes.
Despite numerous past reviews, commissions and inquiries recommending improvements, the sector was completely unprepared for the pandemic, the Long-Term Care COVID-19 Commission said in a 322-page report delivered to the provincial government Friday night.
“Many of the challenges that had festered in the long-term care sector for decades — chronic underfunding, severe staffing shortages, outdated infrastructure and poor oversight — contributed to deadly consequences for Ontario’s most vulnerable citizens during the pandemic,” the commissioners wrote.
The province failed to learn from the SARS epidemic in 2003 and should heed expert advice this time around, they said.
“Now is the time to revisit the delivery model for long-term care and adopt a better way to provide care for Ontario’s seniors,” the report said.
Nearly 4,000 long-term care residents and 11 staff have died of COVID-19 since the pandemic hit.
Poor facility design and resident overcrowding heightened sickness and death in the nursing homes, the commission found, while a severe staffing shortage and a workforce poorly trained in infection control measures compounded the situation.
New facilities need to be built to address the needs of the aging population, the commission said, adding that the government also needs to reconsider how those nursing homes are managed, with a focus on quality care.
It suggested a new model to build long-term care homes in the future, similar to what’s in place for privately funded hospitals, courthouses and light rail transit systems.
“All involve the construction of infrastructure that is paid for upfront by private investors who receive a return on their capital with profit over time. However, others actually operate the infrastructure — the courts, hospitals, etc. — once built,” the report said.
Then, the commission suggests, a mission-driven organization — be it public, not-for-profit or for-profit — would handle the care of the residents.
The commission took particular issue with long-term care homes that are owned by investors.
“Care should be the sole focus of the entities responsible for long-term care homes,” it said.
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The commission was also critical of the slow decision-making process and the “lack of urgency” Premier Doug Ford’s government displayed during the early weeks of the pandemic. The report said that in late March 2020, when homes began to go into outbreak, the government had yet to formalize its response structure.
“Without an established, practiced plan in place, the government found itself making up its emergency response as it went along,” the report reads. “As noted, a pandemic is an inopportune time to create a nuanced, well-thought-out and thorough response plan.”
The commissioners said Dr. David Williams, the chief medical officer of health, in particular, was too slow to act on emerging information about COVID-19.
He was hesitant to acknowledge that community spread was happening, that asymptomatic patients could spread the virus and that masks would be helpful when it comes to prevention.
In fact, they wrote, he only issued directives after consulting the deputy minister of health and the COVID-19 Command Table.
“Delay is deadly,” the commissioners wrote.
Williams and the government repeatedly ignored the warnings of scientists, doctors, local public health officials and even the minister of long-term care, the report reads.
In some cases, the government acted without first consulting Williams or other public health experts.
The report also outlines in stark terms the plight of the long-term care workers who went to gruelling ends to care for their patients, at great risk to themselves and their families.
The commissioners said workers described making personal protective equipment out of “pop bottles and plastic bags” because regular masks were in such short supply.
Others said they would cry before and after shifts, vomit in lockers because of stress, and watch residents they loved die in great numbers.
“Many continue to be traumatized as a result of this experience and will require ongoing counselling and support,” the report reads.
For residents, the mental health consequences were akin to those faced by prisoners in solitary confinement, the commissioners said.
Ontario launched the commission on May 19, 2020, in an effort to determine what went wrong in long-term care homes during the pandemic’s first wave.
At that time, long-term care residents accounted for nearly 1,400 of the province’s 1,904 COVID-19 deaths. Five staff members had also died of COVID-19 at that point.
But even after the commission was launched — and after it released two interim sets of recommendations — the virus continued to tear through the facilities.
The commission, led by Frank Marrocco, associate chief justice of the Superior Court, heard from long-term care residents, staff and management.
It questioned government officials from Williams to Long-Term Care Minister Merrilee Fullerton to Health Minister Christine Elliott.
In all, the report said, the commission heard from more than 700 people.
Earlier Friday, Ford said he welcomed the commission’s report, as difficult as it would be to read.
“What happened in our long-term care homes, it was tragic,” he said. “And it was terrible. But most of all, it can never be allowed to happen again.”
NDP Leader Andrea Horwath said the commission paints a picture of years of neglect in the sector followed by a series of bad choices made by the Ford government.
“Sorrow for the survivors and families of the victims is not enough,” she said in a statement. “We need to act urgently on this report to ensure this never, ever happens again.”
The head of the Ontario Long-Term Care Association, meanwhile, said the report is a step in the “journey to reimagine seniors’ care.”
“As Ontario continues to respond to the pandemic, it must remain our priority and focus at this time,” Donna Duncan said in a statement, pointing to the work long-term care homes are doing to alleviate strain on hospitals.
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