TORONTO — Vaccination against COVID-19 will still be required for employees at many Ontario long-term care homes even though the province has lifted its official mandate for the sector, but some are concerned about the possibility of legal challenges.
Workers in long-term care were the only ones required by the government to get vaccinated against the virus. Monday had previously been set as a deadline for staff to get third shots, but instead, the policy ended as part of a broader lifting of restrictions announced last week.
In a memo to operators, the Ministry of Long-Term care said homes can keep mandating shots for existing staff and new hires if policies comply with the law.
“The vaccination program in long-term care homes has been a tremendous success, supported by the dedication of you and your leadership teams,” Erin Hannah, associate deputy minister of long-term care, wrote to licensees on March 9.
“At this stage of the pandemic, we are able to shift from a provincial directive that requires homes to have a mandatory vaccination policy to a guidance-based approach that continues to support homes with their employer-led policies and best practices.”
Extendicare, Chartwell and Sienna, three major long-term care chains in the province, told The Canadian Press that they were retaining mandatory vaccination policies.
Extendicare and Sienna’s policies requires two doses for staff.
Chartwell spokeswoman Sharon Ranalli said the company is keeping its policy and “will continue to consider it against changing circumstances in the future.”
The City of Toronto said its mandatory two-shot vaccination policy for all workers and new hires, including at municipally run long-term care homes, will also remain in place.
Donna Duncan, CEOOntario Long-Term Care Association, said late last week that homes were “in the process of confirming their vaccine policies” after the province announced the changes.
“Many homes had established vaccine mandates for staff and new hires prior to the provincial directives, and we expect many will continue,” she said in an emailed statement.
More than a third of Ontario’s total COVID-19 deaths have been among long-term care residents.
The sector was devastated by thousands of deaths and outbreaks earlier in the pandemic before vaccinations became available in late 2020.
Last summer, before the province decided to mandate vaccines for the sector, a group of major Canadian long-term care operators including Chartwell Retirement Residences, Extendicare, Responsive Group Inc., Revera Inc., and Sienna Senior Living announced they would mandate vaccinations for their workers.
Dr. Samir Sinha, director of geriatrics at Sinai Health in Toronto, said smaller homes may struggle more with maintaining mandatory vaccine policies because they have fewer legal resources to defend them.
“The biggest concern, it’s not really for the big chains. Ironically, it’s actually for the not-for-profits smaller, kind of publicly owned … operations that don’t feel that they would have the legal wherewithal to stand on their own and to defend against a claim,” he said.
The CEO of AdvantAge Ontario, which represents municipal and non-profit homes, echoed Sinha’s concerns, saying it was “premature” for the government to lift the mandate.
Lisa Levin said homes are trying to balance their responsibility to protect residents and staff with the possibility of having to defend against costly legal claims from staff who lost work for not being vaccinated.
“It puts homes in a very tough position,” she said.
AdvantAge has provided some general legal advice for members, she said. Some have decided to keep a three-dose vaccination policy while others are still requiring workers to get two shots.
Other pandemic rules are lifting in the sector as the mandatory vaccination policy rolls back. Starting Monday, all general visits can resume in long-term care homes, including from children who are too young to be vaccinated.
Indoor visits in the homes can expand to include four people and there are no limits on the number of people who can visit outdoors. Residents are allowed to go on overnight trips and cohorting is no longer required for social activities.
Outside long-term care, the province has lifted proof-of-vaccination rules and capacity limits in most public settings. As of Monday, vaccination policies are no longer required in hospitals, schools and child-care settings, and the provincial mask mandate is due to lift next week.
Sinha said the rollback of protections coupled with the end of the vaccine mandate in long-term care is leaving vulnerable residents exposed to greater risk if community cases spike again, or if another variant emerges.
“If this is a castle, you’re literally letting the drawbridge down and leaving it unguarded again,” he said.
“I’m genuinely concerned that we are really setting ourselves up for another devastating wave in these settings.”
Also ceasing on Monday is the requirement that long-term care homes report data on staff vaccination status every month. Homes must still report vaccination data about residents.