Ontario’s long-term care sector is in a grave humanitarian crisis

We are a group of physicians, researchers and advocates who have come together to express our grave concern for the safety and well-being of Ontarians who reside in long-term care (LTC) homes.

We call upon the Ontario government to immediately end the violations of peoples’ human rights and control the spread of COVID-19 in LTC. Action is needed today.

To date, the Ontario government’s approach to protect LTC residents has been reactionary at best. The lack of transparency and coordinated provincial oversight has resulted in piecemeal interventions that are too late, or sometimes, even non-existent. Proactive implementation of policies to prevent the spread of COVID-19 are desperately needed.

In the first wave, the Ontario government managed the pandemic in a way that put LTC residents and staff at increased risk for COVID-19, with devastating results. While many countries had challenges managing the rapid spread of COVID-19, Canada had the highest proportion of LTC deaths compared to other OECD countries. In Ontario, this resulted in almost 2000 deaths.

From the Canadian military to an independent commission appointed by the government, many reports from the first wave recommend swift and decisive action to prevent outbreaks in LTC homes. Ontario Premier Doug Ford promised to move “heaven and earth” to protect seniors in LTC. Yet the Ontario government has taken little immediate action in implementing these expert recommendations to improve staffing levels, increase training and improve infection control practices. The government has allowed the situation in our LTC homes to become a preventable and recurring crisis during the second wave, with deaths across the entire province.

In the second wave, we’re still seeing:

– Poor infection control practices. For example, the Ontario government still allows health care workers to work at multiple LTC homes. This goes against infection control practices, many of which we learned from the SARS outbreak nearly 20 years ago.

– Delayed responses to outbreaks in homes. The Ontario government has not consistently or proactively tapped into hospital or community-based response teams despite their expertise in infection control and ability to improve medical care. This failure has resulted in more cases and deaths.

– Lack of transparency. Family members and the public often do not know about staffing levels and infection control standards in a LTC home until it is revealed by a whistleblowing family caregiver or anonymous frontline health worker.

– A worsening staffing shortage. Reports show the province has 30 per cent fewer personal support workers compared to the first wave. Sixty-five per cent of frontline health workers in homes with COVID-19 outbreaks reported not having enough staff to provide daily hands-on care to residents.

– Delays in improving staffing levels. Despite the COVID-19 crisis and the fact that residents have a median life-expectancy in Ontario LTC homes of 18 months, the government has announced that it plans to improve staffing levels within 4-5 years, with little details on funding to support this direction. This timeline is unacceptable.

As physicians, researchers and advocates, we know the ongoing staffing shortages compromise resident care. Due to the Ontario government’s inaction in compelling improvements in private, for-profit settings and insufficient action broadly, LTC residents are at high risk of death from COVID-19. In many circumstances, residents are also left without basic care, hygiene, food and water. This is a human rights violation.

Despite all of this, the Ontario government passed legislation to make it harder for families to seek justice for the tragic loss of loved ones by raising the threshold for liability of wrongdoing for LTC operators, many which are private and for-profit. We are also concerned that the Ontario government has delayed the independent commission’s efforts by delaying release of documents to the commission and impeding its work.

The Ontario government is heading in the wrong direction and LTC residents are paying the price.

An urgent call to action

At a minimum, we demand the Ontario government take the following action immediately:

1. Begin the process of removing profit from LTC. For-profit LTC homes have had far worse outcomes during the pandemic compared to non-profit and municipal LTC homes. Any home operator that does not comply with staffing ratios, infection control protocols or commits any other major infraction which harms the residents should immediately face a harsh penalty. A strong consideration should be given to remove licenses permanently and incorporate the home into the public system.
2. Use all powers and resources available to hire qualified staff who are available now while building capacity through an urgent training and recruitment effort. Legislate a care standard immediately to ensure all LTC residents receive a minimum of four hours of direct hands-on care per day.
3. Set a minimum pay standard for front-line LTC staff consistent with the hospital sector. It is the decent thing to do to support frontline workers.
4. Ensure at least 70 per cent of staff at each LTC home are full time. All staff should be permanent and receive paid sick leave and benefits. In the case of shortages, part-time staff should receive the first opportunity to receive full-time work. Eliminate the use of agency workers.
5. Ensure family caregivers are allowed unrestricted entry into LTC homes with proper PPE to look after their loved ones and make sure appropriate care is being delivered. Legislate and enforce essential family caregivers’ rights to enter LTC homes, whether they are in COVID-19 outbreak or not.
6. Ensure formal partnerships are established between hospitals, primary care teams and all LTC homes. This way, the right expertise can be available at the right time. This will improve infection prevention and control and will cut response times down in the event of an outbreak.
7. Keep hospital or community-based medical teams on standby and give them the authority to go into LTC homes, with or without permission from the home’s ownership, at the start of an outbreak to help with:
   1. infection control practices;
   2. meeting the basic care needs of residents, including feeding and bathing;
   3. medical assessment and treatment of residents affected by COVID-19 or otherwise.

8. Where required, call upon the military to immediately assist LTC homes struggling with large outbreaks where staffing has collapsed.
9. Speed up the vaccination rollout to vaccinate LTC residents, frontline staff and essential family caregivers as soon as possible.

Urgent action is needed now. This is a matter of life and death.

Signed,

Amit Arya, MD, CCFP (PC), FCFP, Palliative Care Physician, Lecturer, Department of Community & Family Medicine, University of Toronto 

Vivian Stamatopoulos, M.A., Ph.D, Associate Teaching Professor, Faculty of Social Sciences & Humanities, Ontario Tech University 

Pat Armstrong, Ph.D., Distinguished Research Professor of Sociology, York University

Naheed Dosani, MSC, MD, CCFP (PC), Palliative Care Physician, Lecturer, Department of Family & Community Medicine, University of Toronto 

Danyaal Raza, MD, MPH, CCFP, Family Physician, Assistant Professor, Department of Community & Family Medicine, University of Toronto 

Semir Bulle, MD Candidate, University of Toronto

Andrew Boozary, MD, MPP, SM Family Physician, Assistant Professor, Institute of Health Policy, Management & Evaluation, University of Toronto 

Jennifer Kwan, MD CCFP, Family Physician 

For a complete list of signatories, click here.

To sign the letter yourself, click here.