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.
  1. Where required, call upon the military to immediately assist LTC homes struggling with large outbreaks where staffing has collapsed.
  2. 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.



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.

The comments section is closed.

  • Donald Cole says:

    Really good piece colleagues. Agree with the urgency, and most of the recommendations.
    Should include the role of local public health better, including support on infection control and outbreak management.

  • G. Weston says:

    I am truly surprised to see this call to action is requesting *more* government intervention.

    This pandemic has revealed the sheer inadequacies of government with the limitations of a single-payor approach to health care evident.

  • Yvonne Ashford says:

    Intergration of care for frail elderly is a strategy that could help support the resident in the home, LTCF as well as hospitalized and palliative care patient. Transferring LTC from private to non profit will take resources we do not have right now. Consider the integration of current resources to the community. For example a small geography with long term care, assistive living and home care services be assigned a team to provide care to that community. A team of PSW and Registered Nurses employed and linked to a well resourced institution who can avail them selves to the needs of the community. Currently the system is so separate and hierarchical with LTC and home care on the lower level. Rejuvenate the community professionals to give confidence to provide the necessary level of care to the families and frail elderly.

  • Randy Filinski says:

    So, it is hard not to agree but shouldn’t we have just one gold standard with your recommendations for ALL LTC providers (profit/nfp) and then enforce the standard or loose your liscence? Your advice is solid but it is equally about a culture shift both clinically and socially with families and and a joint expectation on “how to best care for our elderly”.

    Home Care is broken, Primary Care is fragmented, Acute Care is trying to figure out what their future is and Public Health is it’s own entity.

    I am so tired of sitting at sector tables and trying to help keep an eye on holistic health and healthcare representing needed integration to build a system…we, the community, need to say “enough”.

    So, my rant, as an “older adult with complexity” support the principles around your letter but if we change the legislation, do we just continue as a separate sector and hope that all providers in a community will work together? Isn’t this the promise of the OHTs?

    And then we can move forward. We are human beings, not just clinical sector metrics…and LTC, with your recommendations can help change the culture.

    Thank you for writing.

  • Rona Clarke says:

    Why in the world would any private company be interested in operating a LTC after this pandemic? They would be better off investing in other things like groceries and pharmacies. Much lower risk and likely higher profits for the private companies.

    I predict LTC homes will be shut down and an even longer backlog of patients needing these facilities, which would mean more bed blockers in hospitals.

    Have these people who signed this letter even thought about that?

  • Murray says:

    Why abolish the for-profit model vs enforcing standards?

    Let’s not forget the public funded hospital and community care serves ain’t exactly models of high quality, efficient or effective care.

    There’s a narrative the authors are suggesting that more government involvement is better, particularly around ownership. I similarly don’t feel there is enough evidence of this.

  • Reinwald Wolfe says:

    There simply has to be a way that the private and public sector could collaborate to work to improve LTC.

    I am quite troubled that there is an anti-privatization stance. The irony is that private companies (Pfizer, Moderna) will help get us out of the pandemic. Where there is a will, there is a way.

  • CS says:

    I think “dumped” is not always the case. There comes a time when someone may be very old and frail and needing diaper changes, feeding, medications, they may have behaviour issues like dementia (can be angry, hitting, shouting). These seniors require 24 hour care. It can be too much for a child to care for. Especially in a very expensive place like GTA. How many people can afford to have one spouse stay home full time to care for an aging parent? Can you live off one income and support a family while living in Toronto? Do you know what it means to care for someone with severe medical issues or dementia full time? Would you be able to handle it? I don’t think so.
    The problem with LTC is that people who work there (RNs, PSWs) have a tremendous and important job to do, and they do not receive the respect, pay, or appreciation for what they do. Would you send your toddler to day care in a place where the staff come and go from different daycares throughout the day because the day care only hires them for a few part time or casual hours (to prevent having to pay benefits?)? Would you be happy if the care staff looking after your toddler switched jobs every 4-6 months because they are constantly looking for new better work to pay their own bills?

    We have severely neglected the care of our seniors. Something like this would never happen in the day care / child care industry. But for some reason we just don’t care about seniors.

    Now with COVID, my heart breaks but the reality is that our brainless politicians and the main stream media have blown this up so far out of reality that people working in these care homes got so scared they stayed home and refused to come to work. I guarantee that many of these seniors would have survived if they had the care to recover from COVID. Just a couple of weeks ago there was news piece about PSWs that were so scared to make home visits, a senior was left in their bed for 5 days!! Can you imagine being bedbound in your own stool with no water and food for 5 days! I guarantee that many of these LTC deaths are from dehydration, starvation, and general lack of care because care staff is too afraid to attend to a COVID patient, because everyone all over the media is telling us that COVID is a death sentence…when in fact statistics show that 98% recover just fine.

  • Leslie Roth says:

    Peak virtue signalling here. Sigh.

    Please ask
    1. How many people who signed the letter got their COVID vaccine before LTC?
    2. How many people who signed the letter have reviewed the Long Term Care Homes Act?

  • Robert MacIntosh says:

    Some of these recommendations seem not specific enough. If these signatories are looking to make amendments to Ontario’s Long Term Care Act, they should really get a legal opinion around how to bring specific changes forward. Our health care system thrives on silos. I anticipate it would be really messy to do #7 in their list- “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…”. How in the world do you actually get that to happen? Need clear lines of accountability and governance, not to mention staffing infrastructure etc.

    I get that there is a generation of twitter doctors who get media attention with hyperbole and propagating outrage culture… but if you want real change – don’t wait until a raging pandemic to shop around an online manifesto.

    We know that LTC problems are magnified by the pandemic. How many signatories blissfully had a blind eye to LTC issues pre-pandemic?

    Also, why not propose that LTC workers are uninionized or that PSWs become regulated etc.?

    “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.” So really? Is a front line PSW expected to do the same as an emerg nurse? The qualifications and self regulation are big differences.

    “Where required, call upon the military to immediately assist LTC homes struggling with large outbreaks where staffing has collapsed.” Yes, please in the patriarchal white saviour to rescue a sector largely staffed by racialized women! Oh please.

    I see “good intentions” by the signatories – but the naïveté is astounding. Please consult with experts in law, economics and health policy if you truly want to move ideas forward to implementation.

  • S. Gupta says:

    As an person of South Asian background, the racist undertones in the reporting on “intergenerational homes” was appalling. My elderly parents who live with me are also not priorized for vaccine. These doctors and researchers should redirect their efforts to support aging people to “age in place” in the community. I feel bad for these elderly people who were, let’s face it, dumped by their adult children because the “burden” of caring was too inconvenient. We have a major societal problem here that will not be fixed by throwing more dollars at LTC.

  • Gloria R. says:

    Many aspects of health care are privatized such as dentists, pharmacists, psychologists, dietitians etc.

    Just because something is privatized does not make it fundamentally flawed, does it?

    If so, then it is not just LTC that needs revamping!

  • Phil says:

    Just because one is a physician, does not make one an expert on heath policy. Exhibit A, Dr Fullerton.

    I am not sure why these docs think they would be better.

    The power to implement policies is given to elected officials.

    Physicians are not elected officials.

    Science is imperfect, resources are finite and societal values and preferences need to be taken into account.

    If a 90 year old dies from COVID (or anything really), the number of years lost is far less than if a 50 year old died of that.

    Ethical decisions always have trade offs.

    I am tired of physicians who act as social justice warriors that have myopic views without seeing the big and often more complicated picture.

    Taxpayers may not want to invest in more dollars for LTC, and platitudes from physicians, who are in a privileged position in society will not change that.

    PS- physician services are the only profession funded through the Canada Health Act. I am not hearing the doctors say that they are willing to reduce income to allow other professionals be funded.

  • Sheila Mackinnon says:

    I completely support this much needed call to action.


We are a coalition of health care professionals that work throughout the province who are ashamed at the failures in the private LTC system and its abhorrent impact on the lives of seniors, their families, and the community at large.

CoVaRR-Net brings together some of Canada’s most eminent researchers and experts in a variety of disciplines linked to emerging variants. By connecting this country’s best variants of concern-related research labs, this network ensures a rapid and coordinated response to this complicated facet of the pandemic. Contributors to this piece include Ninan Abraham, Timothy Caulfield, Jen Gommerman, Jason Kindrachuk, Marc-André Langlois, Andrew Morris, Angela Rasmussen, Raphael Saginur and Fatima Tokhmafshan.

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