Ontario’s long-term care sector and the ministry that oversees it were not “prepared or equipped” to handle the litany of issues brought on by the COVID-19 pandemic, according to a new report from the province’s auditor general.
The report on pandemic readiness and response in long-term care, issued by Auditor General Bonnie Lysyk on Tuesday morning, says that by the time the novel coronavirus started to ravage Ontario’s long-term care homes in March 2020, it was obvious “aggressive infection prevention, detection and patient care actions were needed — and needed quickly — to prevent staggering death rates” in the LTC community.
That didn’t happen.
The first cases of COVID-19 were found in four LTC homes on March 17 of last year. From March 2020 to the end of the year, 76 per cent of LTC homes in Ontario reported cases of COVID-19 among residents and staff.
As of April 28, 3,756 residents and 11 staff members in the province’s long-term care system have died.
“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,” Lysyk wrote.
At an online press conference Wednesday afternoon, Lysyk said that directives to the sector from the province and Chief Medical Officer of Health Dr. David Williams were unclear.
“There could have been more clarity and guidance provided by the [chief medical officer of health],” she said.
“Their actions inadvertently complicated things.”
Little preparation after SARS
The report says three main issues led the sector down such a tragic path.
The first is that despite specific recommendations made by an expert panel after the SARS outbreak in 2003, not enough action was taken to prepare for “next time.”
The second is that ongoing concerns raised for well over a decade about systemic weaknesses in the sector have not been addressed.
Third, the sector’s lack of integration with the health-care sector did not enable long-term care homes to fully benefit from needed lifesaving expertise.
The report found that specific issues that impacted residents include:
- Residents were living in rooms with three or four occupants.
- Long-term care homes had insufficient staff and staff training to provide appropriate care.
- Infection prevention and control were not consistently practised in homes even prior to the pandemic.
- A “problematic enforcement practice” culminated in the ministry discontinuing proactive, comprehensive inspections of homes in the fall of 2018.
Emotional toll of no visitors
The report also notes that restricting families from visiting these homes during the pandemic eliminated a valuable source of resident care providers.
“The measure was intended to control COVID-19 outbreaks by limiting the number of people going into homes,” the report states. “However, 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 report makes several recommendations, including that the ministry reassess its long-term care home licensing process to require operators to renovate their facilities within a realistic but shorter, defined time frame.
Another recommendation is to look into whether the province’s long-term plan to add around 45,000 new or renovated beds by 2028 will be enough to meet future demands.
In a response included within the report, the Ministry of Long-Term Care said it thanks the auditor general for recommendations to improve the situation.
“The Ministry shares the goal of ensuring long-term care residents are afforded the dignity, safety and comfort they deserve,” the response reads.
But at a press conference Wednesday afternoon, Minister of Long-Term Care Merrilee Fullerton ducked repeated questions about whether she shares any responsibility for Ontario’s long-term care homes being decimated by the virus.
“I’m one person, this is an integrated response,” Fullerton said, while calling herself a “very caring and compassionate person” and pointing to her previous work as a family doctor as evidence of that.
Instead of taking any responsibility for the 3,767 deaths that happened under her watch, Fullerton repeatedly blamed previous governments.
“Our government is fixing a broken system,” she said.
“I take responsibility for the wellbeing of residents in long-term care and accountability of fixing the disaster of the last 15 years,” she said.
At her press conference, Lysyk said she is “cautiously optimistic” about her recommendations being implemented, and said she is seeing an intent from Fullerton “to make things right.
“There’s a lot of systemic issues that need to be overcome,” Lysyk said.
The ministry says that the sector needs to remain vigilant, despite currently low levels of COVID-19 infection brought on by high vaccination rates. It also says it is developing a new framework to assist the sector, and “redoubling efforts” to support sustainable, longer-term change.
“The devastating experience and impact of COVID-19 on long-term-care residents, staff and their families and loved ones has shone a spotlight on the long-standing challenges in the sector — as well as additional issues that require urgent attention and reform,” the ministry said.