The COVID-19 pandemic has ravaged Ontario’s long-term-care homes, but experts and industry members say the conditions that let it happen have been an issue for decades.
A Canadian Armed Forces (CAF) report detailing findings in five Ontario long-term-care homes released May 26 found that residents were living in deplorable conditions, that there was poor infection control protocols, and staffing levels made it impossible to provide appropriate care.
“The description of what happened is criminal,” said Natalie Mehra, executive director of the Ontario Health Coalition (OHC), an advocacy group that seeks to improve the public health system. “It’s so completely wrong, but these systemic issues of inadequate care, inadequate staffing … this has gone on for decades.”
As recently as December, the OHC was advocating for steps to alleviate what it calls a crisis in personal support worker staffing in long-term-care homes.
“There was a severe, severe staffing shortage before COVID-19,” Mehra said.
In April, workers in long-term-care homes were ordered to work in only one home to help slow the spread of COVID-19. While the move may have helped from an infection-control perspective, Mehra said it exacerbated other issues.
Mehra said it can take years for a personal support worker to find a full-time job, so many were working part-time in multiple homes to make ends meet.
“Once the workers had to choose one home to work in as of April 22, some homes are just decimated,” she said. “They just lost tons of staff.”
Mehra said the conditions of care in these facilities is directly related to the conditions of work.
“I cannot see a way out of this without getting a stable trained workforce in place in the homes,” said Mehra. “In order to stabilize the workforce, they need to improve the wages and working conditions. They need to insist that the homes provide full-time work.”
The private sector’s involvement in long-term care should also be looked at, she said.
“The consequences of trying to make care ever cheaper and cheaper is that people suffer,” she said. “Finally it’s been laid bare for everyone to see. In a horrible way, I’m happy because I hope it means that we can never go back.”
In the long-term-care homes operated by the County of Simcoe, there is a bright spot, as there have been no cases of COVID-19 identified.
"It’s not business as usual,” said Jane Sinclair, general manager of health and emergency services for the county. “There are huge precautions in place.”
Speaking about the CAF report, Sinclair said they are the exception, not the rule, and cautioned against painting all long-term-care homes with the same brush.
“There are many, many amazing long-term-care homes across the province,” she said.
While much has been said about the inspection regime for long-term-care homes and whether it is thorough enough, Sinclair said she doesn’t think that is the main issue.
“It’s much deeper than that,” she said. “If long-term care isn’t funded properly and there isn’t enough staff, then it’s going to be really hard for the homes to make sure everything is done the way it should be.”
Before the government directive that long-term-care workers only work in one home, the county offered its part-time staff full-time hours to secure its workforce.
Sinclair said 206 part-time employees took them up on the offer.
"Even with that, we still struggle with staffing to a certain amount,” she said, acknowledging staffing was a challenge even before COVID-19 started.
“Now we have people that are off for 14 days because they might not even have COVID symptoms, but they came into a risk situation.”
Recognizing these challenges, the county supplements the amount of money it receives from the province to operate its long-term-care homes.
“County council made that decision because they recognize that, with the funding that we have, it doesn’t provide the appropriate level of care,” Sinclair said.
According to the county, the province funds 59 per cent of the cost to operate the county’s long-term-care homes, 29 per cent comes from resident occupancy fees and 12 per cent comes from municipal contributions.
Sinclair added she feels personal support workers, the pillars of long-term-care homes, are not recognized for the hard work they do.
“There is an issue with compensation and just valuing them — that’s got to be a big part of why we can’t get enough people in this industry,” she said. “There needs to be better funding, better staffing levels and better recognition for our care providers.”
While the county long-term-care homes have done relatively well in battling COVID-19, those inspection reports show they are not immune to some of the issues drawing negative attention to the sector.
In a Jan. 20, 2020, critical-incident report for Sunset Manor for Senior Citizens in Collingwood, an inspector details how the licensee (the county) failed to respect a resident’s dignity when staff withheld the application of an incontinence product.
Sinclair said they take these instances extremely seriously.
“Any variance from standards and expectations, we do an entire investigation,” she said, adding dignity is critical when caring for seniors.
“If we find our staff are wilfully not showing dignity and all the respect, then we take action,” she said. "In response to that specific incident, we did take action.”
She could not elaborate due to the fact that it is a personnel matter.
“This doesn’t happen everywhere, but, having said that, there are some really serious underlying support issues for long-term homes that need be addressed,” she said.
Curious about the inspection records from other long-term care homes in Simcoe County? Visit http://publicreporting.ltchomes.net/en-ca/HomeName_Select.aspx.
- Shane MacDonald, Local Journalism Initiative Reporter, Barrie Advance