Auditor General Bonnie Lysyk’s report on the COVID-19 outbreak in Ontario long-term care homes takes aim at the government’s handling of the sector during the outbreak, particularly in the first few months, saying that the government failed to learn from past mistakes like SARS and made a series of unintentional mistakes.
“Beginning in February 2020, the province implemented a number of measures to deal with the impact of COVID-19 in an attempt to minimize its spread,” she wrote. “Unfortunately, some of these measures also had unintended consequences on long-term-care home residents and staff by further contributing to crowding and staffing shortages.
“In addition to these unintended consequences, the province delayed mandating, as opposed to recommending certain measures, did not provide clear directions to homes, and did not inspect to ensure that homes were complying with containment measures.”
Lysyk revealed that homes were not required to prepared for a pandemic emergency like COVID-19 before it occurred.
“By late March 2020, when COVID-19 had begun its ravage of long-term-care homes, it became blatantly obvious that aggressive infection prevention, detection and patient care actions were needed, and needed quickly, to prevent staggering death rates from becoming the norm across Ontario’s entire long-term-care community,” her report states.
“Unfortunately, neither the Ministry of Long-Term Care, nor the long-term-care sector was sufficiently positioned, prepared or equipped to respond to the issues created by the pandemic in an effective and expedient way.”
Opposition parties were quick to blame the Progressive Conservative government under Premier Doug Ford for failing to address the deeply rooted problems.
“The Ford government knew the system was a disaster waiting to happen – and they chose to let it happen,” said NDP Leader Andrea Horwath, adding the Ford government had made “dangerous” choices during the pandemic.
Merrilee Fullerton, minister of long-term care, blamed the previous Liberal government for a nasty legacy of inaction. She compared the “horrible” situation last spring to firefighters rushing to a raging fire.
“I didn’t start the fire,” Fullerton said.
“They may not have started the fire, but they did pour gasoline on it,” Green Party Leader Mike Schreiner retorted.
The auditor says one of the factors contributing to the spread of COVID-19 in long-term care during the first wave was the fact that almost two-thirds of homes that had outbreaks primarily had bedroom designs that housed three or four residents in one room.
“The Ministry and the Local Health Integration Networks, which are responsible for placing residents in long-term-care homes, did not know how many residents were actually housed in three or four-bed wards when the pandemic hit the long-term-care sector in March 2020.”
Long-term-care homes, the report found, had insufficient staff and staff training to provide appropriate care, she further found. “Our analysis of the staffing shortages reported by homes to the Ministry from March 19 to June 30, 2020 found that the staffing shortage peaked in late April, when 36 homes —ranging from a small 56-bed home to a large 300-bed home — reported critical shortages.”
Government oversight was also singled out as a big issue with the Auditor General noting that the Ministry of Long-Term Care has the mandate to inspect homes’ compliance but only has three staff members who have the proper expertise. The report found that the Ministry completely stopped inspections in the fall of 2018, “To focus on clearing a growing backlog of critical incidents and complaints.”
As well, the report found that restricting families from visiting homes “consequently eliminated a valuable source of resident care providers.”
Another contributing factor to the outbreak in the long term care sector according to Lysyk was that long-term care homes were initially not partnered with hospitals or public health units to benefit from their expertise in infectious disease outbreaks and that patients were being brought into long-term care when they should have been being brought out.
Donna Duncan, CEO of the Ontario Long-Term Care Association, called for quick action to implement “historic commitments” to end the sector’s staffing crisis and rebuild old and overcrowded homes.
The following are the Auditor General’s recommendations for LTC:
Pandemic response: While high rates of resident and staff vaccination have changed the current impact of COVID-19 on the long-term care sector, the Ministry and homes need to remain vigilant to respond to ongoing and emerging outbreaks and developments over the course of the pandemic.
Recovery: Developing and implementing an action-oriented recovery framework to assist the sector to transition into the new normal.
Modernization: Redoubling efforts to support sustainable, longer-term change in areas such as staffing and capital development; improved performance, oversight and accountability; and improving quality of care, resident quality of life and public confidence.
With files from The Canadian Press