Ontario did not have a comprehensive plan to address a pandemic and there was no plan to protect residents in long-term care, according to an independent commission tasked with looking into the deadly spread of COVID-19 across the province’s nursing homes.
The 322-page report from the Long-Term Care Commission issued late Friday said long-term care homes were “easy targets” for uncontrolled outbreaks due to decades of inaction by Ontario’s policymakers and leaders. The end result was that staff, long-term care residents and their families suffered terribly with many residents paying the ultimate price with their lives.
“Many of the challenges that had festered in the long-term care sector for decades – chronic underfunding, severe staffing shortages, outdated infrastructure and poor oversight – contributed to deadly consequences for Ontario’s most vulnerable citizens during the pandemic,” the commissioners wrote.
While the province made influenza pandemic plans, created a stockpile of emergency supplies and began earnest preparations in the wake of SARS epidemic in 2003, Ontario’s most current pandemic plan had not been updated since 2013 and attempts to expand the scope of the plan were incomplete by the spring of 2020.
By the time COVID-19 arrived, successive governments had allowed 90 per cent of the province’s stockpile of PPE to expire and be destroyed without being replaced.
“Successive governments should have taken the warnings and lessons from SARS seriously. They should have proactively prepared instead of taking an episodic and reactive approach.”
The report noted that pre-pandemic, many homes were outdated and not up to current standards, adding that containing a virus in such a setting “would prove to be difficult” and that the long-term care workforce was stretched to the limit. There was no plan to provide a surge of workers to replace those who could not or would not come to work in a pandemic and that much of the workforce lacked crucial training in infectious disease prevention and control. It added that the leadership needed to guide them through these difficult times was also missing.
“In spite of the heroic efforts of those staff who remained on the front lines, long-term care residents continued to get sick and die.”
Nearly 4,000 long-term care residents and 11 staff have died of COVID-19 since the pandemic hit.
The commission stated that while there were ample warnings that the virus posed a risk to long-term care, those warnings were not acted upon with sufficient speed and that Dr. David Williams, the chief medical officer of health, in particular was too slow to act on emerging information about COVID-19.
“The province’s response was slow and reactive when the virus arrived and began to spread. Critical decisions came too late, and the government’s emergency response system proved inadequate to protect staff and residents from COVID-19.”
The province was hesitant to acknowledge that community spread was happening, that asymptomatic patients could spread the virus and that masks would be helpful when it comes to prevention.
“Delay is deadly,” the commissioners wrote.
New facilities need to be built to address the needs of the province’s aging population, the commission said, adding that the government also needs to reconsider how those nursing homes are managed, with a focus on quality care.
It suggested a new model to build long-term care homes in the future, similar to what’s in place for privately funded hospitals, courthouses and light rail transit systems.
Then, the commission suggests, a mission-driven organization – be it public, not-for-profit or for-profit – would handle the care of the residents.
The commission took particular issue with long-term care homes that are owned by investors.
“Care should be the sole focus of the entities responsible for long-term care homes,” it said.
Long-term Care Minister Merilee Fullerton responded to the report in a statement, saying the province would be reviewing the recommendations carefully as they “incorporate them into our ongoing efforts to fix the long-standing issues that have challenged Ontario’s long-term care sector.”
“There’s no question that residents and staff at long-term care homes and their families were disproportionally impacted by COVID-19. As I said in my testimony to the commission, we cannot let their experience be in vain — and we won’t,” read the minister’s statement.
The statement added many areas identified in the report were consistent with their ongoing efforts to resolve the challenges facing the long-term care system.
Earlier Friday, Ford said he welcomed the commission’s report, as difficult as it would be to read.
“What happened in our long-term care homes, it was tragic,” he said. “And it was terrible. But most of all, it can never be allowed to happen again.”
NDP Leader Andrea Horwath said the commission paints a picture of years of neglect in the sector followed by a series of bad choices made by the Ford government.
“Sorrow for the survivors and families of the victims is not enough,” she said in a statement. “We need to act urgently on this report to ensure this never, ever happens again.”
The head of the Ontario Long-Term Care Association, meanwhile, said the report is a step in the “journey to reimagine seniors’ care.”
“As Ontario continues to respond to the pandemic, it must remain our priority and focus at this time,” Donna Duncan said in a statement, pointing to the work long-term care homes are doing to alleviate strain on hospitals.
The commission, led by Frank Marrocco, associate chief justice of the Superior Court, heard from long-term care residents, staff and management.
It questioned government officials from Williams to Long-Term Care Minister Merrilee Fullerton to Health Minister Christine Elliott.
Military leaders who organized a deployment into long-term care homes also gave testimony, detailing the circumstances surrounding the mission that led to a damning report on conditions inside the facilities.
In all, the report said, the commission heard from more than 700 people.
A copy of the complete report can be found here.