New Ontario legislation aims to reform long-term care standards

The Ford government has put forth a plan that will attempt to reform and improve standards in Ontario’s long-term care sector that was hit hard during the COVID-19 pandemic.

The new legislation will double maximum fines for long-term care offences and prohibit convicted rule-breakers from working in the sector.

The new ‘Fixing Long-Term Care Act’ — introduced on Thursday — is built on “three pillars” to improve staffing, protect residents through accountability and build modern facilities.

“After decades of neglect and underfunding by previous governments, we are fixing long-term care,” says Long-Term Care Minister Rod Phillips. “This legislation, if passed, would protect our progress by supporting our commitments to increase staffing for more hours of direct care, enhance accountability, and build more modern beds.”

The new law gives long-term care inspectors the power to lay charges on the spot along with doubling fines for individuals, companies or board members. Individuals could be fined up to $400,000 for second offences and corporations could be fined up to $1 million for second offences.

“We are introducing proactive inspections, which are chances to work on problems before they are problems,” says Phillips.

Phillips says the proposed changes send a clear message to operators that the government expects them to follow the rules. He also says the act will make it easier to revoke the license of homes found to be violation of the new rules.

NDP Critic Sara Singh, MPP for Brampton Centre, calls the new legislation a “missed opportunity.” Singh argues the focus on enforcement and accountability doesn’t provide justice on the sectors troubles over the past couple of years.

“There is no real justice here for those families, seniors and workers that had to endure during the pandemic,” says Singh. “Creating more enforcement mechanisms doesn’t actually improve the quality of care right now.”

“This really falls short of what is needed here to transform the system and actually invest in the type of care we need here in Ontario.”

The province says they will be investing $4.9 billion over four years to deliver more staff to provide additional care. The new act will also double the number of inspectors and build an extra 30,000 beds by 2028.

Many advocates have urged the province to move away from for-profit long-term care, something the new legislation does not address. Some of the bad acting operators during the pandemic, including Orchard Villa in Pickering, are up for renewal and expansion.

Family members of residents who died at the home during a COVID-19 outbreak told Ontario’s long-term care commission that the deaths and many of the infections could have been prevented had the home held up its duty of care.

When asked about further investigations and justice into the sectors shortcomings during the pandemic, Phillips says the new plan is about “focusing forward.”

“The police investigate criminality, that’s the way our system works,” he said.

“Today the focus is fixing the system that’s been broken. This has been our government and other governments that have let the system get to the way it is, now we are focused on the future.”

The government is pledging to provide an average of four hours of daily direct care for each resident by 2025, with specific targets set for each year. The long-term care minister is now required to annually report on the government’s targets — and provide an outlined plan of how to reach them if they are not met.

If passed, the new legislation will repeal and replace the current ‘Long-Term Care Homes Act’ in 2007. The bill will return to the house for a second reading, where amendments will be presented and potentially adopted.

The province says the new act will aim to fix the long-term care sector by improving three areas and implementing the following:

Accountability

• Commitment to an average of four hours of direct care per resident per day by March 31, 2025 and the targets for each year (three hours by March 31, 2022; three hours and 15 minutes by March 31, 2023; and three hours and 42 minutes, by March 31, 2024) the law. The Minister will now be accountable for annually reporting on each target and, if the target is not met, producing a public plan that explains why the target was not met and how the next target will be achieved.
• Requiring licensees to integrate a palliative care philosophy into their care and services.
• Mandating each home to have an Infection Prevention and Control (IPAC) lead who is responsible for the IPAC program as their primary responsibility. The IPAC lead must under-take specific training specified in regulation. Inspectors will be required to audit IPAC programs.
• Requiring licenses to ensure that certain staff receive leadership training in accordance with the regulations.

Enforcement

• Implementing new compliance and enforcement tools, including financial administrative monetary penalties in cases of non-compliance.
• Doubling the maximum fines for provincial offences under the Act – which will now be the highest of any jurisdiction in Canada – for individuals ($200,000 for first offence, $400,000 for second offence), corporations ($500,000 for first offence, $1,000,000 for second offence), and board members (for-profit licensees: $200,000 for first offence, $400,000 for second offence; not-for-profit licensees: $4,000).
• Prohibiting any individual, convicted of an offence under the new Act, or found guilty of professional misconduct prescribed in regulations, from working for, volunteering for, or sitting on the board of a licensee or long-term care home.
• Empowering inspectors, not only Directors, to issue compliance actions (including ordering staff, training or education, as well as work and activity orders).
• Creating the power for the Director or Minister to suspend a licence and have an LTC Supervisor installed to take over the operations of the LTC home without having to revoke the licence and close the LTC Home. The LTC Supervisor would allow the ministry full control of the home until the suspension is lifted, licence expires, revocation of the licence occurs or another solution is found. This supervisory function presently exists for government oversight of hospitals and school boards.

Transparency

• Creating a new section of the Act dedicated to Quality of Care and Quality of life. This includes requirements for mandatory quarterly public reporting, including: quality indicators, as well as standardized annual resident and family surveys.
• Regulations to follow to define the roles of caregivers and medical directors in delivering care to residents.
• Introducing an appeal to the Minister in the licensing process.
• Enabling the creation of a Long-Term Care Quality Centre to disseminate best practices through training and research.

The Ontario government is also extending the wage increase for personal support workers until March 31, 2022.

This temporary wage increase includes a $3 per hour wage enhancement for PSWs in Long-Term Care and $2 for support workers in hospitals.

The wage increase extension also comes as many doctors, personal support workers and other health-care professionals are retiring or leaving the profession due to burnout from working during the COVID-19 pandemic.

Phillips says the Ontario government plans to hire 193 long-term care home inspectors by next fall.

He announced Tuesday the province plans to spend $20 million to create a ratio of one inspector for every two long-term care homes and will allow for more proactive visits.

With files from CityNews reporter Shauna Hunt and the Canadian Press