Military’s report paints a grim picture of Ontario’s long-term care system

June 1, 2020

By Nate Smelle

With the death toll in Ontario's long-term care facilities due to COVID-19 rising fast, on April 22 the provincial government decided it was time to seek assistance from the Canadian Armed Forces. At this time, Ontario's Associate Chief Medical Officer of Health Dr. Barbara Yaffe reported that COVID-19 had taken the lives of 447 long-term care residents and one staff member. Since then, the number of deaths due to COVID-19 in Ontario's long-term care facilities has continued to climb, now surpassing 1,500 – nearly 70 per cent of all deaths due to the pandemic province-wide.
In early May, some 250 members of the CAF were deployed to provide around-the-clock care in five of Ontario's long-term care facilities hardest hit by the pandemic. Two weeks later, on May 14 the CAF released a scathing report chronicling observations from the military personnel providing assistance on the frontlines in the battle against COVID-19 in long-term care facilities.
Providing a snapshot of Ontario's long-term care system during the pandemic, the report exposes gross failures in terms of how these facilities are handling infection control, standards of practice/quality of care, shortages of supplies, staffing, communications and behaviour. For instance, military personnel have observed: COVID-19+ residents wandering the facilities interacting with other residents; “significant gross fecal contamination” in numerous residents' rooms, rotting food, cockroaches and flies in residents' rooms; staff using contaminated PPE when moving from COVID-19 units to other units within the facilities, and when providing care to residents; and, a “general culture of fear” to use supplies because they cost money.
Currently, 150 of the province's 626 long-term care homes are experiencing an outbreak, in which there are 1,855 active resident cases and 1,335 active staff cases.
The Ontario Health Coalition reminded the public in a press release last week that they have been repeatedly calling on the Ford government to: improve access to PPE; take concrete measures to address critical staffing shortages; improve infection control and training and workplace safety; take concrete measures to isolate residents who test positive; intervene in homes that have incompetent or negligent management; and, show coherent coordinated leadership in this sector rather than leaving it to voluntary arrangements between provider companies. Indicating that the coalition is “beyond frustrated,” spokesperson Natalie Mehra pointed out that despite the fact thousands of staff and residents have been infected with COVID-19, and nearly 1,500 residents and staff have died, the Ford government has yet to release a “coherent coordinated plan” to intervene actively in long-term care homes with outbreaks.
“Aside from individual staff transgressions, which require proper management of staff and proper training, there are clear systemic issues here,” added Mehra.
“We have repeatedly raised the issue of staff being required to wear the same PPE from resident to resident or patient to patient until it is ‘visibly soiled.' This would have been completely unacceptable prior to COVID-19 and yet it is routinely the case in homes and hospitals that say that they are complying with Public Health Ontario's directives and guidelines. Shortages of PPE and incompetent and negligent management are compounded by the leadership failure in our provincial government which should have applied the precautionary principle and taken much more active measures to improve the standard of infection control, workplace safety and access to PPE.”
Reacting to what the Ford government calls the CAF's “disturbing allegations” in the report, the Ministry of Long-Term Care announced on May 27 that it would be appointing temporary management at each of the five facilities featured in the report – Eatonville Care Centre, Hawthorne Place Care Centre, Altamont Care Community, Orchard Villa, and Camilla Care Community. It was also announced that they had deployed long-term care inspection teams to conduct “comprehensive, detailed inspections” at “high-risk” long-term care homes over the next three weeks.
“What we saw in the reports from the Canadian Armed Forces was gut-wrenching and appalling,” said Dr. Merrilee Fullerton, Minister of Long-Term Care.
“Our inspectors are professionals like nurses, dieticians and physiotherapists and they will stop at nothing to ensure all high-risk homes are quickly returned to places of safety and stability.”
As the chair of Hastings County's long-term care committee, Bancroft's Mayor Paul Jenkins has been closely following the crisis in Ontario's long-term care system prior to COVID-19's arrival in Ontario in late January. As a shared service between Hastings County, Belleville and Quinte West, he said the county is responsible for operating both the Hastings Centennial Manor long-term care facility in Bancroft, and the Hastings Manor facility in Belleville. Although 10 residents and five staff at the facility in Belleville did previously test positive for COVID-19 – three of which have since died – Jenkins said he was pleased to report that the facility in Bancroft has yet to have a single case, and that both facilities are now currently COVID-19 free.
Highlighting how the crisis has been handled so successfully on a locally level, he said “Everything you read in that report they did the total opposite. They isolated people to one area, they went into strict PPE requirements. They put a lockdown on those facilities long before it became the thing to do. Before it became the rule not to have part-time people working in two different homes they put that into place. So they were very proactive and did everything by the book.”
Acknowledging that the crisis in Ontario's long-term care system has existed long before COVID-19, Jenkins said the pandemic has really moved the conversation forward regarding the inadequacies of the system. Describing the whole system as “underfunded,” Jenkins said Hastings County took steps to improve long-term care prior to the pandemic by increasing funding this year by 13 per cent. Addressing some of the shortcomings of the system, and how they will be made worse as the population ages, he said “What everybody needs to realize is, is that people are going into these homes now at a much later stage in the aging process, because people are trying to keep their family members at home. So when they do go in, and this is not 100 per cent of the time, they do require more care, which puts more strain on the staff, which means if you were short-staffed to start with you are really short-staffed based on the way the aging population is going right now.”
Another pressing issue driving the staff shortage in Ontario's long-term care homes coming to a head because of the pandemic, Jenkins said, is compensation. One of the main reasons that long-term care homes are having trouble attracting qualified professional staff, he explained, is that “the pay for a lot of the functions is not fantastic, and a lot of people use part-time workers. The county luckily minimizes that, but a lot of homes use part-time work so it is very, very tough on the staff members and eventually that trickles down to the residents. Now throw in profit to that model. Hastings County is a not-for-profit, so if you are now taking money out of this equation for profit purposes I would think it has to exacerbate the situation.”
Considering many of the issues with the long-term care system in Ontario have been around for a long time, Jenkins believes the crisis is far too complex to solve by simply calling for Minister Fullerton's resignation. Comparing the current situation with long-term care to climate change, he said although it is just come to everybody's attention now “it is something we always knew about. I was watching CBC the other night and one of the panelists said ‘this is like climate change, we all knew it was there, but we just kept kicking it down the road.' And you know what, it is only going to get worse because the big bubble of the ‘Baby Boomers' hasn't quite hit the long-term care scenario yet … but they are going to.”
From the start, Jenkins said his priority has been keeping COVID-19 out of the community, so it does not enter Bancroft's long-term care facility and seniors' residences. While the town has been successful in this regard so far, he is concerned that many people now seem to be less vigilant in their efforts to prevent the spread of the virus since the province began Phase-1 of reopening the economy.
“Now we are into our testy time with the influx of travellers,” Jenkins said. “South Korea is now having a bit of a relapse and they were at the forefront of this. We are not keeping our guard up to what it should be.