As the death toll continues to rise in long-term care homes across the province the majority of the media’s reports are now focused on the impact of COVID-19 on the residents and staff in these homes. I have repeatedly heard the government say that these are unprecedented times and while I acknowledge that the pandemic is unprecedented, the devastating impact the virus has had on long-term care homes should NOT come as a shock. For years, there have been many issues with neglect in long-term care.
The Provincial government has long been aware of staffing shortages, poor working conditions for personal support workers, and quality of care issues in these homes. The government also made the decision last year to scale back on their annual comprehensive inspections of long-term care homes. Part of these comprehensive inspections includes reviewing the home’s protocols for infection prevention and control practices. If non-compliances were identified, action would be taken by the Ministry of Health and Long-Term Care (MOHLTC). CBC News reported that only 9 out of 626 homes received comprehensive inspections last year.
Every long-term care home has a duty to detect and prevent infectious disease.
Under section 86(1) of the Long-Term Care Homes Act, every home has a duty to ensure that there is an infection prevention and control program that must include: a) daily monitoring to detect the presence of infection in residents; and b) measures to prevent the transmission of infections. Even before COVID 19, compliance with this section was important to controlling the spread of the seasonal flu and other outbreaks.
In previous years as part of the inspection process, inspectors raised concerns related to inadequate infection control, hygiene measures and failure to ensure staff compliance with Infection prevention and control programs. Some examples of infractions identified by inspectors in the past included leaving soiled wheelchairs, failure to perform proper hand hygiene before serving food to residents or before administering medications, soiled wash basins on top of the sink in washrooms shared by more than one resident, feces on walls, inadequate washing of linens and the list goes on.
Given the ongoing problems related to quality of care issues, staffing shortages, inadequate wages, and low recruitment rates, you would think it is absolutely critical that the MOHLTC continue to perform comprehensive annual inspections. Yet, our government decided that this was no longer necessary. Just another example of neglect in the long-term care system.
Ontario’s long-term care system has been neglected and the pandemic just exposed the system’s vulnerabilities.
Part of the government’s initial response to this outbreak involved relaxing staffing, training and record keeping requirements for long-term care homes. Homes were also authorized to use volunteers to perform work and redeploy staff within different locations. It was not until March 30th, 2020 that the government issued a directive requiring that all long-term care homes test individuals with symptoms of COVID-19 and those who have come into contact with someone diagnosed with COVID-19. We have been advised by Public Health that it may take up to 14 days for symptoms to appear after exposure to the virus, and still not everyone in these facilities is being tested. This is unacceptable.
Many residents in long-term care are completely dependent on staff to receive the care that they require, and many cannot advocate for themselves. There have been many reports about the residents, staff and families who have seen loved ones die as a result of COVID-19. The impact is devastating. There are also many residents in these homes right now with dementia, Parkinson’s, diabetes, osteoarthritis, mobility problems and other chronic illnesses who may be neglected. The situation poses a significant risk to their health.
Now, after several hundred deaths in long-term care the province announced this past week that it will redeploy staff from hospitals and home and community care to boost staff in long-term care, increase screening, deploy infection control teams and ban employees from working in more than one long-term care home to help curb the spread and save lives. The Federal government has also promised to provide funding to top up the wages of essential workers in long-term care homes who earn less than $2,500.00 per month.
How did we get here and who is at fault?
The sickness and death in long-term care linked to COVID-19 was certainly foreseeable. The government should have intervened sooner and required that all residents and staff be tested from the outset. Homes are still not required to test everyone, but there have been reports of some homes implementing mandatory testing. More information should have been made available to the public by the homes and by the government regarding confirmed case numbers and the availability of staff, and PPE in the homes.
Were long-term care homes meeting the legislated standards? Were they complying with the MOHLTC’s directives during this pandemic? Did they have adequate infection prevention and control programs and were they ensuring staff compliance? Were appropriate measures taken to protect their staff and to report shortages in personal protective equipment and to source additional equipment? Were homes actively screening residents and isolating those showing symptoms? How was screening carried out, particularly in those cases where a resident is suffering from advanced dementia and he or she cannot be relied upon to identify certain symptoms? When all of this is said and done, these are just some of the questions that will need to be investigated.