Seniors Calling ~ Ontario Budget 2021 ~ The Ontario Long Term Care Association has made several recommendations

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For more than 60 years, the Ontario Long Term Care Association (OLTCA) has been
committed to advancing the quality of long-term care services in Ontario. With advocacy
and leadership as a key focus, the Association has been able to influence legislative,
policy and regulatory change, support sector expansion and redevelopment, and provide
educational opportunities to ensure the increasing needs of residents are being met with
safe, high-quality care.

Today, the OLTCA represents 70% of the long-term care homes in Ontario. Like the system itself, the OLTCA includes a range of ownership models: private operators, non-profit and charitable organizations, and municipally operated homes. Members provide care and accommodation services to more than 70,000 residents annually.

The OLTCA represents the shared interests of all homes across the province, and believes
that collective responsibility is required to build a strong and sustainable long-term care home sector.

In a report submitted for consideration to the Ontario Government ahead of the March 24th release of Ontario’s budget, the Ontario Long Term Care Association has developed a framework for consideration as Ontario moves forward.

The impact of COVID-19 on the residents of Ontario’s long term care homes has been devastating. The lives of tens of thousands of residents, their loved ones, and the staff who care for them have been changed forever by the events of the last 12 months. We must honour those lost to this terrible disease by resolving to work together to build a stronger system of care for our most vulnerable citizens – our seniors.

The Ontario Long Term Care Association (OLTCA) has been advocating for immediate
actions to safeguard against further tragedies, while recognizing that many of the issues that made long-term care homes vulnerable relate to longstanding issues that need systemic
change.

In a 2021 Budget Submission, OLTCA made key recommendations that aim to protect residents against Covid-19 and support long-term care homes in providing safe and quality care, now and in the future.Now is the time for all of us to come together – homes, government, health system partners, families and seniors advocates – to protect seniors today and mobilize immediately to modernize our systems of care for our ageing population for tomorrow. This is our collective responsibility.

The following recommendations OLTCA have made include:

• Protecting residents by continuing to take immediate and decisive action to ensure
long-term care homes and staff have the resources in place to prevent and contain
this aggressive virus.
• Supporting homes to provide safe and quality care for our vulnerable seniors by
continuing to stabilize the operations of long-term care homes with critical funding and
supports.
• Recovering and rebuilding a strong long-term care system to serve seniors now and in the future through transformation that finally addresses the longstanding issues that made long-term care homes and their residents and staff so vulnerable.

Research and analysis by the OLTCA and the Ontario Science Table show that community
rate of transmission is the single largest contributor to outbreaks in long-term care homes. The same research shows that once in a long-term care home, COVID-19 results in greater cases and tragic loss of life in homes that are older and more crowded. These homes were slated for redevelopment more than a decade ago but rebuilding has not moved forward.

Our collective energies need to be focused on protecting residents through the pandemic and rebuilding for the future. Two key priorities are moving forward towards approval through Ontario’s enhanced capital program and a $1.75 billion commitment to kick-start capital renewal of  long-term care homes, and implementing the commitment to an average of 4 hours of care.

OLTCA states that the time is upon us to come together to finally address the true issues that made Ontario’s homes vulnerable – the longstanding issues of an undervalued and underfunded long-term care system. The seniors’ population is rapidly ageing, with a growing need for investment and innovation in models of care and support. OLTCA further states that recent investments from the Province are laying the groundwork to redevelop ageing buildings, improve care, and make long-term care a great place to work.

As the pandemic continues to challenge Ontario and the world, there remains an urgent need for action to strengthen long-term care homes’ ability to prevent and contain Covid-19. Several urgent areas of action remain, including supporting critical safety initiatives needed to protect residents and staff. Long-term care staff are frontline heroes caring for our seniors and fighting COVID-19. To ensure they are protected, long-term care must continue to be prioritized for personal protective equipment (PPE) and testing. It is also critical to support homes by creating and funding in-house infection prevention and control (IPAC) expertise. IPAC is a 24/7 priority for homes. In-house staff are required to support and oversee day-to-day implementation of IPAC practices and protocols.

Front-line care staff in long-term care homes continue to face unprecedented pressures to deliver quality care to residents while following critical IPAC and safety measures to prevent the spread of COVID-19. We must continue to protect their scarce time for these efforts. The current priorities are the rapid vaccination of residents and staff containing current outbreaks, and protecting against the emergence of new variants.

OLTCA has been advocating for more frequent and less invasive testing leveraging emerging testing technologies. A number of member homes ran the pilots for the rapid antigen testing. The ability of the antigen testing to provide real-time results is valuable, however it may not be appropriate for all homes.

OLTCA is recommending a more flexible approach to testing that gives homes the ability to design a strong testing strategy based on the needs of their residents and staff using PCR, rapid antigen testing or other approved testing methods in the future.  As the virus and our understanding of it evolves, including what we learn about the effectiveness of vaccinations at reducing transmission, the OLTCA strongly recommends a collaborative approach with government, homes and health system partners to design and implement initiatives to prevent and contain COVID-19.

OLTCA’s latest forecasts indicate that the sector will overspend the COVID-19 funding
announced by government by more than $250 million by the end of March 31, 2021.
Increased and ongoing funding (beyond March 31, 2021) is required to continue to support
extraordinary costs. The vast majority of these costs are driven by the increase in the number of and intensity of outbreaks; higher staffing costs related to overtime and sick pay; new staff; high agency staff costs; costly PPE supplies driven by global demand; and specialized supports from hospitals and other partners.

COVID-19 funding has been provided to homes based on factors such as the age and size
of home, as well as outbreak status. While some homes are facing significant additional costs beyond their allotted funding, others have underspending that will be reconciled by government in future years. OLTCA estimates that the homes facing overspending require $300 million in additional funding to maintain their efforts to fight COVID-19. As the current funding model for homes does not allow for timely reconciliation and redistribution of funds, additional funding needs to be provided to homes now, which can be offset by future recoveries from homes that are underspent.

Recommendations: Give long-term care homes the tools and resources to fight COVID-19.

1. Continue prioritization of personal protective equipment (PPE). Establish a provincial approach to ongoing sourcing and procurement of PPE for those homes that don’t have the capacity. And, in cases of supply shortages, ensure long-term care homes are a priority.
2. Enhance testing and logistics for long-term care. Allow homes the flexibility to design a strong testing strategy that meets their resident and staff needs using PCR testing, rapid antigen testing or other approved testing methods, as they become available.
3. Train, certify and hire infection prevention and control (IPAC) specialists for each home. Support long-term care homes with funding to train and appoint at least one in-house IPAC expert for each home.
4. Continue to support long-term care homes to do whatever it takes to prevent and contain the virus by providing additional funding for all COVID-19 related expenditures. Many homes are currently spending in excess of the funding.

Recommendations include:
• More than $1 billion in time-limited funding to support COVD-19 response
•$1.75 billion multi-year to develop new and older homes
•$1.9 billion multi-year to achieve an average of four hours of care per resident

Stable staffing and operations require predictable funding and supporting policies to ensure
homes can focus on fighting to prevent and contain COVID-19 through this second wave and
with new variants threatening a third, even more deadly wave.

Further recommendations are to reduce crowdedness and improve infection prevention and control (IPAC) in older long-term care homes and to extend full occupancy protection to all homes until at least June 2021 so homes can continue to reduce crowdedness, maintain cohorting and isolation rooms according to IPAC, and continue to focus scarce staff on
caring for existing residents.

The Ontario Long Term Care Association’s budget submission further recommends maintaining stability in base funding to ensure homes can focus on managing the pandemic. Maintaining the High Wage Transition Fund beyond April 1, 2021 will support stability pending a broader review and transformation of the funding model.

There is a need to support homes with coaching and resources rather relying on a harsh
enforcement approach. This was a recommendation of the Gillese Inquiry. Punitive directives
will not help homes stabilize and provide the best care for residents, and are driving staff out
of the sector. Longer-term, a comprehensive review of the Long-Term Care Homes Act and inspection system are required to support a culture shift that focuses on high performance and quality improvement towards a truly resident-centered regime.

The recovery of long-term care homes beyond the pandemic must be grounded in
addressing the longstanding issues facing this critical sector. This requires a transformation
of the sector – its staffing, operating, funding and compliance – to achieve a truly resident
centered system of long-term care. Ontario’s commitment of $1.75 billion in capital and $1.9 billion to increase staffing are a strong foundation.

An underfunded and understaffed long-term care sector was vulnerable to the ravages
of the pandemic. New innovative models are needed to create a pipeline of talent that homes can recruit.  OLTCA’s report urges Ontario to move quickly and decisively to redevelop older homes. The intensity of outbreaks has been more than 2 times higher in older homes, and has been 3 times higher in older homes that include 3- and 4- person rooms. Nearly half of the province’s stock of long-term care homes is older.

The recent enhancements to the capital program address the underfunding ignored by
past governments and place the sector on stronger footing to renew homes. Changes are also needed to the approval process so that the remaining 24,000 older long-term care beds, or spaces, can be approved quickly and rebuilt within the next 4 years before their licenses expire. The demand for long-term care is significant. It is critically important for older homes to get shovels in the ground as soon as possible.

The Ontario Government will release the 2021 Budget on March 24th. In a March 11th media release, the Minister of Finance, Peter Bethlenfalvy, stated, “The Ontario government will continue to focus on protecting people’s health and jobs through the COVID-19 pandemic.  The Budget will support the province’s comprehensive vaccine distribution plan, along with providing additional resources for the health care sector and initiatives to protect the economic well-being of families, workers and employers.”

Minister Bethlenfalvy said, “Even though the light at the end of the tunnel shines brighter with each person that is vaccinated, we are going to take nothing for granted. This caution is necessary to save lives. And it’s also necessary for our economic and fiscal recovery, because as I often say, without healthy people, you can’t have a healthy economy. So, we’ll defeat the virus by working together. And when we do, our collective efforts will turn to unleashing the growth that we are going to count on for a strong recovery.”

To read the Ontario Long Term Care Association’s full report, visit the website.