By Peter Chow
“ALL THEY NEEDED WAS WATER AND A WIPE DOWN”
The final report of Ontario’s independent commission into long-term care in the pandemic was released Friday.
“For example, the commission was told that malnutrition and dehydration occurred due to a lack of available staff to tend to resident needs. As a result of these conditions, some residents spent their final hours in complete isolation and ultimately died alone.”
The commission was informed of the deaths from neglect by several sources, including the Canadian Armed Forces, said John Callaghan, the commission’s chief counsel.
“We wanted to make sure that people understood that we knew that, and that we had seen evidence of that in our review,” he said.
Callaghan pointed to the notes of one member of the Forces who said in one of the homes they came to assist, 26 people had died from neglect and dehydration before their arrival when “all they needed was water and a wipe down.”
Canada has the worst record for COVID-19 deaths in long-term care (LTC) homes compared with other wealthy (OECD) countries.
The study by the Canadian Institute for Health Information found that the proportion of COVID cases in Canada in LTC facilities was 9%, but deaths in LTC represented 60% of overall COVID-19 deaths, which is significantly higher than the OECD average of 38%.
There have been 7,428 cases of COVID among residents of LTC facilities in Ontario with 3,901 deaths.
Crucially, Ontario’s LTC facilities have fewer health care workers per 100 residents than the OECD average.
LTC facilities continue to be chronically understaffed and vulnerable to predation by for-profit conglomerates.
58% of LTC homes are privately owned, 24% are non-profit and 16% are municipal.
In January, the medical journal, the Lancet, in its World Report cited numbers that found in Ontario there was a significant difference in death rates depending on the type of home, such that “in facilities with an outbreak, 6.5% of all residents in for-profit facilities died of COVID-19, whereas 5.1% died in nonprofit facilities and 1.3% in municipal homes.”
The high proportion of COVID-19 deaths among seniors in LTC homes has exposed long-standing deficiencies in long-term care in Canada generally, but Ontario specifically..
In April 2020, the governments of Quebec and Ontario each requested assistance from the Canadian Armed Forces (CAF) to help manage COVID-19 outbreaks at 20 LTC facilities in Quebec and 5 in Ontario.
Military medical teams were called in to remedy horrific conditions, including residents being left malnourished and dehydrated and in dirty diapers for hours or days.
The CAF drew the curtain back on horrific allegations of elder abuse in 5 Ontario long-term care homes, with precise, graphic reports of residents being bullied, drugged, improperly fed and in some cases left for hours and days in soiled bedding.
Conditions in two of the seniors homes, in Pickering and in Etobicoke, appeared to be nothing short of horrid and inhumane, as ill-trained, burned-out and, in some cases, neglectful staff coped with the overwhelming care needs of elderly residents, many of whom suffer from dementia or other disabilities.
The CAF submitted a report, which described poor quality of care, chronic under-staffing and inappropriate treatment of residents.
A June 2020 report on LTC staffing by the Royal Society of Canada stated that “the pandemic just exposed long-standing, wide-spread and pervasive deficiencies in the sector” and made recommendations to address “the workforce crisis in nursing homes.”
The report noted that nurses provide little direct care to residents and 90% of direct resident care is provided by unregulated and unlicensed care aides or personal support workers (PSWs).
Hailed as “heroes” of the pandemic by Premier Doug Ford for their service in nursing homes despite the risks of catching COVID-19, PSWs are being left out in a provincial budget that did not make their temporary $3 hourly wage hikes permanent.
More than 6,800 nursing-home staff, most of them PSWs, contracted the virus – including 11 who died – and most of their two-to-three week absences due to COVID were without pay.
PSWs in LTC homes are among the lowest-paid workers in health care, with wages disproportionately low for the demands of their job.
PSWs in LTC face physically and psychologically demanding working conditions.
Many workers experience severe time pressures and an overload of work.
Staffing levels in Ontario long-term care homes are at their barest, with many new PSWs quitting due to the overwhelming stress of the job.
Because of chronic under-staffing there aren’t enough PSWs to do the work, to feed and dress and bathe patients, and if residents have dementia or disabilities, it can be impossible to properly care for residents within the time frame they are given.
PSWs just entering the workforce aren’t prepared for what they’ll face.
One new PSW graduate showed up for her first day at work, went out on her lunch break and never went back. She switched to waitressing, a lot easier work, less stressful and better paying.
PSWs are getting burnt out and tired and discouraged.
Long-term care facilities are vulnerable to predation by for-profit conglomerates.
58% of LTC homes are privately owned, 24% are non-profit and 16% are municipal.
Private corporations, left to their own interests and devices, will not keep staffing at levels where they can provide solid adequate care.
For-profit LTC homes have had larger COVID-19 outbreaks and more deaths of residents from COVID-19 than non-profit and municipal homes, with a 1.96-fold increase in the extent of outbreaks and a 1.78-fold increase in the number of resident deaths due to COVID-19, compared with non-profit homes after adjusting for surrounding health region numbers.
All comparisons favoured municipal homes, which generally operate with the support of municipal contributions and benefits that allow for greater staffing levels and capital expenditures.
25 years ago, Mike Harris and his Progressive Conservative party ousted Bob Rae’s NDP government in Ontario, starting the so-called “Common Sense Revolution.”
Pledging to tackle Ontario’s deficit, the Harris government pushed tax reductions and slashed public spending on health care, education and social services.
The government closed hospitals and eliminated the jobs of thousands of nurses, infamously comparing them to the people who lost their jobs after the hula hoop fad died down in the early 1960s.
LTC did not escape the cuts. Harris’ government reduced the public role in long-term care, relaxing regulations and lessening public oversight.
1996, when Mike Harris got rid of the resident-staff ratio, was when the present-day nursing home crisis began.
Ontario has not had a staffing standard ever since.
After that, staffing levels dropped and it became harder to take care of residents.
The Harris government ignored the law passed in 1994, that would have created a public home care system like every other province in Canada.
Instead, they created the Community Care Access Centres (CCACs) and then forced them to privatise services — even when it was demonstrated that privatisation would cost more in the long run.
This was the start of the despised system of “competitive bidding” in Ontario’s LTC.
Today, we have 14 LHINs, Local Health Integration Networks (replacing the CCACs), each with their duplicate administrations.
The Harris government opened the system to for-profit bidders and today chains of for-profit companies have gained the majority of the “market share” as they call it.
Under the Conservative government, the growing corporate business of caring for seniors flourished and corporate players such as Sienna Senior Living, Revera, Extendicare and Chartwell expanded their reach.
In the past, Ontario had a standard of care, but it was taken away by the Harris Progressive Conservative government.
At the time of its abolition, the standard was insufficient – it was set at only 2.25 hours per resident per day.
Since that time LTC homes have changed dramatically: residents are much more complex, more impaired, with higher levels of dementia, disability and medical acuity. Requiring more intensive care.
To its credit, in November, 2020, the Ontario Ford government has acted on the key recommendation made by the Ontario’s Long-Term Care COVID-19 Commission – that the province will mandate having 4 hours of daily care per patient in long-term care homes.
The only opposition to these standards is the Ontario Long-Term Care Association (OLTCA), which mainly represents for-profit nursing homes.
Although the OLTCA acknowledges understaffing as a critical issue, it doesn’t want a legislated minimum standard. In fact, it has called for “flexible staffing.”
The OLTCA is saying they need more staff, but they’re asking to substitute lower trained staff for higher trained staff.
Lower trained and lower paid.
The CBC reported that last month, Ontario’s LTCs were still breaking the rules, with one major company, Extendicare, responsible for 22% of infractions. According to the CBC’s investigation, “for-profit long-term care homes received 70% of the violation citations. An additional 8% of the violations were found in nonprofit homes managed by for-profit companies.”
This is further evidence that while the LTC crisis in Ontario is widespread, the heart of the problem is found among for-profit homes.
Now the LTC industry is pleading poverty, while paying lobbyists to seek protection from lawsuits.
In response, Ford’s Conservative government has introduced new legislation that would shield itself, as well as LTC homes, from COVID-19-related lawsuits, as long as the parties acted in “good faith” during the pandemic.
This places a legal wall around LTC corporations – some of which are currently facing class action lawsuits.
One lawsuit in particular, accuses 96 long-term care homes as well as the Ford government of negligence during the pandemic.
The lawsuit claims:
“Elderly people in long-term care have suffered enormously as a result of negligence, incompetence and indifference by profit-seeking corporations that have engaged in egregious practices while at the same time paying out tens of millions of dollars a month in profits to their shareholders. This is morally reprehensible.”
The COVID-19 pandemic has shown that the long-term care system is fractured along the lines of privatization, underfunding, and understaffing.
This crisis should be seen as a moment of clarity, where Ontarians can choose what values we want to build into a new LTC system.