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Responding to the Crisis in Long-Term Care

"The neglect, underfunding and overcrowding of Ontario’s long-term-care facilities under the watch of numerous governments over many decades has been tragic.

Sadly, the situation has only worsened with the COVID-19 pandemic, which struck residents living in these facilities the hardest, resulting in thousands of needless deaths.

Enough is enough, immediate measurable action is required to address this crisis and save the lives of our vulnerable seniors and their caregivers."

This is the beginning of a letter writing campaign from the Toronto Star that so many residents of Don Valley North have emailed in this week. The letter, which I share with you here, includes 5 demands for all three levels of government. I completely agree with the hundreds of you who have signed on: this is an issue for every one of us.

Let me start by sharing how I believe we got to this terrible place and why the five demands above for urgent Long-Term Care response are critical.

There are 626 LTC homes in Ontario. Each municipality is required to run at least one home, so these make up 16% of all LTC homes. Toronto, for instance, owns and operates ten LTC homes that came under management of the new city at amalgamation. Another 27% of LTC homes in Ontario are run by charitable not-for-profit organizations, like the Yee Hong Centre in Scarborough. The remaining 57% are all run by for-profit companies, such as Chartwell, Extendicare, Sienna Living, etc.

In 2010, the Ontario government changed the admission criteria for Long-Term Care, requiring new residents to have high or very high physical and cognitive challenges to qualify for admission. New residents now come to Long-Term Care at a later stage in the progression of their diseases, when their health is more likely to be unstable, more complex, and more physically frail. The fatal flaw in that plan, designed to address growing need and shrinking capacity, was inadequately anticipating the impact on staffing needs.

If I think back to 1979, when my grandfather was in a long term care home, he was paired with a gentleman of greater mental ability but with mobility issues in a room for two. They filled each other’s gaps with minimal nursing care needed. Throughout Ontario, those same rooms for two are still in use but both inhabitants have very high needs. When you add a highly infectious disease control issue into that environment, it takes constant professional care in that room to guard against risk.

Indeed, staffing levels and hours of quality care have shown to be a determining factor in the success of managing outbreaks. The City, for instance, provides a liveable wage to its workers, greater management accountability as a public organization, and has set a policy for more hours of hands-on care, especially for those residents at risk of wandering. The result: homes managed by the City have fared far better than those in private or not-for-profit homes.

The aging care infrastructure is also in dire need of an upgrade as the current facility standards have proven to be inadequate to reduce the risk of infection.

You can’t wait until each LTC home has an outbreak to bring in additional help. That is too late to prevent death. Since January 1st, 2021, 200 long term care residents and two staff members have died of COVID-19. That does not include those that may have died of the other complications of being in lockdown without adequate physical and mental stimulation.

On Tuesday, the Province released new projections that show that up to 2600 more LTC residents could die of COVID-19 in this second wave if we don't take decisive action.

This is why I fully support this call to action:

  1. The Province must immediately implement constant COVID-19 rapid testing for all LTC residents and staff, in addition to immediate vaccinations in homes, leveraging military healthcare professionals, if necessary. A public tracking systems for vaccinations should be made available on a facility-by-facility basis.

  2. The Province must immediately restore the previous LTC home inspection regime that they eliminated last year. There should be mandatory public reporting focused on infections, medical supply, staff availability, and appropriate access to local hospitalization and specialized care. Provincial and municipal inspectors should be deployed to assist this program.

  3. The Province and Federal government must provide $100 million in immediate emergency and ongoing funding to hire additional full-time long-term-care staff and raise the wages for all long-term-care workers, as the government of Quebec has recently instituted.

  4. The Province must establish an emergency rapid response task force comprised of trained infection-control health-care workers available to act immediately as emergencies are identified.

  5. The Province and Federal government must appoint independent federal and provincial ombudsman, respectively, with a national regulatory authority attached to Health Canada, to review all complaints and investigations and to oversee strict new long-term-care standards related to ensuring humane care and residents’ rights, staffing and pay levels, building designs and usage of funds.

I should close by speaking to the very shocking projections we heard from the Province on Tuesday and the lockdown measures advised. I share in the confusion and frustration that have been expressed by many, including the front page commentary by Bruce Arthur.

In times of crisis such as this, governments must step up to provide clear, consistent, and common-sense rules to address the situation. This must come with a coherent rationale for the rules and a system of enforcement that will be effective. Unfortunately, we have seen none of this from the Province thus far in the second wave of COVID-19.

In order to see results, we need clear benchmarks, clear direction on what activities are essential, and a stricter lockdown to save lives. This must also be paired with supports like paid sick leave, a moratorium on evictions, direct supports to businesses and residents, and greater testing and contract tracing. These are all responses that have been described as essential by the Province's own public health experts, but have yet to be enacted by the Provincial government.

In the absence of all this, we must follow the advice that Dr. de Villa and Mayor Tory have been giving for the last few months: stay home whenever possible. Only go out for food, exercise, or other essential trips, using your best judgement whenever possible.

We are returning to the conditions of March through May. Back then we learned how to grocery shop online, wait in line to enter the drug store, leave family members behind and send in one household member to keep stores less crowded. We checked on one another by phone and by zoom. To support those who lost employment, we donated to food banks and local not-for-profit community agencies.

We have to do all of this again but the novelty of it has entirely worn off. I know it will all be harder than when we began last year. We hope you will remember that while my team and I can’t visit you in person, we are here for you and we are still working every day to support the community. Please know that you can call us about anything. If we are not directly responsible, we still want to know what is causing you concern and we’ll quickly direct your concerns to the right place.

Remember what we said last March: We Are All In This Together.


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