Province looking at toughening long-term care enforcement as part of revamp

The Ontario government is considering adding former police or security officers to its inspection teams and toughening enforcement as part of its plan to improve accountability in long-term care, according to sources.

The province has signalled it will bring in legislative and other changes this fall to answer recommendations and calls to improve Ontario’s beleaguered long-term care system.

More than 4,000 long-term care residents died and thousands more became ill and struggled during the pandemic, prompting calls for change. Infection and death rates among Ontario long-term care residents, especially during the first and second waves of the pandemic, were among the highest among wealthy countries.

Former finance minister Rod Phillips, who took over the long-term care portfolio in June from former minister Dr. Merrilee Fullerton, has spent the summer learning about issues and recommendations for improving the system, including meeting with long-term care commissioners and others.

Among other things, Phillips has — unannounced — accompanied some inspectors going into long-term care homes. He has said the province and operators need to work to restore public confidence in the system.

Vanessa De Matteis, spokesperson for the minister of long-term care, said “nothing is off the table” when it comes to making changes to improve long-term care.

The lack of real accountability for long-term care operators has been a focus of critics, advocates and the province’s long-term care commission during the pandemic and earlier.

Ontario already has the legislative tools to take action against homes that don’t comply with the rules, according to the long-term care commission report. It just rarely uses them.

“The evidence before the Commission is that fines or prosecution penalties for failure to comply with orders under the Long-Term Care Homes Act, 2007, are rarely applied as a form of corrective action, which may explain the lack of urgency demonstrated by long-term care operators to achieve compliance,” wrote the commission. It added that limited inspections mean non-compliance is less likely to be discovered.

“It is evident from this approach taken by the Ministry that licensees have little reason to fear repercussions for non-compliance. It is unlikely that non-compliance will be discovered since inspections are limited. Further, when non-compliance is discovered and an inspector takes action, there is generally no follow-up to determine if the home has achieved compliance. In the rare event that an order is issued, there are few, if any, consequences for breaching the Act or its regulation.”

The licensees have little to fear, the long-term care commissioners wrote, because the province is unlikely to shut them down “due to the dire lack of beds and the growing demand for long-term care in the province.”

The commission also called for more proactive inspections, with a focus on infection prevention and control, rather than simply inspections based on complaints. Proactive inspections have been reduced dramatically in recent years.

Dr. Samir Sinha, director of geriatrics at Sinai Health in Toronto, said enforcement is key as is working with homes to help them reach standards.

“Regulations and standards are useless and meaningless if they are not upheld on behalf of the close to 100,000 older Ontarians who rely on long-term care services each year.”

Ninety per cent of residents have some form of cognitive impairment and at least two-thirds are living with dementia, he said, “which makes them incredibly vulnerable and it is hard for them to advocate on their own behalf.”

Relying on families and staff to blow the whistle or highlight problems is also unfair. Reports by military who went into some of the province’s hardest hit long-term care homes described a culture of fear in those settings, he added.

Grace Welch, with the Champlain Region Family Council Network’s advocacy committee, said there need to be consequences for repeated non-compliance by long-term care operators.

“We used to see all these inspection reports and never see any action taken. Some of the really bad offenders had terrible outbreaks and have been awarded licences to expand.”

Outbreaks in long-term care dropped dramatically in Ontario once residents were vaccinated. Long-term care and retirement home residents, among the most vulnerable in the province, were also among the first to be vaccinated. Now most are receiving a third dose of COVID-19 vaccine.

In recent weeks, the number of long-term care outbreaks has begun to slowly increase. As of Monday, 17 homes across the province had COVID-19 outbreaks, including two in Ottawa. At one of those, in Residence Saint-Louis, six residents and two staff members have tested positive, according to Ottawa Public Health.