Updated: Mar 29
Policy Brief by Alicia Gibson
The Problem with Ontario's Long-Term Care Homes
Throughout the COVID-19 crisis, one of the biggest enlightenments has been the lack of
quality care, patient neglect, and frequency of human rights violations that occur throughout
Ontario’s long-term care facilities. An investigation into these issues was conducted by the
Canadian military’s Augmented Civilian Care (ACC) team on April 24, 2020, in which a formal report was submitted to the province, as well as the ministers of Health and Long-Term Care. The report stated a complete remodeling of the province’s Long-Term Care Homes Act (LTCHA) was necessary in order for the provincial government to be able to ensure the proper level of care, treatment, and operations within privately-run health facilities in Ontario.
The report conducted by the ACC illustrated the horrendous picture of what residents had been experiencing prior to, and subsequently made worse by, the pandemic. Common themes in the report include a lack of infection control, a lack of access to necessary finances, neglect of psychosocial support for residents, instances of physical and verbal abuse of patients, and a large disconnect between staff and the patients and their families regarding the patient’s condition, levels of pain, etc. .
The CBC recently wrote an article investigating long-term care facilities that discusses these very issues. Carolynn Snow, a long-term care resident, depicts personal service workers (PSWs) as well as non-medically trained staff working 14 to 16 hour days . She argues that the exhaustion of staff, the lack of knowledge on how to adequately care for patients during a public health crisis, and the lack of funding to achieve these ends are having grave consequences for patients. Snow explains that the situation is extremely “demoralizing for both staff, and the residents” .
The issue, then, in terms of Ontario’s private health care policy is that it has failed to consider the impacts of a public health crisis on private health care facilities. These policies impact the private sector’s ability to deliver a high-quality standard of care through limiting the financial contributions from the government. This financial constraint forces PSWs and non-medically trained staff to perform the type of care that requires the expertise of Registered Nurses (RNs) and Medical Doctors (MDs), highlighting the lack of qualifications needed for operating as a ‘legitimate’ private care facility. What the ACC report demonstrates is that these gaps need to be addressed by policy amendments to ensure a standard of care through regulatory means, especially during a public health crisis such as COVID-19.
Private Healthcare Policy in Ontario
The province utilizes a dual healthcare system for the purpose of releasing the financial and labour-intense demands of the public sector (i.e. hospitals) while also offering a more intimate, personally tailored social-setting for long-term patients such as privately operated homes. Prior to the recent amendments to this policy, the private and public health sector did differ in terms of financial resources, patient accessibility, and staff licensing and qualifications . However, the policies did not appear to differ on matters of quality and standard of care. The effects of the pandemic have not only highlighted many flaws within Ontario’s healthcare policies, but they have amplified the major discrepancies between the levels of care that are received within the public and private health care sectors as a whole.
The LTCHA promises that, through the collaboration of long-term care providers, caregivers, volunteers, and the government, patients and their families are guaranteed a high-quality level of care. As well, there must be a certain level of “accountability and transparency to demonstrate that long-term care homes are governed and operated in a way that reflects the interests of the public” .
However, as the ACC report points out, the current policy contains loopholes and grey areas that, in the wake of COVID-19, have played out negatively for the residents as well as the staff of long-term care facilities. For example, The LTCHA permits prolonged isolation and containment of residents, outlines that facility funding is on the burden of patients, and permits private facilities to continue operating without any requirement to be re-evaluated by the government to ensure adequate operations and levels of care .
The impacts of this policy have been felt most greatly in long-term care facilities that were previously facing financial disparity, had little to no collaboration with RNs, MDs, or public health resources, and had existing issues of understaffing. In Ontario, approximately 70% of COVID-19 related deaths have been residents of long-term care homes, and roughly 10% of all cases across Canada have been long-term care facility staff . Ontario, alongside Quebec and Alberta, have experienced the highest number of COVID-19 related health issues, deaths, and concerns pertaining to the virus within long-term care facilities.
Ontario’s Resolution for A Healthier and Safer Future
On May 12, 2020, the government of Ontario made amendments to the LTCHA in response to the demands of long-term care facilities in the wake of COVID-19. The new policy addresses the issues outlined in the ACC report, with a focus on a new standard for high-quality care. These amendments protect the resident’s right to restorative care services such as mental health resources, recreational activities, and social service consultation. The bill now outlines a more pristine list of requirements for becoming certified as a long-term care facility in the province, as well as higher qualifications for staff, including a necessary retraining component . Improvements to reporting are now following a zero-tolerance mandate, which requires mandatory evaluations of conditions and/or incidents with the option of police involvement. As well, the policy now includes incentives for high-performing private homes, which allow private facilities to accumulate government funding based on continuous quality improvement .
Although the province has responded with policy changes to better manage COVID-19, the new standard of care will benefit patients beyond the scope of the pandemic. The accountability to accumulate the necessary financial and professional resources is much greater. In addition, the new policy forces long-term care facilities to be a space that recognizes the humanity, as well as the social and mental health needs, of its residents through regulated accountability . The inconsistency caused by the province’s dual health care system can now begin to be reconciled as the private health care sector is encouraged, as well as enabled, to perform at the same standard as the public health sector.
Canada. Observations in Long Term Care Facilities in Ontario. Toronto: Joint Task Force 4th Canadian Division, 2020
Kirsten Fenn, ‘I’m Deathly Afraid’: Long-term Care Residents Fear Emotional Neglect, Understaffing as 2nd Wave Looms (Toronto: CBC Radio: The Current, 2020)
Long-Term Care Homes Act, 2007, S.O. 2007, c. 8
Pandemic Experience in the Long-Term Care Sector: How Does Canada Compare With Other Countries?. Ottawa: Canadian Institute for Health Information, 2020
Long-Term Care Homes Act, 2007, S.O. 2007, c. 8