No Hamilton long-term-care home has had a comprehensive inspection in years
It has been 814 days since the provincial government last conducted a full comprehensive inspection of any long-term-care home in Hamilton.
None of the city's 27 long-term-care (LTC) homes had a so-called Resident Quality Inspection in 2019, 2020 or so far in 2021. Seven of Hamilton's LTC homes have not had a full comprehensive inspection since 2017.
Resident Quality Inspections are thorough unannounced two-stage investigations of long-term-care homes that look at all aspects of the operation, including emergency preparedness and infection prevention and control.
During an RQI, inspectors conduct confidential interviews with a minimum of 20 residents and up to a maximum of 40 residents selected at random from a provincial database, along with interviews of family members and direct observations of how care is delivered in the home.
The last RQI inspection, ironically, of a Hamilton home concluded Nov. 19, 2018 at Grace Villa on the east Mountain.
The home was the site of a widespread COVID outbreak this winter that infected more than 140 residents and left 44 dead. There was an uproar when it was discovered a complaint-based inspection of Grace Villa - not an RQI - occurred in mid-December and no violations were found, despite the home being in the midst of a terrible outbreak.
Last month, heartbreaking letters from Grace Villa workers were published that described the frightening conditions inside the home during the outbreak.
The mid-December inspection was a complaint-based inspection, designed to look into the specific issues surrounding a complaint about the home.
After the 2018 election, the Ford government shifted away from RQIs to complaint-based inspections following a recommendation by Ontario's Auditor General," according to a statement from the Ministry of Long-Term Care, to help clear a backlog of complaints that had grown to 3,000.
But I don't think the Auditor General ever said You should stop doing RQIs,'" said Dr. Samir Sinha, director of health policy research at the National Institute on Ageing at Ryerson University. I don't think this government ever said We will stop doing RQIs.'"
Sinha, who has previously published a review of long-term care in Canada, called complaint-based inspections largely toothless," largely ineffectual," and definitely not" as comprehensive as an RQI.
It's a black hole," Sinha said about the disappearance of RQIs. You have very little insight in terms of what's happened (at a home). It's almost as if we were setting up homes in Hamilton to potentially fail and fail hard.
If the ministry is saying they have been actively moving away from the RQIs toward this complaints-driven process, hopefully they now realize that's not appropriate," said Sinha. I think it really is questioning our ability to ensure that homes truly are complying with the regulations we have in place to protect the most vulnerable Ontarians."
According to a report sent to the long-term care minister in December by the Ontario Long-Term Care COVID-19 Commission, there were only 27 RQIs carried out in 2019 among the province's 626 homes.
This reduction in RQIs which are intended to provide a holistic review of operations in the homes left the ministry with an incomplete picture of the state of infection prevention and control and emergency preparedness," the commission stated.
The commission is asking the government to resume RQIs and hire enough inspectors so that each home in Ontario has an RQI at least once a year.
A ministry spokesperson said all LTC homes in Ontario are inspected at least once a year and the ministry can now respond faster to urgent concerns" with the complaint-based model.
We can prioritize homes based on risk, so that homes with complaints, critical incidents, or a history of noncompliance and other risk factors are subject to extended inspections," said a statement by Mark Nesbitt of the long-term care ministry.
Nesbitt said there were nearly 2,150 inspections carried out across the province in 2020.
Nesbitt also said inspectors investigating a complaint can look into and report other infractions separate from the original complaint that come to light during an inspection of a home.
Natalie Mehra, head of the Ontario Health Coalition, said she's deeply, deeply concerned" that annual comprehensive inspections of LTC homes has essentially vanished in Ontario.
The residents in these homes are vulnerable, they don't have a voice, they don't have a way to advocate for themselves," said Mehra.
They're closed in behind the four walls of the homes," she said. They need people to go in and be their eyes and their ears.
The history of long-term-care in Ontario shows that when the annual inspections are cancelled, within a few years we start to see absolute horror stories about what's going on in the homes."
Mehra also said complaint-based inspections are nowhere near as comprehensive as an RQI.
For anyone to pretend that those two are equivalent is to deliberately mislead people into thinking a complaint-based inspection is more than it is," said Mehra.
Complaint-based inspections are not full home inspections," she said. They're not even close.
I think it's disingenuous of the minister or her spokespeople to mischaracterize them as though they're equivalent or even close to equivalent."
Sinha said the lack of comprehensive inspections in 2019 may have heightened the problems that developed in the province's long-term-care homes last year when the pandemic swept through.
What's deeply concerning is there is no assurance we were making sure in an unannounced way that homes truly were prepared for an emergency or infection prevention and control measures," said Sinha.
That sort of information would help us understand very quickly in 2020 which are the homes that were struggling as little as a year ago," he said.
That way, you could very quickly figure out where you need to put additional support and resources at the start of the pandemic."
A Spectator investigation published last week showed 71 per cent of COVID cases involving LTC residents in Hamilton and 75 per cent of COVID deaths occurred in just four homes.
Sixteen of the city's 27 LTC homes had reported no deaths as of Jan. 21.
Steve Buist is a Hamilton-based investigative reporter at The Spectator. Reach him via email: sbuist@thespec.com