Ontario’s nursing home residents remain vulnerable to future pandemics, outbreaks, AG report warns
Vaccines have rescued of Ontario's nursing homes from the ravages of COVID-19 for now but residents remain vulnerable to future pandemics and outbreaks because of poor infection prevention, crowding, inadequate staffing and inspections.
That's the bottom line in a new report from auditor general Bonnie Lysyk which contains no surprises," she acknowledged Wednesday.
Lysyk pointed to repeated warnings from her office and advocates for the elderly that successive provincial governments have let vulnerable residents down by leaving the long-term sector ill-equipped" for emergencies.
With the arrival of vaccines, the number of COVID-19 outbreaks and deaths have been significantly reduced in the long-term care homes, but the long-standing systemic issues that place residents at risk remain to be addressed," Lysyk wrote.
Neither the Ministry of Long-Term Care nor the province's 626 nursing homes were sufficiently positioned, prepared or equipped to respond to the issues created by the pandemic in an effective and expedient way," she found.
More than 3,900 residents have died from COVID-19.
The auditor's 107-page report makes 16 recommendations to Premier Doug Ford's government, including more speedy renovations to eliminate three- and four- bedrooms where COVID-19 spread so quickly.
Nursing homes should also be required to have pandemic plans and conduct annual exercises before the influenza season to simulate infectious disease outbreaks and responses so staff are better prepared.
Mistakes made in the early days included moving elderly, non-acute patients in hospitals to nursing homes at higher-than-usual rates, putting them in harm's way.
Some of these measures... had unintended consquences on long-term care home residents and staff by further contributing to crowding and staffing shortages," said Lysyk, noting some facilities were already struggling to contain the spread of COVID-19."
As well, she cited unclear messages" from the government and chief medical officer Dr. David Williams, including a directive that nursing homes try to prevent residents from leaving the premises but that was open to interpretation at each location.
There were devastating and deadly outbreaks that prompted Ford to call in military medical teams a year ago to help some of the hardest-hit homes where staff levels fell to 20 per cent, making it impossible to provide adequate care and lead to horrific conditions later detailed in a Canadian Armed Forces report.
Restrictions on visitors such as family members to nursing homes - imposed by Williams to stop people from bringing the virus in - consequently eliminated a valuable source of resident care providers," the report said.
On the larger rooms, Lysyk said goverment licences for 26,500 beds in 40 per cent of Ontario's 626 nursing homes expire in four years.
However, the ministry (of Long-Term Care) could not tell us how many of these beds will need to be renovated to comply with current ministry bedroom standards that limit the number of residents sharing a room to two."
Those standards were first established in 1999.
Two-thirds of homes with severe outbreaks had older bedroom designs, and 15 of 16 nursing homes that saw more than half their residents infected were operated by for-profit operators with older bedroom designs, Lysysk said.
Taking further aim at the for-profit sector, she said such operators had 53 per cent of beds but had 70 per cent of deaths in the first wave that ended in August. In contrast, just 15 per cent of non-profit operators and municipal nursing homes have mostly older bedroom designs.
The goverment has already taken a number of actions to improve the situation in nursing homes, such as committing to four hours of daily hands-on care for residents and the hiring of thousands more nurses, personal support workers and other staff by 2025, and is fast-tracking four new nursing homes in the GTA using modular construction techniques.
Another shortcoming identified in Lysyk's report - that nursing homes have not had proper links for assistance with nearby hospitals - has also been addressed, with many hospitals taking over management of some homes and sending doctors and other staff to help.
Another report on the impact of COVID-19 in nursing homes is expected Friday from the Long-Term Care Commission appointed by Ford last July. It has already made a number of interim recommendations, such as the four-hour care standard.
Ontario Ombudsman Paul Dube continues work on an investigation his office has been conducting into the impact of COVID-19 in nursing homes.
Rob Ferguson is a Toronto-based reporter covering Ontario politics for the Star. Follow him on Twitter: @robferguson1