Soo....
The Auditor General's Office released a report this week on LTCs and Covid in Ontario.
Its frankly, unsurprisingly, damning in so many ways.
While the management response, particularly early on, was bungled by the current government.........
The report does correctly point out that the Liberals let a lot of problems fester over 15 years; including building next to no new long term care capacity; and failing to see proper standards around quality of life and infection control implemented in a timely way (notably capping residents to 2 per room; which has been the approved Ministry Standard since 1999) .
The standard is not an arbitrary one, as LTCs that had no more than 2 residents in any room had far fewer outbreaks and deaths during Covid.
The AG previously reported on the need for this and the slow pace of change in 2009. Not much was done.
At any rate, before I get into more detail; the report link:
So we'll kick off the charts and quotes by looking further into the above 2-person per room maximum standard.
"The Ministry released its new resi-dency standards in 1999 in its Long-Term Care Design Manual. However, home operators were not required to renovate an existing home until its licence expired. As such, Ontario currently has many long-term-care homes that are operating under older design standards."
"The Ministry could not tell us how many of these beds will need to be renovated to meet the new design standards that limit room occupancy to two residents"
Excuse me? That is something that the Ministry is not entitled to be ignorant of!
It gets better:
"The Ministry and the LHINs, who are responsible for placing residents in long-term-care homes, did not know how many residents were actually housed in three- or four-bed wards when the pandemic hit the long-term-care sector in March 2020"
"We also noted in our analysis that 15 of the 16 homes where over half of the home’s residents contracted COVID-19 in the period we reviewed (March 19 to August 31, 2020) were for-profit homes that had primarily older bedroom designs. "
"For-profit homes housed 53% of the beds in the province (Figure 3), but accounted for 70% of the resident deaths from March 19 to August 31, 2020. More than half of for-profit long-term-care homes in Ontario have primarily older bedroom designs. In comparison, about 15% of non-profit and muni-cipal homes have primarily older bedroom designs."
That's one hell of a correlation!
Get a load of this comparison between Ontario and BC:
"According to a September 2020 article in the Canadian Medical Association Journal, 63% of Ontario long-term-care home residents were in a shared room with one to three other residents prior to the COVID-19 pandemic. In comparison, only 24% of long-term-care home residents in British Columbia were in a shared room before COVID-19. The article indicated that, as of September 10, 2020, British Columbia had a resident infection rate of 1.7% compared with Ontario’s rate of 7.6%."
Also
"A study published in the Journal of the Amer-ican Medical Association in November 2020 found that residents in Ontario long-term-care homes that were “highly crowded,” where the majority of residents are housed in shared bedrooms and wash-rooms were more than twice as likely to develop infection and die from COVID-19 than residents in homes with mainly single-occupancy rooms. The study was conducted on 618 homes where a total of 5,218 residents developed COVID-19 infections and 1,452 died of COVID-19 from March 29 to May 20, 2020."
**
Another reason BC did better:
**
This is big............The Liberals get credit for passing the legislation below, but they chose not to proclaim it either.......so they and the current government wear the result.
In 2018, the province passed amendments to the Long-Term Care Homes Act, 2007 and Regulation 79/10 to allow fines and penalties. However, at the time of our 2020 continuous follow-up, the amendments had not yet been proclaimed. The Ministry told us during our 2020 continuous follow-up work that it had decided to not implement any fines or penalties; instead, it will be taking a “supportive” rather than a punitive approach to overseeing homes. We have significant concerns about this decision: • The Ministry could not explain what its supportive approach entailed or how it intends to implement it.
Of note here is that non-compliance with standards is a big issue in the LTC sector.
**
Now lets talk about how the lack of full-time staff created a good deal of the risk experienced during the pandemic.
Part-time staff often work full-time hours in 2 or more facilities, as opposed to working full-time hours in 1 facility which reduces the risk of contagion.
For those working part-time hours it also typically means lower levels of training and experience.
Some part-time staff will always be part of any employment model, but I would like to see us at or above 80% FT in this sector.
*****
I'll leave it at that for now, but I encourage anyone w/interest in fixing these issues to follow the link and read the entire report.
Its a litany of issues that the Ontario government and the Ministry of Long Term Care knew about long before Covid, and under successive parties made far too little effort, if any, to resolve.
www.macleans.ca
