The challenging path to improving long-term care in Ontario

Everyone is saddened by the tragedy of death in long-term-care (LTC) homes during the pandemic and some have offered to help blow up the system and start over. As a former long-term-care administrator, I have read many of the articles published and offer my own road map to improvement.

1. Every resident in a private room is key to infection prevention and control. No more multi-person rooms (most have two residents but some older homes have more). Those larger rooms can be made singles for the current private-rate paying residents or become new activity rooms allowing more social distancing. The former private rooms, become the domain of the former basic or semiprivate paying residents. Each person now has their own room and private washroom.

The downside is the homes occupancy has now been reduced by 20 per cent. A home of 128 residents with 76 private paying and 52 basic paying residents now only cares for 102 residents but all are in private rooms. The home now loses revenue from 26 residents; $22,700 per year. Implemented in 651 LTC homes in Ontario the cost would exceed $35 million. But what do we do with the 26 displaced residents? Obviously you can’t turf them out so homes would gradually phase out the use of multi-person rooms and as rooms were vacated, start the new regime.

The province has already acknowledged the need for more LTC beds so ramp that process up to include this improvement also. A bigger but better system has to be a government priority.

2. Fully implement the Resident Quality Inspection Program. This comprehensive ministry process is already in place but there are not enough inspectors to carry out annual inspections. This process would have identified many of the deficiencies recently reported by the Canadian military. The number of inspectors likely needs to be doubled.

3. The planned government inquiry into the LTC industry needs to solidly address the issue of quality in all homes. The highest standards possible need to be the hallmark of Ontario homes, regardless of owner.

4. There should be a higher standard for the number of hours of care each resident is entitled to and homes should be funded to that level.

5. All LTC homes should be required to maximize the use of full-time staff with part-time positions being minimized to reduce the transmission of infection. Some homes have 30 per cent or more part-timers on staff who work for multiple employers to make a living wage. Improve the working conditions of employees by making them full-time with all the attendant benefits.

6. Better pay for the essential workers we call PSWs. Why are they paid lower than hospital workers and more in municipal homes and less in for-profit homes? LTC homes should want to retain their good workers and one way to do this is to match the best wages going.

7. Better infection control practices at the entrance of every home. Only during the pandemic have homes had staff screening those entering. How about at least detailed sign-in procedures, automatic temperature screening and video recording of all who enter?

8. LTC best practices must balance both infection control and resident quality of life issues. Taking away family visits, restricting recreation and removing caring volunteers are drastic measures that impact the mental health of residents.

So how badly does the Ontario government want an improved LTC system? Many improvements are possible, but a lot of thought and even more funding is required.