Commission flags poor oversight of nursing homes
Effective inspections and management are crucial in the battle to stop the grim march of COVID-19 infections and deaths in Ontario's long-term care homes, a commission delving into the situation reported on Friday.
The interim report, which comes amid surging cases, notes 100 homes have seen an outbreak in the last six weeks, with 300 more deaths.
“Questions and concerns have been raised about the effectiveness of the province's oversight and inspections system,” the report states. “Several issues have surfaced that the commission believes require urgent attention.”
On Friday, the province reported 1,780 new COVID-19 cases, a slight decline from a day earlier. However, the number of deaths almost doubled to 25 from the 14 reported on Thursday.
The spread of the virus has “hit a critical point,” said Health Minister Christine Elliott, who urged people to wear masks and remain physically distant.
Rising cases prompted the province on Friday to tighten restrictions in three more areas starting Monday.
Moving into the “orange” zone are the Middlesex-london and Thunder Bay areas, while the Haliburton, Kawartha, Pine Ridge District Health Unit moves to “yellow.”
The change to orange includes restrictions on visitors to longterm care homes and beefed up testing in the facilities.
“Over the last seven days, we have seen the trends in key public health indicators continue to go in the wrong direction in these three regions,” Elliott said.
Elliott had no immediate comment on the interim report from the long-term care commission.
Among issues the commission flagged was a provincial decision in the fall of 2018 to end comprehensive inspections implemented in 2013, and a lack of enforcement when issues are uncovered.
Only 27 homes were inspected last year, far fewer than in previous years, the report states. Inspectors looked at only 11 of the province's 670 nursing homes proactively from March 1 after the pandemic hit to Oct. 15.
The result, the commission said, are wide gaps in what the government knows about infection prevention and control in the homes, as well as their emergency preparedness.
The commission recommends resumption of annual resident quality inspections in all homes and more intensive follow-ups on complaints.
Enforcement of compliance orders issued when problems were identified was another area of concern, the report says. Part of the problem is a reliance on voluntary compliance by nursing homes, without mandatory verification they have actually complied with orders.
Inspectors issue mandatory orders only in “extreme circumstances,” the report says, noting only 21 were handed out between January 2019 and August 2020.
Fines or prosecutions are “rarely applied,” resulting in a “lack of urgency” from home operators to address violations.
In addition, management of long-term care homes has been at best uneven, the commission concludes.
“We heard that homes where leaders were visible and provided clarity around staff roles and responsibilities fared better than those where leadership was less engaged,” the report states.
Also Friday, the province appointed nine people to its new COVID-19 vaccine panel, headed by retired chief of national defence staff Gen. Rick Hillier. The panel will oversee distribution of the vaccine when one eventually becomes available.
Among its members are Dr. Dirk Huyer, chief coroner of Ontario, Toronto's former police chief Mark Saunders, and Linda Hasenfratz, head of car parts giant Linamar. Also appointed were Dr. Homer Tien, a trauma surgeon, bioethicist Maxwell Smith, and infectious diseases specialist Dr. Isaac Bogoch.
Several issues have surfaced that the commission believes require urgent attention.