Understanding the tragedy in long-term care

In the last years of their lives, my parents both developed disabilities that resulted in them moving into Revera’s Leaside Retirement Residence. The Revera staff cared for them compassionately, and eventually helped our family to cope with their passing. We deeply appreciated the personal commitment that Revera caregivers showed for our parents.

When the CEO of Revera (not knowing about my folks) asked me to help Revera review their experience with COVID-19, it seemed appropriate payback for my parents’ care to chair an expert panel that would examine the company’s response to the virus. My conditions were that I would not receive any form of compensation or reimbursement for this work, and would have final editorial control of the panel’s report.

This panel worked hard examining reams of information provided by Revera, including a statistical analysis of outbreaks in Revera long-term-care (LTC) homes developed by independent data analysts. The panel report will be published in the near future. However, Ontarians need to know that there were two major factors that contributed to the outbreak and spread of the virus in Revera’s LTC homes.

Ninety-seven per cent of Revera LTC residents’ infections during COVID’s first wave can be traced back to outbreaks that occurred prior to April 20. Since family caregiver visits to LTC homes had been suspended in March, there is little question that these infections were unknowingly brought into LTC by well-meaning, asymptomatic staff who often lived in communities with a high prevalence of infection.

It was not until May that our public health officials introduced mandatory bi-weekly COVID-19 testing for asymptomatic LTC staff. This policy dramatically reduced deaths in Ontario’s LTC homes: from 80 a day at its peak, to single digits by June.

The second factor contributing to the spread of infection within LTC homes was the presence of multi-residential rooms, where up to four residents were literally sharing infected air. The studies that link COVID LTC deaths to private ownership of homes by companies like Revera often fail to mention that these companies operate virtually all the homes in Ontario with multi-residential rooms. Of Ontario’s 80,000 LTC residents, the 28,000 people living in homes with these multi-residential rooms were at tremendous risk for the virus spreading between them.

Why had the private companies like Revera not redeveloped these buildings to eliminate multi-residential rooms in homes originally built in the 1970s? Prior to SARS-CoV-2 arriving in Ontario, Revera had made application to the Ontario government to redevelop the majority of these older homes. I accept part of the blame for the delay in redeveloping these multi-resident room homes, since the ministry that I served for four years failed to approve most of the applications for redevelopment, as had the current government prior to COVID-19.

The accusation that infections were caused by privately owned home operators reducing staffing to maximize profits is false. This claim is made by individuals who must not understand how care is funded in Ontario’s LTC homes. The personal support workers (PSWs) who provide most of the care in LTC homes are generally unionized, and hourly wages are similar in privately owned and non-profit homes.

The operators of LTC homes cannot profit from “skimping” on staffing, since their revenues from the province are entirely dependent on how much they pay out to their care providers.

The death of more than 7,000 Canadians in LTC homes is tragic. However, if we are to pay appropriate tribute to those whose lives were cut short by COVID-19, it is essential that we determine the true causes of this tragedy to avoid it happening again.

The problem is not the ownership model of LTC homes. The major oversights that led to this tragedy were a failure to proactively test asymptomatic LTC workers and a failure of successive governments to approve redevelopment in homes with multi-residential rooms. Blaming other causes is specious and does not honour the memories of the Ontarians whose lives have been lost to this terrible pandemic.