Too Little, Too Late

Report slams Ontario for failing to safeguard long-term care residents from COVID-19

ONTARIO’S LONG-TERM CARE MINISTER DR. MERRILEE FULLERTON REFUSED TO APOLOGIZE AND BLAMED PREVIOUS GOVERNMENTS FOR “MANY YEARS OF NEGLECT”

CANADA HAS ONE OF THE WORST records in the world for protecting long-term care residents from COVID-19, and the outrageous story behind this record is laid out in jaw-dropping detail in Ontario’s Long-Term Care COVID-19 Commission Final Report, released on April 30, after testimony from more than 700 witnesses.

The sorry chronicle is a must-read for anyone who wants to honour the memory of 4,430 long-term care residents (more than 50 per cent of Ontario’s death toll of 8,000) who lost their lives in the pandemic. Its appalling findings – and those of Ontario’s Auditor General, which came out two days before – raise questions about why no one has been held accountable for the dereliction of duty.

In the scathing 322-page report, the commission said Ontario government officials downplayed the risks and failed to protect long-term care (LTC) homes as COVID-19 spread around the world. Even as the seniors’ residences became the epicentre of COVID-19 outbreaks, the provincial government dragged its feet on simple actions that could have saved lives – such as requiring masks in homes – and made problems worse with confusing, contradictory and poorly planned responses that exacerbated the carnage.

“If they had [acted sooner], the human and financial costs of the COVID-19 pandemic would have been significantly reduced,” the commission said, making 85 recommendations to improve the response to future outbreaks, overhaul longterm care to put residents first and improve access to home care. Appointed by Premier Doug Ford’s Conservative government in July 2020 to investigate the virus’s rapid spread in long-term care homes and how to prevent future disease outbreaks, the commission also recommended the ministry of long-term care should follow up by tabling a report in the legislature in April 2022 and 2024 “describing for the benefit of the stakeholders and the public the extent to which it has implemented this commission’s recommendations.”

At a news conference responding to the report on May 3, Ontario Long-Term Care Minster Dr. Merrilee Fullerton refused to apologize, blamed previous governments for “many years of neglect,” and abruptly left the room shortly after a reporter asked if she regretted saying last fall that the number of long-term care deaths in the first wave was comparable to “a bad flu year.”

After the first confirmed Canadian case was reported in Ontario on Jan. 25, 2020, the commission detailed how the Ontario Nurses’ Association and Ontario LongTerm Care Association (which represents residence owners) expressed worries to the health ministry. It has long been known, from earlier long-term care inquiries and reports, that residents would be sitting ducks in a pandemic, since they were housed in three- and fourbed wards and shared bathrooms with as many as eight other people, which made infection control virtually impossible. Long-term care homes lacked everything from personal protective equipment (PPE) to infection-control training, pandemic preparedness plans, provincial inspections and enough staff. The health ministry didn’t take any action in response to the worries.

When Chinese and Australian health officials disclosed in late January that asymptomatic people could unknowingly spread the virus, Ontario’s health ministry warned hospitals – but not longterm care homes. A Feb. 12, 2020 briefing note to Health Minister Christine Elliott underlines the thinking at the time. “The risk to LTC homes is low,” it noted.

The response was no better from Fullerton, who a nurses’ union leader testified was “unprepared” and “didn’t have responses to our questions” when asked about the risk to long-term care at a meeting in February 2020.

By early March 2020, the virus was devastating seniors’ homes in Europe, Washington state and B.C. In Ontario, Dr. Monir Taha of Ottawa Public Health emailed the health ministry March 3 to ask if longterm care homes should start routine COVID-19 testing. He was told there were no plans to do so.

On March 18, Taha wrote Dr. David Williams, Ontario’s Chief Medical Officer of Health, to urge the adoption of full-time masking in long-term care, but Williams didn’t mandate this in seniors’ homes until April 8, a lag the long-term care commission described as “a critical time, during which COVID-19 escalated and many homes began to experience outbreaks.”

Instead of helping homes, the health and long-term care ministries ordered hospitals to discharge chronically ill elderly patients to make room for an anticipated crush of COVID-19 cases. About 2,200 patients were sent back to the homes even after outbreaks had started. This made isolating COVID-positive residents even more difficult and increased the workload for beleaguered staff, up to 80 per cent of whom were off sick or refused to work for fear of catching the virus in some homes. The homes were also told not to send residents to hospitals.

As hospitals were getting the province’s limited stockpile of PPE, long-term care homes were asking volunteers to make cloth masks, and some personal support workers were advised to wear garbage bags over their clothes and make face shields out of clear plastic pop bottles. “They are for hospital workers, not for us,” a manager told staff in one home begging for masks.

Williams didn’t issue his first directive to long-term care homes until March 22. “It would be the subject of numerous and at times confusing amendments over the course of the pandemic,” the long-term care commission said. Amazingly, it didn’t require staff to take any PPE precautions when dealing with suspected or confirmed COVID-19 cases. Williams left it up to the province’s 34 local health authorities to figure out their own COVID-19 measures. “There was absolutely no plan for infection control when this hit,” one long-term care worker told the commission. “[It] blew me away.”

The province didn’t bar long-term care staff from working at more than one facility until April 22, nearly a month after B.C. had done the same; many of the low-paid, mostly part-time workers had jobs at multiple residences to make ends meet. The ban “came far too late, for far too many,” the commission said, noting most of the 1,815 long-term care residents who died in the first wave were infected before April 22.

It wasn’t until mid-May, a month after the province called the Canadian military to support homes overwhelmed by outbreaks (in one, 26 residents died of dehydration, due to lack of staff), that the long-term care ministry got cabinet approval to appoint hospitals as temporary managers to oversee them. Even Elliott was frustrated by the time it took the long-term care ministry to step in and seize control at homes that, as the health minister said in an internal note, had “little or no management staff available” or weren’t meeting health requirements. “This delay in arriving at a suitable solution never should have occurred,” the long-term care commission noted. “Proper provincial preparation – even in January, February or March – should have revealed that such a solution might be necessary.”

Only in late May did the province offer webinars to long-term care staff on PPE use and isolating the sick from the healthy residents after more than 1,450 longterm residents had already died.

As cases declined over the summer, Ontario squandered the chance to prepare homes for the widely prognosticated second wave that hit in September. During the lull, facilities were asked to assess their preparedness, but the results weren’t shared with local health units, partner hospitals or government inspectors, even when a home was identified as problematic. The province didn’t allocate funds to hire new inspectors to oversee the homes until November 2020; one home had no inspections even with four COVID-19 outbreaks, 156 resident cases, 82 staff cases and 14 deaths.

The health ministry paired each home with a hospital to provide infection-control support, but this buddy system wasn’t put in place until November 2020. And it wasn’t until the tail end of the second wave in February 2021 that Ontario announced a plan to train up to 8,200 new personal support workers – eight months after Quebec launched a similar program. “This move came too late,” the commission noted. In the end, more longterm care residents died in the second wave – 2,066 – than in the first. Although LTC deaths have tapered off in the third wave after elders were prioritized for vaccinations, “it is premature to claim victory,” the commission wrote, noting that our aging population will be vulnerable to inevitable future pandemics. “Ontario must resolve to remember the lessons so painfully learned here.”

“THERE WAS ABSOLUTELY NO PLAN FOR INFECTION CONTROL WHEN THIS HIT,” ONE LONG-TERM CARE WORKER TOLD THE COMMISSION