A photo of Seniors living in a long-term care faciliy
Seniors living in a long-term care faciliy Credit: Province of British Columbia / Flickr Credit: Province of British Columbia / Flickr

According to Public Health Ontario, 4,517 people living in long-term care (LTC) homes have died from COVID. That number would be far greater if it included LTC residents who died from malnutrition, dehydration, lack of medical care, lack of care and negligence.

According to Natalie Mehra, Executive Director for Ontario Health Coalition (OHC), LTC has been in a staffing crisis since 2015. It got much worse during COVID because wages and working conditions dramatically declined. She says personal support workers (PSWs) voted with their feet leaving this branch of the health care sector in droves.

The Ford government has been aware of the situation for a very long time. In fact, OHC released a major report commissioned by UNIFOR before the pandemic. The report, Crisis Shortage of PSWs in Ontario’s Long-Term Care Homes, was presented to Doug Ford by UNIFOR representatives during a December 2019 meeting.

In February 2020 the Ford government agreed to bring in an expert staffing panel who produced their own report in July 2020. The panel’s report reiterated staffing conditions exposed by the OHC. However, instead of acting on recommendations the Ford government came up with their own plan.

Just 15 more minutes

Currently, municipally run facilities typically provide 3.06 hours of care per resident per day. Not-for-profit homes provide 2.86 hours per day. While private, for-profit homes provide only 2.67 hours of individual care each day.

The first incremental improvement, a 15-minute daily increase, was to be implemented by March 31, 2022. It would ensure three hours of care per day. That never happened.

The OHC just released a report that looked into the 15-minute improvement in are called, Crisis Unabated: The Failure to Improve Dangerously Low Care Levels in Ontario’s Long-Term Care Homes.

When OHC tried to get data from more than 70 LTC homes, over half refused to provide information about resident and staffing numbers. They often cited confidentiality as the reason even though the names of staff and residents did not need to be included.

Of those LTC facilities that did cooperate, many sent data that was unusable. For example, providing the number of staff on duty during a given time, but not providing the number of residents receiving care.

Mehra maintains, “This is outrageous given that the homes are funded by public money and by the residents. And, the people asking were the family councils and families of residents in the homes.”

That data should be published on a website that is available to everyone. Instead, LTC homes in Ontario can refuse to provide that data even to the residents who employ them.

So, what exactly are these LTC homes hiding? And, why is the Ford government not demanding that these statistics be made available to the public? Why is there not more transparency in an industry that has been fraught with dereliction of duty of care?

Few residents see three hours of care a day

At the end of the day, OHC did a deep dive into data for 23 LTC homes and their findings are very disturbing. Only six homes actually met the 3-hour target. Another 17 homes (75%) have care levels below the 3-hours per person per day. Over 1/3 have care levels below 2.75 hours per resident per day.

When care drops below 3 hours per person per day then residents suffer. First to go are the twice weekly baths. Next, it’s the regular brushing of teeth. Less personal time also means moving residents from place to place using wheel chairs long before they become immobile. This inevitably speeds up muscle atrophy and loss of mobility.

There’s less time to reposition bed ridden residents in an effort to prevent pressure ulcers. Less time for changing incontinence diaper, or dispensing medications, or providing water and juice for hydration.

Not one home in Ontario is anywhere close to the four hours of personal care that is actually required to meet the basic needs of LTC residents.

Both patients and staff are being let down

Rabbi Shalom Schachter spoke at a OHC press conference where the Crisis Unabated report was launched. Schachter represented the Interfaith Council and is also a member of the OHC LTC Committee.

Schachter said, “We are still experiencing the death of many from our 21st century COVID pandemic. Not just in the world, but here in Ontario because our government has failed to take the measures necessary to protect us. This is no where more evident than in the long-term care sector.”

Schachter went on to say that we as a society have let down both LTC residents as well as the frontline staff who care for them.

“Each home was required to file with the government their staffing data by February 28th of this year. We demand that the government release immediately the full reports from each home that they received. Ontarians have the right to know which homes are meeting the government targets and which ones are providing less care. These reports will also indicate which homes have higher proportion of staffing made up of full-time workers and which homes are using higher levels of casual or agency staff,” said Schachter.

Employers have an economic incentive to employ more part-time and agency staff because makes it easier to pay less total compensation per hour than full-time staff. This differential was made easier when the government repealed the provision of the Employment Standards Act which required equal pay. Without sufficient levels of frontline PSWs LTC homes will never be able to meet, let alone exceed, minimum levels of care.

Schachter points out, “The government may argue that the new law only requires a target of three hours of care per resident per day, averaged across the entire province. That approach to the governments fix is unacceptable. It condemns residents in many homes to receive less than three hours of care if other homes receive more than three hours of care.”

He demands to know why for-profit homes receiving provincial funding are able to hide their lower levels of care through a provincial average that is raised up by the higher level of care of municipal and not-for-profit homes?

And, he’s not alone. Relatives of residents are asking the same question.

For profit and non-profit care are not the same

Mary Anne Kolibash lives in Toronto. Her 86-year-old father has lived in an Extendicare facility in Sudbury since October 2021. He lives with dementia, mobility issues, and needs help with most of his hygiene and dressing.

Because of the long drive, Kolibash stays for ten to 14 days at a time visiting her father for five to eight hours each day. From day one, Kolibash was told the home was short staffed and that remains a perpetual problem.

As a result, daily hygiene and toileting routines were scaled back. This led to her father getting a genital infection. Her father’s care plan regarding walking cannot be adhered to. With so little time to care for her father, PSWs save time by using a wheel chair. This has undermined his mobility.

Kolibash says, “I’ve noticed that there is absolutely zero time for any one-on-one with the residents and I know that that’s important to the residents and it’s also important for the staff to have some kind of interaction.”

Kolibash describes staff literally running around because they are so over worked. She sees under staffing taking a physical and emotional toll on PSWs.

At least one PSW has told Kolibash that they need to look for another job because this one doesn’t pay enough. Even with years of experience, they cannot get hired full-time. “They deserve to be treated and paid much better,” says Kolibash.

Sue’s mother is in a LTC home in Southwestern Ontario. She asked that her last name be withheld for fear of retribution against her mother by management of the LTC home.

Sue’s 85-year-old mother has Alzheimer’s and has lived in a for-profit LTC home for nine years. Her mother has been sexually assaulted at least six times and physically assaulted more times than Sue can count. The attacks have come from other residents.

Sue says, “It’s all happened in her home where she should be safe and cared for. Unfortunately, the reality of the situation is that there’s not enough staff there to be able to keep her safe or to be able to provide for her basic needs adequately.”

Sue points out that before COVID staffing levels in for-profit homes was an issue and attributes this to the minimum amount of care required by law for homes to operate. So, the neglect and inhumane living conditions are in no way a symptom of the pandemic. Instead, they were exacerbated and laid bare by COVID.

COVID spread like wildfire through the memory care section where Sue’s mother lives. It spread even though the residents had received four shots and never left their home. Instead, they were infected by the people who care for them.

Sue is adamant that the nurses and PSWs are not to blame. She knows that they were forced to take short-cuts. She says staff were exhausted often working double and triple shifts.

Organizations like the Red Cross were brought in to help and management pitched in. Sue said that was the first time the place had been properly staffed.

Once the outbreak ended, things returned to ‘normal.’ Sue recommends dropping by evenings and weekends to understand just how short-staffed LTC homes really are.

Sue’s mother needs help eating each of her three daily meals. That uses up two hours and 15 minutes every day. She requires help with everything including getting up and going to bed. The three-hour minimum does not come close to meeting her mother’s needs.

Sue says, “It’s pathetic the conditions our elderly are being forced to live in. If any other population was receiving the level of care that is provided in long-term care homes, there would be an outcry. These people are paying to be cared for and forced to sit in their own waste. Sadly, many of them have no voice to be able to tell anyone. So, families need to advocate for them. I am grateful for the staff who do what they can to take care of my mother but I’m also saddened by the fact that my mom doesn’t get the care she deserves. The conditions residents of long-term care homes are living in is inhumane and something has to change.”

Little accountability for negligence

Ford also promised that his government was going to increase fines for negligent facilities. Not only have those fines never been used, not one LTC home operator lost its license for risking the health and safety of residents.

Ford was going to reinstate inspections, yet annual comprehensive inspections have not been re-established.

Mehra says the remedies are simple. Immediately hire more qualified staff. Then, plan how to attract the 30,000 LTC and hospital staff that are urgently needed. Create full-time jobs with benefits that allow staff to build community with the residents while putting an end to the precarity of their work. Mandate four hours of care per resident per day to begin right now.

The Ontario government needs to immediately release the staffing reports filed back in February so Ontarians can see for themselves the abysmal state of LTC.

Mehra said, “The experience of long-term care in the last two plus years is unparalleled in our experience. I personally have done this [work] for 25 years and I have never seen such suffering. I have never seen such egregious wrong done in health care facilities ever.”

Ford is not only sanctioning the untenable living and working conditions found in LTC homes, he is actively recruiting and underwriting the expansion of private, for-profit substandard care.

All parties have a social and moral obligation to address the ongoing LTC crisis during this election.

May 23, 2022 – Editors note: The following sentence has been edited for clarity: “The report, Crisis Shortage of PSWs in Ontario’s Long-Term Care Homes, was handed to Doug Ford by UNIFOR representatives during a December 2019 meeting.”

Doreen Nicoll

Doreen Nicoll is weary of the perpetual misinformation and skewed facts that continue to concentrate wealth, power and decision making in the hands of a few to the detriment of the many. As a freelance...