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A resident is taken to a waiting ambulance as nurses and PSWs at Sienna Senior Living St. George Care Community in Toronto watch from the windows as a support rally takes place in front of the building on Jan. 7, 2021.Frank Gunn/The Canadian Press

The vast majority of public-health units in Ontario are not taking enforcement action against long-term care and retirement home operators, despite numerous instances of alleged abuse and neglect during the coronavirus pandemic.

The Globe and Mail contacted all 34 health units in Ontario, asking whether they have used their powers under provincial legislation to compel operators to address health and safety concerns in homes with an outbreak of COVID-19.

Among the 32 health units that responded, only four – York Region Public Health; Hamilton Public Health Services; Kingston, Frontenac, Addington and Lennox Public Health and, most recently, Simcoe Muskoka District Health Unit – have issued enforcement orders since the onset of the pandemic last March. The health units have cited a total of 17 homes, including two that have been fined, for problems such as staffing shortages and poor infection-control practices.

The hands-off approach elsewhere in Ontario means that home operators face few if any consequences for putting the health and safety of residents at risk. Meanwhile, COVID-19 cases continue to climb.

The virus has killed 3,347 residents in long-term care homes. In the midst of the second wave, there are now 1,253 active resident infections, up from 53 in mid-September. The number of homes with outbreaks sits at 255 – 40 per cent of all facilities.

The toll is also mounting in retirement homes, where 490 residents have died of COVID-19, up 75 per cent since early September.

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The Ontario Ministry of Long-Term Care has primary responsibility for ensuring that homes comply with provincial legislation designed to protect residents. The independent commission probing long-term care homes has expressed concern about the ministry’s lack of enforcement, and has called for the resumption of proactive annual inspections that are intended to discover systemic issues in homes.

Between March 1 and Oct. 15 of last year, only 11 of the province’s 626 long-term care homes received a proactive inspection, the commission has said, leaving the ministry with “an incomplete picture” of the state of infection control and emergency preparedness.

“It’s concerning to me when public health seems to be leading any definitive action in these homes,” said Samir Sinha, a geriatrician at Sinai Health System in Toronto. “Why is this not happening by the group in charge of inspections and compliance?”

While enforcement orders are few and far between, six health units – including Hamilton, Ottawa, Toronto – have issued directives under the provincial Health Protection and Promotion Act, appointing hospitals to temporarily manage homes with COVID-19 outbreaks.

Enforcement orders issued under the same act are aimed at curbing the spread of the coronavirus or preventing an outbreak of COVID-19 altogether. Simcoe Muskoka’s Medical Officer of Health Charles Gardner issued an order earlier this month to Roberta Place, a nursing home in Barrie where the U.K. variant of COVID-19 is behind a devastating outbreak that has infected all but two residents and killed 40.

Karim Kurji, York Region’s medical officer of health, has issued five orders, including four against Sienna Senior Living Inc., one of Canada’s largest operators of private, for-profit long-term care homes.

The health unit issues an order only after staff have exhausted all efforts to work in a “persuasive manner” with a home, Dr. Kurji said. “If their best efforts are being made, we don’t need to move to an order.”

The three Sienna homes issued orders in the second wave include Langstaff Square Care Community in Richmond Hill, where no residents have died during an outbreak of COVID-19, Villa Leonardo Gambin in Woodbridge, where 25 residents have died, and the Villa Da Vinci Retirement Residence, also in Woodbridge, where the virus has claimed six lives. The Ontario government has placed Langstaff Square and Villa Leonardo under temporary hospital management.

Sienna responded to the orders by taking “immediate steps to create and implement robust action plans to strengthen our existing protocols,” spokeswoman Nadia Daniell-Colarossi said.

Dr. Kurji issued his most recent order on Jan. 7 to OMNI Health Care Ltd., owner of 18 for-profit long-term care homes in Southern Ontario. The day the order was issued, 19 of the 78 residents of Willows Estate Nursing Home in Aurora, north of Toronto, were sick with the virus.

Patrick McCarthy, chief executive officer of Peterborough-based OMNI, said in an e-mail that the outbreak “evolved rapidly over several days” and was exacerbated by the absence of several key staff from the leadership and nursing team who were quarantined.

The company brought in management and nursing staff from some of its other facilities and also immediately recruited additional contract workers from employment agencies, Mr. McCarthy said. Ten residents at Willows Estate have died of COVID-19.

The associate medical officer of health for Hamilton, Ninh Tran, says he started issuing orders in mid-November, when COVID-19 outbreaks became more frequent and intense. He has issued seven enforcement orders and three directives, appointing a hospital to temporarily manage a home.

“We’re just ramping up our response in general,” Dr. Tran said. “We want to make sure we have done our best to address the issues as timely as we can.”

COVID-19 outbreaks are now over at five of the homes. For-profit operator Revera Inc. challenged an order Dr. Tran issued on Nov. 23, citing “inadequate control measures” to limit the spread of the virus at Baywoods Place, a Hamilton nursing home it owns.

Revera spokeswoman Marie Fitzpatrick said the order was lifted after the outbreak ended.

In Kingston, medical officer of health Kieran Moore did not wait for a home to have an outbreak of COVID-19 before taking enforcement action. He issued enforcement orders against four retirement homes in the spring, and fined two of them $750 each.

“They all knew we would use the act to its fullest and fine them if necessary,” Dr. Moore said.

His proactive measures have kept the virus at bay in the region, where only one person has died of COVID-19.

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