Long-term care commission urges Ontario to improve inspections, enforcement

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The independent commission probing Ontario’s long-term care homes says the government should resume proactive inspections and step up enforcement as cases continue to climb during the second wave of the COVID-19 pandemic.

In a six-page report released Friday, the three-member commission led by Associate Chief Justice Frank Marrocco said it was making a second set of early recommendations to the government “because of the continued vulnerability” of residents in long-term care homes. A first interim report, released on Oct. 23, called for beefed-up staffing and faster virus testing in homes, saying that residents were “forgotten” until COVID-19 deaths started to mount. The commission’s final report is not due until April.

“As is apparent, the province is in the midst of a second wave of the COVID-19 pandemic and residents in [long-term care] homes continue to be at increased risk,” the commissioners said Friday in a letter to Long-Term Care Minister Merrilee Fullerton.

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“Since the release of our interim letter and recommendations on October 23rd, over 100 homes are experiencing an outbreak and more than 300 residents have died.” As of Friday, 2,265 long-term care residents in Ontario have died during the course of the pandemic.

“Questions and concerns have been raised about the effectiveness of the province’s oversight and inspections system, whose primary focus is to protect the vulnerable people in [long-term care] homes,” the report said.

The commissioners call for the resumption of proactive annual inspections that were phased out in 2018 on the recommendation of the auditor-general to prioritize inspections based on complaints. The proactive inspections, known as Resident Quality Inspections, were intended to discover systemic issues in homes, such as infection control problems. Between March 1 and Oct. 15, however, only 11 homes received a proactive inspection, the report said, leaving the ministry with “an incomplete picture” of the state of infection control and emergency preparedness.

The commission also calls for more funding in next year’s provincial budget to train and hire new inspectors to conduct annual, unannounced inspections of the province’s 626 long-term care homes. The commission also called for stronger enforcement of fines or penalties for companies that do not comply with infection-control measures or care plans for residents.

Samir Sinha, a geriatrician at Mount Sinai Hospital who has testified twice at the commission, said the members are committed to understanding the systemic issues plaguing long-term care homes and called on the government to act on their recommendations quickly.

“Currently our inspections process is broken,” he said. “I definitely would invest in the system to make sure that it actually has the capacity ... to make sure that every home is receiving a comprehensive annual inspection.”

The commissioners also said there should be at least one staff member on-site each day in a full-time position who is accountable for residents’ quality of care. They called on the government to post on a central platform the performance reports about homes, including inspections, so the public and other homes can assess the situation.

Ms. Fullerton said the government recognizes the urgency of the situation and has invested $750-million into homes during the pandemic.

“Many of the areas identified by the Commissioners are consistent with our efforts currently underway as we continue to work hard to solve the long-standing and systemic challenges facing the long-term care system, which have been exacerbated during COVID-19,” she said in a statement.

Meanwhile, Ontario on Friday unveiled the nine members of its COVID-19 vaccine distribution task force, which includes Ontario Chief Coroner Dirk Huyer, who is co-ordinating the province’s outbreak response, Ontario Regional Chief RoseAnne Archibald, and former Toronto police chief Mark Saunders. Retired general Rick Hillier will chair the task force, which met for the first time on Friday.

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