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Personal Support Worker Cecile Lasco works at the Wellesley Central Place in Toronto on Oct 18.Fred Lum/the Globe and Mail

Ontario’s commitment to provide nursing home residents with four hours of daily care will be based on an average across the entire sector, a standard that critics say falls short of ensuring that all facilities meet the basic needs of seniors.

The new standard is aimed at addressing staffing shortages in the years leading up to a global pandemic that cut a deadly swath through the province’s nursing homes. Many of the 3,826 residents who succumbed to COVID-19 died in virus-stricken, understaffed homes.

The provincial government initially promised in November, 2020, to phase in the four hours of care by March, 2025. Under proposed legislation introduced in October governing long-term care – the tightly regulated and publicly subsidized spaces most people know as nursing homes – the province would spend billions of dollars on hiring more workers, doubling the number of inspectors and building new facilities to replace crowded, older ones with multibed wards.

Bill 37, called the Fixing Long-Term Care Act, enshrines the four hours of care and stipulates how the average is to be calculated: The number of residents in all homes across the province will be divided by the total hours of direct care they received from registered nurses, registered practical nurses and personal support workers.

Nursing home activists and labour leaders representing health care workers have long called for a provincial standard for daily hours of care to fix a sector often stretched to capacity. They said the increasingly complicated needs of elderly residents, many of whom are frail and cognitively impaired, demand a hiring spree to boost care beyond the current average of under three hours a day.

During two days of public consultations at a legislative committee reviewing the bill in late November, the government was criticized for not guaranteeing a minimum of four hours of hands-on care a day at each home, and for not making the standard legally binding.

The advocates called on the government to calculate the average of four hours on a home-by-home basis, hasten its implementation, and impose consequences for those facilities that fall below the threshold.

“We know there is disparity in the quality of care offered in long-term care homes,” Briana Broderick, a vice-president of the United Steelworkers, told the committee. “The proposed method of measuring care hours shields underperforming homes from scrutiny and leaves the people in care in those homes unprotected.”

Jane Meadus, a lawyer at the Advocacy Centre for the Elderly in Toronto, said, “Residents need these hours now, not in four years.”

Bill 37 is scheduled for debate in the Ontario Legislature on Monday, and is expected to pass third and final reading this week.

Premier Doug Ford’s government used its majority in the legislature to vote down every proposed amendment to the wording of the four-hour standard. In doing so, his administration ignored the advice of an independent commission that examined the devastating impact of the coronavirus pandemic on Ontario’s long-term care homes. The three-member commission, led by retired associate chief justice Frank Marrocco, specifically warned against calculating hours of care on a sector-wide basis.

In its report released in April, the commission says the average of 2 hours 45 minutes of care that residents currently receive has long been inadequate. It says the situation is “even worse” for some residents who receive less than the average.

“The presentation of staffing data as an average is misleading; the danger lies in the extremes, where insufficient care is being provided,” the report says.

Several studies have found that between four and four-and-a-half hours of care a day are necessary to promote the health and well-being of seniors in nursing homes. In 2008, health care expert Shirlee Sharkey recommended guidelines that could provide nursing home residents in Ontario with up to four hours of care each day, depending on their needs. But the Liberal government of the day resisted implementing the minimum standards.

Nursing homes are not currently required to publicly report the number of hours of care they provide to residents. But one study published in the Canadian Journal on Aging in 2016 found that residents in municipally owned homes typically receive more care than those in for-profit homes.

Colin Best, a board member of the Association of Municipalities of Ontario and chair of its health task force, told the legislative committee that the province’s towns and cities contribute an estimated $350-million annually to the homes for operating costs over and above funding from the province.

By contrast, the for-profit sector, which accounts for two-thirds of the province’s 626 nursing homes, pays out a portion of its funding in dividends to shareholders.

Warren (Smokey) Thomas, president of the Ontario Public Service Employees Union, said the four-hour target is meaningless because it cannot be enforced.

“An individual home could fail to deliver four hours of care and still not be in violation of the act,” he said.

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