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Nurses and PSWs at Sienna Senior Living St. George Care Community in Toronto wave from the windows as a support rally takes place in front of the building on Jan. 7, 2021.Frank Gunn/The Canadian Press

When paramedics responded to a call for help at a nursing home with the largest outbreak of COVID-19 in Ontario, they found their patient naked, alone, ashen-faced and struggling to breathe.

Measures to protect residents in the home from the coronavirus were “minimal to non-existent,” and staff were “complacent” about safety precautions, says a copy of a report prepared by Toronto Paramedic Services and obtained by The Globe and Mail.

“Door is wide open to hall,” the report says. “Staff did not come to the room or give us report whatsoever. Completely ignored us.”

The virus has torn through St. George Community Care, a 238-bed facility in Toronto, where 156 residents have tested positive for COVID-19 – more than any other long-term care home in the province during the second wave of the pandemic. Fourteen residents have died and another 54 remain sickened with the virus.

The provincial government responded to the crisis on Monday – four days after the home’s medical director resigned in the middle of the outbreak – by bringing in University Health Network to temporarily manage the for-profit St. George facility.

Health care experts say the province should have intervened much earlier. They also say the government should require homes to publicly disclose the number of staff working in their facilities, which could act as an early warning system.

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Paramedics transport a woman at Sienna Senior Living St. George as long-term care workers and their union, SEIU Healthcare, call for increases in funding for resident care at the long-term for-profit care corporation amid a COVID-19 outbreak, on Jan. 7, 2020.CARLOS OSORIO/Reuters

A sudden drop in the number of staff, caused either by workers booking off sick with the virus or not showing up for other reasons, would signal that the home is struggling to care for residents, said Amit Arya, a palliative-care physician at William Osler Health System specializing in long-term care.

“It’s shocking that in addition to cases and deaths, we don’t have transparency from all homes about their staffing,” he said.

Ontario hospitals are currently managing 18 long-term care homes with outbreaks of COVID-19. But in many instances, the province is not sending in hospital teams to take over management until COVID-19 has spread throughout the home and staffing has become critically low, leaving residents unable to get basic care.

All but three of the homes hospitals are managing are owned by for-profit corporations. St. George in downtown Toronto is owned by Sienna Senior Living Inc., one of Canada’s largest operators of private, for-profit long-term care homes. Two other Sienna homes – Rockcliffe Care Community in Toronto’s Scarborough area and Langstaff Square Care Community in Richmond Hill, Ont. – are also under hospital management.

Rockcliffe’s COVID-19 outbreak peaked on Nov. 14, with 143 residents and 62 staff sickened with the virus. Two weeks later, on Nov. 28, the province appointed Scarborough Health Network to manage Rockcliffe, where 23 residents have died.

The province also appointed Mackenzie Health to manage Langstaff the same day – one week after York Region’s Medical Officer of Health, Karim Kurji, issued an order against the home for inadequate staffing levels and infection control measures during an outbreak of COVID-19. To date, no residents have died of the virus.

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A worker at Sienna Senior Living St. George Care Community in Toronto cleans the inside of windows on Jan. 7, 2021.Frank Gunn/The Canadian Press

Dr. Arya, who has led hospital response teams into long-term care homes with COVID-19 outbreaks, said the large publicly traded chain operators with shares listed on a stock exchange are often hesitant to reach out for help.

“They are beholden to their shareholders,” he said. “The No. 1 priority should be the well-being of residents.”

Doris Grinspun, chief executive officer of the Registered Nurses’ Association of Ontario, said she fielded calls on Christmas Day from doctors and nurses at some hard-hit homes, asking her to send nursing staff into the facilities.

“What’s very tragic is that unless people speak out or the media gets hold of something, we truly do not know what’s really happening inside many of these nursing homes,” Ms. Grinspun said.

Family doctor Silvy Mathew issued an urgent plea for help at Tendercare Living Centre last month after she worked a Sunday shift at the for-profit home in suburban east Toronto.

Most of the 16 infected residents Dr. Mathew cared for were weak from illness and a lack of food and water. Not enough staff were available to sit with sick patients to help them eat and drink, Dr. Mathew told The Globe last month.

North York General Hospital took over management of the home on Dec. 23. To date, 73 residents of Tendercare have died of the virus, eclipsing the previous record of 70 deaths at Orchard Villa in Pickering, Ont., this spring.

The Ontario government has assigned hospitals to help long-term care and retirement homes through the second wave of the pandemic, as part of the province’s “hub-and-spoke” model. University Health Network is responsible for 15 long-term care homes in Toronto.

Without a formal management agreement, a hospital’s role is limited to advising a home on such things as infection control measures. Now that UHN is managing St. George, it has “more authority to direct operations within the home,” said Gillian Howard, a spokeswoman for the hospital network.

Sienna spokeswoman Nadia Daniell-Colarossi declined to comment on the paramedics’ report on the patient with COVID-19 and the resignation of the home’s medical director.

“If any individual chooses to resign it is a personal decision,” she said in an e-mail.

Sienna posted an ad on Tuesday, saying it is “looking for two attending physicians and a medical director to join the medical staff team at St George.”

The College of Physicians and Surgeons of Ontario has policies regarding closing a medical practice, and says a physician’s obligation is, first and foremost, to their patients.

Ms. Daniell-Colarossi said staff at St. George and UHN are “working hard to provide the highest level of personalized care possible as they fight the COVID-19 virus, which continues to be a challenging adversary for the entire long-term care sector.”

The virus has killed 2,909 residents of long-term care homes in Ontario.

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