Long-term care in Ontario post-COVID-19: What now?

The impact of the COVID-19 pandemic within long-term care (LTC) homes in Ontario has been undeniably devastating. With almost 4,000 dead and “war zone“-like living conditions exposed, residents, caregivers, and policymakers seem to finally agree that the sector representing the province’s most vulnerable population requires change. Whether this change will be transformational or simply routine has yet to be determined.

Following a year-and-a-half of turmoil characterized by three progressive waves of COVID-19, residents of Ontario’s LTC homes are finally seeing the light at the end of a dark pandemic’s tunnel. As of June 9^th, thanks to high levels of vaccination among LTC residents and staff and to improvements in key public health care indicators, fully immunized residents were able to finally leave their homes for day and overnight social outings and trips. What residents and caregivers most anticipated, though, were the loosened restrictions that came into effect on July 7^th, which included residents being allowed indoor visits with two general visitors and two caregivers as well as up to 10-person gatherings outdoors. Personal care services also resumed in the homes, and there are no longer limits on the number of people who can be designated caregivers.

There is no doubt that this re-established sense of normalcy in Ontario’s LTC homes is deeply appreciated by residents, caregivers, and staff. But many stakeholders continue to worry that the pre-COVID-19 conditions of these homes which allowed for the virus to ravage through the sector have yet to be properly addressed. After the release of a final report by the province’s Long-Term Care COVID-19 Commission in April 2021, which highlighted the neglect faced by the sector and the need for sweeping reform, Premier Doug Ford and his then-Minister of Long-Term Care Merrilee Fullerton pointed fingers at previous Ontario governments for failing to act before announcing a myriad of solutions, including investments to increase staffing, improve infection prevention and control, and develop more stringent accountability measures and performance indicators. Though they may be steps in right direction, they are far from adequate.

Notably, the current government’s proposed solutions fail to adequately address the specific recommendations outlined in the Commission’s report regarding LTC sector reform and ownership.

Perhaps the most pressing concern identified in the Commission’s report concerns those LTC homes throughout the province that are owned by investors. The report states that “Care should be the sole focus of the entities responsible for LTC homes,” seemingly calling out stakeholders whose primary focus is profit-making. Yet actions by the current provincial government do not indicate that any measures will be taken on this front. In October 2020, the government voted in favour of protecting for-profit companies’ role in Ontario’s LTC system, rather than replacing them with a non-profit and public system. That vote was in response to a motion tabled by Official Opposition Leader Andrea Horwath, whose NDP party criticized the government for allowing for-profit corporations to cut corners in care in order to maximize profits.

Notably, the current government’s proposed solutions fail to adequately address the specific recommendations outlined in the Commission’s report regarding LTC sector reform and ownership. The Commission states that new facilities need to be built to address the needs of Ontario’s increasingly aging population, adding that the government also needs to reconsider how those nursing homes are managed, with a focus on quality care. It suggests a new model for building future LTC homes, similar to what’s in place for privately funded hospitals where a mission-driven organization—be it public, not-for-profit or for-profit—would handle the care of the residents.

The provincial Conservatives have a history of encouraging for-profit growth in the LTC sector. In fact, former Conservative Premier and firm supporter of the privatization of LTC in Ontario Michael Harris is now the Chair of the Board of Directors at Chartwell – the largest private operator in the Canadian LTC sector. Further, Premier Ford recently appointed the former Minister of Finance Rod Phillips as the new Minister of Long-Term Care, which some claim is an insult to the sector itself following Phillips’ resignation from his former Cabinet post in December 2020 after it was revealed that he traveled to the Caribbean island of St. Barts during a period when the government was advising people not to travel outside of the country. Phillips is also known to have multiple private business interests outside of politics, and critics have warned that his appointment is simply a continuation of the Ford government’s privatization agenda.

The overall lack of urgency by the current Ontario government surrounding efforts to tackle the LTC crisis is upsetting, particularly given the fact that calls for reform from LTC academics and advocates have grown louder in the wake of COVID-19. The solutions — including those recommended by the Commission, particularly a public LTC insurance plan and a universal LTC program — have been presented loud and clear by organizations and advocates alike. What isn’t clear is whether the current Government will choose to listen, or whether Ontarians will vote for change at the polls in 2022.