Dr. Doris Grinspun
It was March 11 and RNAO was among a group of stakeholders at a face-to-face consultation organized by ministry of long-term care (LTC) staff to discuss recommendation #85 of the Long-Term Care Homes Public Inquiry. This recommendation, which was released on July 31, 2019, resulted in a ministry-led study to determine the adequacy of registered staff in LTC homes. I was asked to present RNAO’s position and spoke about the poor staffing and deficient skill mix Ontario nursing homes have had for the past two decades. I lamented that this type of deficient staffing compromises the health and well-being of residents in good times, and is downright dangerous going into a pandemic.
Soon after I completed my remarks, my Blackberry buzzed. It was a message from the World Health Organization officially announcing that COVID-19 was now classified as a pandemic. I apologized to those in attendance, informing them that our policy director would continue to represent RNAO while I left to direct matters at RNAO home office. There were several aspects of RNAO’s ready-to-go plan that needed to be put in motion.
Since that March 11 meeting, RNAO released its ‘report of reports,’ listing 35 studies as well as recommendations from inquests and public inquiries over the last two decades, each calling for changes in LTC, including improvements on staffing. This compilation of reports was made public on June 5, adding fuel to a firestorm of fury about the over-studying of LTC and the decades of government neglect to act on repeated recommendations.
Political leaders past and present say they want to “fix the problems in LTC,” and while I believe their intentions are heartfelt, residents, their families, and the staff who care for them can’t wait any longer for change.
Political leaders past and present say they want to “fix the problems in LTC,” and while I believe their intentions are heartfelt, residents, their families, and the staff who care for them can’t wait any longer for change. No study and no words will deliver better care for residents. More funding and better staffing will.
On June 10, RNAO released its Nursing Home Basic Care Guarantee that calls on government to fund four hours of direct nursing and personal care per day, based on a skill mix of regulated and unregulated care providers (see full details in our feature in this issue).
I’m not one to say “I told you so,” but as we have all watched COVID-19 batter the LTC sector over the last few months, I can’t help but reflect on the unheeded warnings of RNAO over the past two decades. It is disheartening, exhausting and expensive to continue to study problems for which we have already presented concrete and viable solutions. The shortcomings in LTC are known and understood. What we now need is the political will to act – and to do so fast.
Canada’s performance through the pandemic has settled somewhere in the middle of the pack generally, but specific to seniors in LTC – it’s been disastrous. A June 2020 Canadian Institute for Health Information (CIHI) snapshot of our country’s pandemic experience found LTC residents accounted for 81 per cent of all reported COVID-19 deaths. In Ontario, 80 per cent of all COVID-19 deaths were in LTC. It weighs on me that we asked families to stay away from their loved ones to protect them, but what happened was passive abandonment due to the lack of PPE, delays in universal masking of staff, no surveillance testing, and shortfalls in staffing. When COVID-19 arrived, LTC was already in a precarious position, and the virus led to an unraveling of the sector that caused thousands of preventable deaths. Half of all nursing homes in Ontario experienced outbreaks, due mostly to health system failures.
As COVID-19 case counts began their rise through February and March, experts across the country worried the system would crumble. In Ontario, hospitals have emerged through the crisis relatively unscathed. The same is not true of LTC, which has indeed crumbled before our very eyes. With the government’s laser focus on protecting the hospital sector, LTC was left far behind, as were primary care and home care.
RNAO has been advocating on behalf of LTC for many months, calling for better access to PPE, universal masking of all LTC staff facing residents, pre-outbreak testing and surveillance, isolation of suspected and confirmed COVID-19-positive persons, more robust case and contact tracing, and urging for LTC staff to only work at one facility full-time. We vocalized our concerns directly to Ontario’s chief medical officer of health, the health minister, the minister of LTC, at the provincial collaboration table, in the media, and online through our various updates, blog posts and social media presence. On several occasions, I also communicated directly with the premier.
As we prepare for a second wave of COVID-19 – expected in the fall – we need to focus on LTC, primary, home and community care (see what’s next in my July 24 blog post). We need to step outside of the hospital sector and ensure congregate settings that have cracked under the pressure of the first wave are given the attention and focus they need and deserve. We didn’t do enough to protect these settings when COVID-19 arrived, and we cannot ignore the impact that shortsightedness has had – and will continue to have.
The government report released July 30, which outlines changes to LTC staffing, promises important improvements. However, to save residents’ lives and boost their well-being, we must immediately move from more reports to decisive actions. Older adults who call LTC “home” deserve nothing less.