It’s one of the worst kept secrets of the pandemic that it has disproportionately affected long-term care homes and the elderly. According to the people charged with investigating those effects, 55 per cent of long-term care homes have experienced COVID-19 outbreaks, and 75 per cent of all COVID fatalities were in long-term care, and as we enter the second wave, those investigators have come forward with some immediate advice.
On Friday, the Ontario Long-Term Care COVID-19 Commission published a five-page interim report with recommendations about what the Government of Ontario and long-term care homes can do now with the increasing number of COVID cases around the province, even if this is not their final word on the subject.
“We are sending this letter today because the second wave is upon us and, given the continuing urgency of the situation and high risks in long-term care homes, our Commission is making some early recommendations that focus on staffing, collaborative relationships, and infection prevention and control (IPAC),” read a letter co-signed by the three members of the panel Frank Marrocco, Angela Coke, and Dr. Jack KItts.
“Based on the information we have gathered to date, we feel confident in providing these early recommendations now, consistent with the precautionary principle, instead of waiting for more certainty as the pandemic continues to grow.”
Primary among the recommendations is the need to do something about staffing shortages in long-term care homes, especially with personal support workers (PSWs) who are now barred from working in more than one home at a time due to safety measures to prevent the spread of COVID. The commission added that’s not just a matter of getting more PSWs, but that people need to find becoming a PSW more attractive with full-time hours, better job security, and flexible hours.
For long-term care home residents, the commission is recommending that each person gets a minimum daily average of four hours of direct care. This would represent a huge need to increase staffing, which would require the provincial government to increase funding, and that’s another one of the commission’s recommendations. The commission is also suggesting that long-term care homes work on human resource strategies to fill all staffing needs, and to start taking steps to make sure that the “psycho-social” well-being of residents is being met along with the physical health needs.
These are the five recommendations as outlined in the report:
1. In addition to increasing the supply of PSWs, ensure that LTC staff recruitment efforts address the requirement for an appropriate staff mix to meet the increasing acuity and complex care needs of residents.
2. While all witnesses agreed on the need for staffing flexibility given the 24/7 nature of homes’ operations, more full-time positions must be created to ensure staffing stability and retention, and resident continuity of care.
3. Beyond these initial steps, identify the permanent investments required to develop and implement a comprehensive human resources strategy that addresses the full range of staffing issues in the sector. The ministry’s Long-Term Care Staffing Study, released in July 2020, identifies the best path forward. Further “study” of the Study is not necessary. What is required is the Study’s timely implementation.
4. Consistent with that study, the Commission recommends a minimum daily average of four hours of direct care per resident. The government needs to increase permanent funding for more nurses and support staff, to enable homes to increase their staff to resident ratio, and provide more hours of care, based on residents’ needs.
5. Given the essential role of families and caregivers in supporting not just physical care needs but the psycho-social well-being of residents, we reinforce the calls from residents, families and caregivers to ensure that families and caregivers have ongoing, safe and managed access to long-term care residents.
The advise from the commissioners was welcomed by the people representing workers in long-term care homes.
“The Commissioners are right: long-term care staffing is in crisis and was in crisis well before the pandemic,” said Donna Duncan, CEO of the Ontario Long Term Care Association (OLTCA) in a statement. “Ensuring that the fundamentals such as timely access to personal protective equipment, rapid testing, hospital partnerships and dedicated infection prevention and control expertise are available in our homes is fundamental to protecting our residents, staff and family.It is also key to our ability to recruit and retain the new work force we desperately need.”
The opposition parties leader agree that action is needed, and these initial recommendations from the commission are a good place to start, but they’re suspicious about the government’s intention to proceed.
“Sadly and sickeningly, so much of what the commission has found so far underlying that is not new,” said Official Opposition leader Andrea Horwath in a statement. “Chronic understaffing leading to resident neglect has been hurting people for years — and has only gotten worse as for-profit corporations cut more corners to pocket bigger profits over the last two decades.”
“I am urging Doug Ford to act now to implement every single one of the long-term care commission’s interim recommendations,” Horwath added.
“I fear these calls to action will fall on deaf ears like so many past reports because to date the Premier has not had the political will to put care over cost-cutting,” said Guelph MPP and Green Party of Ontario leader Miker Schreiner in a statement.
“The only acceptable course of action today is to hire and train more nurses and PSWs to guarantee four hours of daily care per resident,” Schreiner explained. “Health advocates have done the math and it will cost the province $1.6 billion to end the chronic staffing and care shortages in long-term care.”
Schreiner’s numbers come from the staffing study of long-term care homes that was completed earlier this year. The study was one of the recommendations to come out of the Public Inquiry into the Safety and Security of Residents in the Long-Term Care System, which was called after Elizabeth Wettlaufer killed eight and attempted to kill at least six others while working at long-term care facilities across southwestern Ontario.
The number was backed up by a study from the Canadian Centre for Policy Alternatives (CCPA) in June when they pegged the cost of bringing wages and staffing up to recommended levels of quality of care and safety at $1.8 billion. “While $1.8 billion may seem like a lot, it represents just a 1.2 per cent increase to overall program spending by the province,” said Sheila Block, CCPA Ontario senior economist. “A fairly paid workforce with adequate staffing levels is a crucial first step toward a quality long-term care system in Ontario.”
Late last month, the Government of Ontario announced the COVID-19: Long-Term Care Preparedness plan, which touted hundreds of millions of dollars in new spending in long-term care but only $20 million for additional personnel, and $10 million for new training that would only result in the hiring of 150 new staff members.
The final report of the commission is expected by April 30, 2021.