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Ontario Public Service

Fixing long-term care; submission to Premier Ford

June 18, 2020

Dear Premier Ford,

As part of my promise to work with you, and in response to your public request to hear from frontline inspectors, to resolve the terrible tragedy that has occurred in our long-term care system I am sending you solutions from their perspective.

The attached submission is the result of consultations we have held with the inspectors, who are OPSEU members. Our members know better than anyone on how to ensure that employers comply and that best-practices are followed.

The government would be wise to pay close attention to these recommendations in order to help ensure the wellbeing of our province’s seniors, and to provide a sense of security and satisfaction of due diligence for all Ontarians.

The inspectors who OPSEU represents are dedicated and passionate about the essential work they perform, and to the people they are serving. Keeping our seniors safe from illness, such as COVID-19, or any other form of abuse or ill-treatment, is their Number 1 concern.

I look forward to having discussions with you about this submission at your earliest convenience.

Sincerely,

Warren (Smokey) Thomas,
President of OPSEU


Fixing the long-term care inspection system

The findings in this submission have been gathered from frontline long-term care home inspectors who are represented by OPSEU. The recommendations are expert opinion on how to better protect our seniors during COVID-19, and beyond. OPSEU and its members are committed to being part of the solution to the crisis in long term care.

Years of erosion of long-term care inspections

There is a long history, several governments in the making, of the erosion of long-term care inspections, and OPSEU has been sounding the alarm every step of the way.

In 2010, the McGuinty government announced a new, in-depth inspection regime, but didn’t hire enough inspectors to carry it out.

  • In 2012, after the media reported that inspections were so far behind that it would take five years before every home had an annual Resident Quality Inspection (RQI), then Minister of Health Deb Matthews announced that only LTC homes with complaints or critical incidents would receive annual inspections.
  • In December 2014, 60% of LTC homes hadn’t had an annual inspection.  Then Associate Minister of Health Dipika Damerla promised to finish those inspections in 6 weeks, after taking 11 months to do the previous 40% of inspections.
  • In 2019, under the Ford government, only nine annual RQIs were completed – the rest of the inspections were triggered by complaints or critical incidents.

What really happened with inspections during COVID-19 crisis?

OPSEU long-term care home inspectors were disappointed by the Premier’s comments on May 28, 2020, when he said that the union and its members refused to do in-person inspections. There were no work refusals – in fact, many of our members volunteered to go in and do the inspections. We realized right away that the Premier must have been misinformed by the managers and senior bureaucrats in the ministry. Here’s the real story.

  • March 16, 2020 – Inspectors started working remotely upon the direction of the Director of the Long Term Care Inspections Branch on March 14, 2020.
  • March 19, 2020 – Inspectors were instructed by the Director to stay in contact with their assigned homes remotely, to finalize outstanding inspection reports, that inquiries are on hold, that low-risk inspections are on hold, and that they will receive instruction on how to move forward with high-risk inspections.
  • April 1, 2020 – OPSEU asked the Ministry for more information on what working conditions would be expected and what safety precautions would be taken for inspectors who are assigned to in-person inspections of long-term care homes. The Ministry responded that LTCH inspectors will not be physically redeployed and that they should continue their work remotely, and if that direction changes, further communication would be provided.
  • April 16, 2020 – OPSEU received disclosure from the Ministry that inspectors would be returning to the field. In a subsequent call with the employer, they said they do not have firm plans, protocols or a start date in place at his time. When asked about PPE, the employer at first suggested that Inspectors get PPE from the LTC homes. OPSEU objected, and the ministry said they would provide equipment but didn’t give any information on what would be provided.
  • April 17, 2020 – OPSEU had another call with the Ministry and asked what protocols, resources and health and safety measures would be implemented for inspectors.
  • April 20, 2020 – OPSEU and Ministry had a call and the Ministry had no new information but they stressed that PPE would be provided to inspectors.
  • April 30, 2020 – 52 out of 164 inspectors volunteered to do in-person inspections at long-term care homes. They were told they would be working in teams led by public health, and that the inspectors were to be in an observation role only – no interviewing residents or workers.
  • May 8, 2020 – Onsite visits and inspections of “red” coded homes began with inspectors who volunteered. All inspectors continued to conduct offsite inspections remotely as well.
  • May 13, 2020 – The Ministry informed the union that they are using a volunteer system for on-site high-risk inspections of “red” and “yellow” coded homes. The ministry told the union that regular “business as usual” inspections will continue to be done remotely until further notice.
  • May 27, 2020 – OPSEU received disclosure from the ministry that inspectors will be doing onsite visits in LTC homes.
  • May 28, 2020 – Premier Ford told media that inspectors refused to do onsite inspections during the pandemic.
  • May 31, 2020 – One LTCH inspector has tested positive for COVID-19. He is at home with symptoms. He attended one long term care home.

Recommendations for an effective long-term care inspection system

  1. Immediately implement annual Resident Quality Inspections (RQI) for every long-term care again. Relying solely on complaints from a vulnerable resident population or long-term care staff who fear for their jobs, or waiting for critical incidents to occur before inspecting homes is, and has clearly been catastrophic during the pandemic.
  2. Hire the appropriate number of inspectors to do both the annual RQI inspections as well as the inspections triggered by complaints and critical incidents.
  3. Ensure that the Ministry stocks an ample supply of PPE as well as a contingency supply for inspectors to do in-person inspections safely.
  4. Create a safety protocol for long-term care home inspections, train inspectors on the protocol, and inform all long-term care homes of the protocol they must follow while being inspected.
  5. Assign inspectors to specific long-term care homes so that they get to know the issues in those homes.
  6. Ensure that long-term care homes are provided with support after they are inspected. Some homes get inspection reports and either don’t understand the findings or don’t know how to implement the necessary changes.
  7. Levy fines against long-term care homes that do not comply with orders.
  8. Provide additional oversight of managers in MLTC when they remove inspectors’ findings from inspection reports, to ensure the manager’s direction stays within policy.
  9. Legislate proper staffing levels in long-term care home to ensure high-quality care, and give long-term care home inspectors adequate staffing levels, tools and the authority to enforce it.
  10. Bring long-term care into the public health care system and remove for-profit care from the system. Making long-term care a publicly-provided service with more ministry control means better care for residents, and fewer violations and critical incidents for inspectors to investigate. Providers from the for-profit sector have a financial incentive to cut corners on staffing, on resident care, and on PPE. As a result, during this pandemic, residents are dying four times more often in for-profit long-term care homes.  Even before the pandemic, for-profit homes had 16 per cent higher death rates than publicly run facilities and 33 per cent higher hospitalization rates.  They also experienced higher rates of falls, incontinence, and use of restraints.
  11. During COVID-19, make arrangements for travel, child care, elder care and temporary housing (e.g. hotels) for inspectors who are inspecting long-term care homes in person, especially if they have to isolate from vulnerable family members after potential exposure to COVID-19.
  12.   During COVID-19, in order to avoid cross-contamination of long-term care homes, do not send inspectors to more than one long-term care home without adequate self-isolation time between visits to different homes.

Conclusion

Front-line inspectors have been raising alarms about conditions in some privately run long-term care homes for some time, but their warnings have failed to make it up the chain at the ministry level.  It is clear that oversight must be provided to managers at the MLTC to ensure they’re following policy.   The COVID-19 pandemic has underscored the fact that there are not enough inspectors to properly keep tabs on all the long-term care facilities in Ontario and more resources are urgently needed.  Most importantly, the whole long-term care model must be fundamentally overhauled and be completely publicly run.   Any time profits come first, people are bound to fall through the cracks and that is clearly what has happened in some privately run facilities.