That the province this week announced an independent commission will investigate Ontario’s long-term care system comes as no surprise. Outbreaks have killed many vulnerable residents of long-term care and retirement homes: The resultant public outcry demanded Queen’s Park do something.
The commission, set to begin in September, will be charged with improving the long-term care system to better protect residents and staff during any future outbreaks.
Long-term care residents account for almost 60 per cent of the 1,900 coronavirus-related deaths in Ontario. That percentage grows when other facilities such as retirement and group homes – in Waterloo Region, for instance, about 82 per cent of fatalities have been linked to outbreaks in institutional settings.
Some of that was to be expected, as residents of such facilities tend to be older and more susceptible to infection, the spread hastened by proximity. Steps were taken to mitigate the risks, though with mixed results – some long-term care homes have seen minimal impacts – one or two staff members – while others such as Forest Heights Revera in Kitchener have seen devastating results: 49 deaths linked to COVID-19.
The coronavirus crisis has put into sharp relief the longstanding issues with the long-term care system, particularly where staffing is concerned. Long before the current pandemic, there were concerns about low staff numbers, training, turnover and the ensuing risks. At the root are costs and the associated accessibility to care for the elderly among us, a growing segment of the population.
Many studies have looked into the shortages of frontline employees, particularly personal support workers (PSWs), in long-term care facilities. Such workers are the ones providing hands-on care to some 80,000 long-term care residents in Ontario. Long-term care homes reported that they are working with shortages on almost all shifts, every day. Weekends are worse. Rural areas are even harder hit. The shortages mean that there are not enough PSWs to staff existing beds let alone the 15,000 planned new beds the province announced last year to ease the long waiting lists.
A report, Caring in Crisis, released in December by the Ontario Health Coalition examined what it called the PSW crisis in Ontario’s long-term care homes. Workloads were described as too heavy, with staff leaving for jobs with less workload, including taking other jobs such as housekeeping in long-term care homes. Part-time staff, said the report, were working two jobs because they are not guaranteed hours, making scheduling more difficult. Vacations were denied because of staffing shortages. Recruitment has been continuous and not always fruitful.
Some of those same issues were addressed in the Public Inquiry into the Safety and Security of Residents in the Long-Term Care Homes System, launched in 2017 in the wake of the offences committed by Elizabeth Wettlaufer, and published last year.
These are only two of the most recent looks at deficiencies in the industry.
What remains to be seen is what more the upcoming commission will recommend to counter the longstanding problems. Money will be at the heart of the matter – as with all precarious work, low wages, poor benefits and insecure hours lead to vacancies, low morale and staff turnover. Reversing those conditions will be costly, ultimately leading to higher costs to residents and their families, in all likelihood … if the industry goes down that road.
Included in the mix will be the division between for-profit and non-profit homes, with many fingers already pointing to the discrepancies in the number of cases and fatalities in for-profit facilities. In the end, the issue will be politicized.