The 322-page report released late Friday by Ontario’s Long-Term Care COVID-19 Commission is right on target in many (though not all) of its pointed recommendations. Doug Ford should move quickly.
Never again. The Ford government’s deathly mismanagement of COVID-19 in Ontario’s nursing homes is documented in grisly detail in the scathing 322-page report by Ontario’s Long Term Care COVID-19 Commission’s, released Friday. Further, it explains how the sector, its residents and staff were rendered vulnerable and unprepared by 30 years of successive government neglect. Ontario, rich in economic and social resources, had one of the worst rates of nursing home deaths in the industrialized world.
This comprehensive, accessibly written report doesn’t stop there. Its 85 meticulous recommendations lay out a plan to fix Ontario’s long-term care system and ensure this completely preventable tragedy never happens again.
Does the report get it right? Yes, in many, many ways. It reinforces that Ontario doesn’t need more studies — we have more than enough evidence to make dramatic improvements to nursing home care. It also emphasizes urgency — change needs to happen now.
There are many excellent recommendations to improve quality of care. These include actions to improve complex care, dementia care and to provide culturally appropriate care that attends to language, spirituality, sexuality, Indigeneity, and race/ethnicity.
Recommendations on staffing quantity and quality and better working conditions hit the mark, such as ensuring higher wages, 70 per-cent full-time staffing, and meaningful training.
Recommendations about infection prevention and control are detailed and useful. Helpful direction on inspections and inter-governmental coordination to support, rather than complicate, nursing home quality are particularly timely, given the current restructuring of Ontario’s health system. There are solid recommendations to address underfunding, too.
Ontario must move swiftly to implement these recommendations. They will advance safe, high-quality nursing home care, go some way to honour those who suffered and died, and provide a much-needed COVID recovery stimulus to the Ontario economy.
But the report gets some things wrong. Yes, it summarizes accurately the well-documented relationship between for-profit ownership and poor-quality conditions of care and work. Yes, it recommends that municipalities and charitable non-profit providers have more opportunity for nursing home ownership and operations. But the report flounders by failing to generate an alternative to for-profit involvement in rebuilding and operating this crumbling sector.
For rebuilding, the report recommends private-public partnerships (P3s) because these are commonplace rather than because they are good value. Given the considerable evidence of much higher cost and poorer outcomes in these projects over public alternatives, the commission seems uninformed on this issue.
In discussing nursing home operation, the report suggests that good “mission-driven” for-profits should be distinguished from bad “solely commercial enterprises” but does not say how this distinction can be made, how these organizations can be held accountable, or how levels of profit and mission can be regulated or monitored. No doubt on the weekend, for-profit long-term-care companies were running to publish statements about a mission-driven approach on their websites!
Further, the report fails to grapple with issues related to significant sub-contracting to for-profit companies across the nursing home sector, for food service, cleaning, laundry, management services and more. This sub-contracting exists in many for-profit, public and non-profit nursing homes in Ontario. Research has shown that sub-contracts, while initially attractive, over time tend to produce lower quality and higher costs than in-house services.
In Canada and other countries, there are many workable public and non-profit alternatives to for-profit rebuilding and operations. Indeed, some publicly funded services that were previously contracted out to for-profit operators are being returned to direct government operation, due to persistent cost hikes, poor accountability and abysmal service quality. While successive provincial governments have ignored this evidence, it is there for the asking.
That said, Ontarians should be grateful to the commissioners for producing a useful, comprehensive report that lays out many urgently needed actions to strengthen, support and improve long-term care. For the Ford government, redemption is impossible. To restore public trust, even in part, it must take immediate action on the majority of the commission’s recommendations and make long-term care a top priority.
Susan Braedley is an Associate Professor at Carleton University whose research program focuses on identifying promising practices in long-term care.