Long-Term Care – A Call to Action

Doug Ford, Premier of Ontario

Christine Elliott, Deputy Premier, Minister of Health, Ontario

Merrilee Fullerton, Minister of Long-Term Care, Ontario

September 24, 2020

Long Term Care Needs You

To Parliamentarians and Decision Makers:

The onslaught of SARS-CoV-2 (COVID-19) some seven months ago has shone the spotlight directly on the travesty existing in Long term Care Homes (LTCs) in Ontario. This crisis, culminating with COVID-19, has been steadily escalating over the years, perpetuated by a succession of non-acting governments.  Successive provincial and federal governments, by way of strategic funding and policy decisions, have allowed this situation to reach catastrophic proportions.

Residents, care givers, health care workers and others have been advocating on behalf of the declining conditions in LTCs for years. Little real action has been undertaken by governments to address the matter.  The residents of LTCs, our loved ones, deserve safe, comfortable homes in which to live with dignity.

Studies do not fix the shortcomings. Only serious action by governments can do that. There are a myriad of studies providing recommendations to improve the conditions of LTCs. Why are recommendations not explored and implemented?

The Honourable Eileen E. Gillese, Commissioner of the Long-Term Care Homes Public Inquiry, “The Public Inquiry into the Safety and Security of Residents in the Long-Term Care Homes System” released her final Report and Recommendations at noon on July 31, 2019. Recommendation 85 reads:

 “The Ministry of Health and Long-Term Care should conduct a study to determine adequate levels of registered staff in long-term care (LTC) homes on each of the day, evening, and night shifts. The Minister of Health and Long-Term Care should table the study in the legislature by July 31, 2020. If the study shows that additional staffing is required for resident safety, LTC homes should receive a higher level of funding overall, with the additional funds to be placed in the nursing and personal care envelope”.

A long-term care staffing study was commissioned by the ministry in February 2020 in response to recommendation 85 of the Justice Gillese report of the Public Inquiry into the Safety and Security of Residents in the Long-Term Care System. (from the report):

“The number of staff working in long-term care needs to increase and more funding will be required to achieve that goal. Quality of care and quality of life for long-term care residents are significantly impacted by the long-term care labour force, which is currently spread far too thin. The acuity of residents has risen 20% between 2004 and 2018 based on CMI data, and the need for long-term care has also increased. Staffing has not kept pace with the medical needs of increasingly frail and elderly residents, neither in number of staff or in specialized expertise. We urge the ministry to move towards a minimum daily average of four hours of direct care per resident as quickly as possible. Achieving this objective will require funding support, in addition to a larger pool of trained staff. This number should be based on hours worked, rather than hours paid”.

I provide an example of the disparity between actual and the minimum recommendation as outlined in the study.  My wife is a resident of a municipally operated Long-Term Care Home.  The 2020 direct care staffing for this facility is reported as 2.93 hours per resident per day. Understanding that the majority of residents enter LTCs when they are in need of amplified care, the recommended minimum direct care staffing of four (4) hours per day is more realistic in the real world. Under the present funding envelope, the recommended minimum four (4) hours per day is totally impossible for my wife’s residence and the vast majority of Ontario Long-Term Care Homes.

Simply stated, Long-Term Care Homes require funding representative of the care they are expected to deliver and the care our elderly and fragile members of society, our loved ones,  deserve. It is imperative that the amount of funding and the methodology of allocating those funds be aligned with the acuity of residents in our LTCs.

Even if one accepts the Case Mix Index, (CMI), a tool which in and of itself is flawed, the application of the CMI is faulty.  The province accumulates data submitted by individual LTCs to calculate the CMI for each LTC – the proportion of funding each receives.  The problem is, the amount of funding, the financial envelope, the pot if you wish, does not change and has not changed materially for years. Clearly a reallocation of a fixed total does not address an overall funding shortfall.  Simply stated, an increase in acuity level in an LTC will result in decreased funding because another LTC reported a higher acuity level. Yet, both are deserving and the residents suffer. Decreased funding to an LTC experiencing increased care needs is unconscionable.  And yet the province’s dismissal of LTC funding needs results in exactly that.

Aside from the obvious requirement for increased funding overall, there are other opportunities and options to be considered. Some are tied to money, some are not. Some considerations that could be explored:

  • For-Profit Homes:
    • Long-Term Care privatization should be stopped;
      • Approximately 57% of LTCs in Ontario are for-profit (the highest in Canada);
      • For-profit LTCs receive the same government allowance per bed as other LTCs, yet:
        • In the midst of the pandemic, deaths relative to the number of beds are reported as:
          • 9% in for-profit LTCs;
          • Just over 5% in non-profit;
          • Less than 5% in municipal.
      • For the same period, for-profit corporations paid shareholders a $58 million ($58,000,000) investment return.
      • During the phase-out period, investment returns should be eliminated or at least capped, ie. Savings account or variable mortgage rates.
  • Funding:
    • Staff wages must increase to recognize the service these front-line workers provide. Nurses, PSWs, Nutritionists, Recreation Coordinators, Cleaners, Administrators, everyone working in an LTC, must be properly compensated.
    • Working conditions must be improved. These are health care facilities, not assembly line manufacturing plants;
    • Funding for LTCs should be commensurate with the quality of care our elderly and fragile members of society deserve;
    • Facilities must be renovated, refit and constructed to address climate conditions, ease of care and the comfort and dignity of the residents;
    • Staffing must be formulated and funded to meet at least the minimum levels supported by several studies, including the February 2020 study commissioned by the ministry;
    • Staffing could be augmented by:
      • Secondary school students could provide social interaction and support for residents which would count towards their required volunteer hours;
      • Nursing and PSW students could receive practicum credits by working in LTCs;
      • Construction of new LTCs could include dormitory residences for health care students who would provide LTC health care support in lieu of rent.

The current Long-Term Care scenario cannot be allowed to continue.  I call on all levels of government to seriously address and rectify this unacceptable state of affairs, this affront to the well-being and dignity of those who have contributed so much to society, our loved ones.

Respectfully

Clinton Halladay

293 Summers Rd

Elgin, ON   K0G 1E0

clint.sharon@halladay.ca

CC:

Provincial:  Peter Bethlenfalvy;  Randy Hillier;  Steve Clark;  Teresa Armstrong.

Federal:  Chrystia Freeland; Elizabeth May;  Jagmeet Singh;  Jean-Yves Duclos;  Jo-Ann Roberts; Justin Trudeau; Michael Barrett;  Patty Hajdu;  Yves-François Blanchet.

Municipal and Local:  Brian Campbell;  Dr. Paula Stewart;  Jennie Bingley;  Ruth Sirman;  Susan Roberts.

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