Ontario’s Long-Term Care COVID-19 Commission Releases its Final Report

June 23, 2021

Katherine Ferreira

The current COVID-19 pandemic has had a devastating impact within the province of Ontario. The residents and staff of long-term care homes have been among those most affected by COVID-19.  By the end of April 2021, the pandemic had caused the deaths of approximately 4000 residents and 11 staff at long-term care facilities.[1] Although long-term care residents only represent 0.5% of Ontario’s population, they accounted for 64% of COVID-19 related deaths in the Spring of 2020.[2]

Due to the disproportionate impact of the COVID-19 pandemic on long-term care homes, the Long-Term Care COVID-19 Commission (the “Commission”) was established in the Summer of 2020 as the first wave of the pandemic eased.[3] The purpose of the Commission was to “investigate the cause of the spread of the virus in long-term care and how it affected residents, staff, volunteers and family members”.[4] The Commission conducted its investigation during the second wave of the pandemic between September 2020 and March 2021. As part of its investigation, the Commission heard from over 700 people and stakeholders on the front lines including families, residents, staff, hospitals, long-term care home licensees and operators, public health units, inspectors, experts, researchers, government officials, associations and advocacy groups. [5] As the Commission was conducted during the pandemic, it received information in real time and issued two sets of interim recommendations.

The Commission released its final report on April 30, 2021(the “Report”). In its Report the Commission outlined its findings and provided 85 recommendations.[6]

Key Findings

Overall, the Commission found that Ontario was not prepared for the pandemic and that the province’s long-term care homes had been neglected for decades making them easy targets for uncontrolled COVID-19 outbreaks.

More specifically, the Commission found that successive governments had neglected the long-term care sector, leading to issues involving outdated infrastructure (which made it difficult to contain a COVID-19 outbreak), insufficient staffing and a lack of crucial training for the workforce regarding infectious disease prevention and control.

The Commission also found that Ontario was unprepared for the COVID-19 pandemic. As part of its Report, the Commission noted that Ontario experienced a deadly SARS outbreak in 2003 which led to a number of excellent recommendations. According to the Report, while the province initially paid attention to the recommendations, pandemic preparedness had lapsed by 2020 resulting in no up-to-date pandemic plan and the expiration and destruction of most of the province’s stockpile of emergency health supplies which had been amassed after SARS. In fact, by 2019 the province had destroyed 90% of the stockpile, including surgical masks and N95 respirators.

Further, the Commission found that the province’s initial response to the pandemic was too slow, including delays in introducing universal masking, limiting staff from working in multiple long-term care homes and implementing precautions to address the prospect of asymptomatic spread of COVID-19. Compounding the issues with Ontario’s response was a failure to adhere the precautionary principle – a key recommendation previously made by Justice Campbell as part of the SARS Commission – that provides that you should not wait for scientific certainty before introducing reasonable precautions to protect against a hazard, such as COVID-19.

Recommendations

As part of its Report, the Commission made 85 recommendations to help ensure that long-term care homes are better equipped to respond to current and future outbreaks, including additional funding and legislative or regulatory amendments.[7] As outlined below, the 85 recommendations were divided into12 sections.

The complete text of the Report and recommendations can be found here.

• Pandemic Preparedness

The recommendations in this section are intended to address shortcomings in pandemic preparedness on the part of the province and long-term care homes. The Commission emphasized that pandemic preparedness is crucial to ensuring that devastation within long-term care homes does not occur again.

• Addressing the Aftermath of COVID-19 for Residents and Staff

The recommendation in this section is intended to address the significant impact of the COVID-19 pandemic on the emotional and psychological well-being of staff and residents within long-term care homes.

• Infection Prevention and Control

The recommendations under the Infection Prevention and Control section are intended to standardize and prioritize Infection Prevention and Control (“IPAC”) best practices in long-term care homes. The Commission emphasized that IPAC is essential to combatting infectious diseases such as COVID-19.

• Strengthening Health Care System Integration

Under the heading Strengthening Health Care System Integration, the Commission made recommendations to help strengthen the integration of long-term care into Ontario’s health care system. In doing so, the Commission noted that long-term care homes formed crucial ad hoc partnerships with the broader health care system, especially hospitals, during the COVID-19 pandemic.

• Improve Resident-Focused Care and Quality of Life

The recommendations in this section are intended to ensure that residents receive the care promised to them under the Long-Term Care Homes Act, 2007, especially the fundamental principle requiring long-term care homes to be operated so residents “may live with dignity and in security, safety and comfort and have their physical, psychological, social, spiritual and cultural needs adequately met”.

• French Language Services

The recommendation under the French Language Services section is intended to protect the rights of Francophone residents in long-term care and ensure that they receive care and services that are culturally and linguistically appropriate.

• Address the Human Resource Challenges

The recommendations in this section are intended to address the human resources issues in long-term care homes that exacerbated the effects of COVID-19 including staff shortages, an insufficient skill mix and a lack of training and education opportunities for staff.

• Funding

The recommendations under the Funding section provide that Ontario’s long-term care funding must be increased and reoriented in order to effectively meet the care demands of residents, those waiting to be placed in long-term care and the projected substantial increase in demand for long-term care capacity.

• Increase Accountability and Transparency in Long-Term Care

In this section of the Report, the Commission made recommendations intended to bolster long-term care leadership, accountability and oversight in order to better protect residents and staff at long-term care homes. The recommendations under this section also address the province’s compliance oversight and enforcement to hold licensees accountable for the safe and respectful care required under the Long-Term Care Homes Act, 2007.

• Comprehensive and Transparent Compliance and Enforcement

The recommendations under this section provide that the Ministry of Long-Term Care, the Ministry of Labour, Training and Skills Development, and the public health units need to coordinate their work in order to facilitate comprehensive and effective inspections. The Commission also stated that serious and repeated breaches need to result in serious consequences noting that the long-term care inspection and enforcement regime did not adequately address long-standing compliance issues before or during the pandemic.

• Health Protection and Promotion Act Investigations

Under this section, the Commission recommended changes to investigations under the Health Protection and Promotion Act to assist future investigations into the causes of disease and/or mortality in Ontario including amendments to the Public Inquiries Act, timely production of required documents and additional protection for whistleblowers.

• Responding to the Commission’s Report

The recommendation under this section provides that on the first and third anniversaries of the release of the Report, the Ministry of Long-Term Care should table a report in the Legislature describing the extent to which it has implemented the Commission’s recommendations.

Conclusion

In its Report, the Commission identified numerous flaws in Ontario’s pandemic response as well as the long-term care sector.  The Commission warns that a future pandemic is not a possibility, but rather is inevitable.[8] To ensure that the devastating impact of COVID-19 and other infectious diseases does not recur, the recommendations of the Commission- unlike the lessons arising from SARS- cannot be forgotten.

[1] Ontario’s Long-Term Care COVID-19 Commission: Final Report, (The Honourable Frank N. Marrocco) at 8.

[2] Ibid at 37.

[3] Ibid at 29.

[4] Ibid at 8.

[5] Ibid at 10.

[6] Ibid at 222-249.

[7] Ibid at 221.

[8] Ibid at 27.

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