Disturbing insights into long-term care from a former inspector

She did hundreds of LTC inspections in Ontario during her career and saw amazing acts of kindness — and indefensible corruption
By Steve Paikin - Published on May 28, 2020
A Canadian Forces report released Tuesday revealed disturbing details about Ontario’s long-term-care system. (iStock/ SolStock)

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I won’t give you her real name, so let’s just call her Michelle.

I’ve known her for 20 years. She’s an absolute salt-of-the-earth type. Cares about people. Does good work. She’s ethical. So when Michelle agreed to tell me about her time spent as a long-term-care-home inspector in Ontario — particularly in light of this week’s damning report from the Canadian Forces — I was all ears.

“Karma’s really a bitch, Steve,” she tells me, chuckling.

Michelle says that because anyone who’s worked in the long-term-care sector for the past couple of decades could see this disaster unfolding, slowly but surely, year after year. Governments of all stripes have treated the sector poorly and, as a result, things have exploded with this week’s shocking revelations from five of the province’s worst-run homes.

“Long-term care is the forgotten child of the health-care system,” she says. “It’s never garnered much attention. Always been a second thought.”

The Canadian Forces report details instances of cockroach infestations, residents left to stew in their own feces, acts of cruelty, and more in the five homes it was called to assist in on an emergency basis. Its mission has now been extended into June.

Michelle painted a picture of an utterly dysfunctional inspection system rife with incompetence and mismanagement, practices bordering on the corrupt — and worse. She took me back a decade, when the Dalton McGuinty government actually attempted to toughen up the inspection regimen. Ontario took its Ministry of Health inspectors, who traditionally showed up to homes more as “advisers,” and tried to transform them into genuine investigators, on the hunt for malfeasance.

Despite this effort, a LTC nurse named Elizabeth Wettlaufer still managed to murder eight long-term-care residents (and tried but failed to kill six more) between 2007 and 2016 in southwestern Ontario. And inspections didn’t discover her murderous rampage. Only Wettlaufer’s own admission of guilt made the holes in the inspection process glaringly apparent.

“That should have shone a bright spotlight on our sector,” Michelle says. “It should have ripped things wide open.”

Instead, she says, it got about a month’s worth of headlines, and then life went back to normal. And not a good normal.

Michelle, who may lean a little conservative but is basically moderate politically, says that former Liberal health minister Deb Matthews tried to put a better system in place when she took over the ministry in 2009. Matthews essentially brought in three types of inspections:

  • Critical incidents (unexpected incidents, such as death or  catastrophic fall)
  • Complaints (from staff, family, or residents)
  • Resident Quality Inspections

It was this last category that was supposed to be the game changer. Matthews hired 100 new inspectors. Instead of responding to events that had already happened, they were supposed to do annual RQIs proactively in every LTC home. That’s where the inspectors — anywhere from three to seven of them — go in and essentially spend up to two weeks at each LTC home attempting to get a genuine picture of what goes on in every home.

Good stuff, right?

Well, it should have been. But Michelle says two things immediately went south. First, there weren’t enough inspectors to complete the onerous process, so things were constantly running behind schedule. Michelle can’t remember a year during which every LTC home actually underwent the required RQI. The backlogs grew, which sort of defeated the purpose of the thing.

Second, and much more disturbingly, Michelle says that, in some cases, the fix was in.

“We generally met as a group prior to entering the homes,” she recalls. “And, on occasion, a senior inspector would say, ‘The administrator here is a friend of a friend. So we’re not going to find anything here, okay?’”

On other occasions, Michelle says, she inspected homes on her own, only to be told even before beginning her work what the results of her investigations would be.

“You’re going to find this, this, and this, and you’re going to write it up this way, okay?” Michelle says she was told on several occasions by senior officials.

She’d push back, saying that she hadn’t even begun her investigation yet.

“Doesn’t matter,” her superior would insist. “You’ll write it the way I want.” In those cases, Michelle says, her superiors wanted her to throw the book at the home operator, presumably as part of some kind of revenge plot. Michelle wrote it as she saw it. Her superior then sent someone else in to rewrite her report.

“There were so many egos, you can’t believe it,” she recalls.

“I’m still in touch with former colleagues,” she adds. “Some of the stories are horrific. It’s hard to imagine the level of harassment and bullying and abuse that is inflicted upon inspectors in the Ministry of Health.”

What I find interesting about Michelle is that, in spite of everything, she still good things to say about the sector and many of the people in it.

“Nursing homes don’t go out of their way to abuse people,” she insists. “Most of the people are amazing. They’re angels. You don’t go into this line of work because it’s easy.”

And how should the current Ontario government fix things?

“Have the ministry make homes conducive to healthy living,” she says. “Bring long-term care to the forefront.” That means no longer having four residents living in a single room. “That is so wrong for infection prevention and control, amongst a myriad of other issues.”

And fund them properly. Michelle saw too many examples of inadequate provincial funding resulting in LTC homes cutting back on even the most basic things, such as coffee servings at meals or dressing changes — or, perhaps even more significantly, incontinence products.

“It needs a whole re-look,” she says. “It needs to land, not in the lap of the long-term-care homes, but, rightfully, in the minister’s lap.”

Michelle says that, for the most part, she found that homes tried hard to provide quality of care for residents. But, given the shortage of qualified staff and outdated facilities, getting that done was tough — particularly because some residents are prone to violence.

As Premier Doug Ford is promising that an independent commission will begin holding hearings in July, it’s possible that a re-look is on its way. Then again, if the last two decades are any indication, Ontario may fixate on this tragedy while it’s in the headlines, then go back to its habit of willful blindness.

If Ford wants to leave a legacy of positive transformation, he need look no further than the system that houses the long-term-care residents that he so eloquently champions during his daily media briefings.

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