Long-term care has been in trouble for years. When will we do something about it?

OPINION: The system was in bad shape even before the pandemic — and it will be in bad shape after it, too, if we don’t take action
By Matt Gurney - Published on Oct 08, 2020
Staff stand outside Orchard Villa Long-Term Care in Pickering on June 1. (Frank Gunn/CP)

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On Thursday, the Ontario Patient Ombudsman released a report that examines the impact of the first wave of COVID-19 on Ontario’s long-term-care system. The report makes for grim reading. But in only one way is it surprising. And the surprise reflects badly on all of us as citizens of this province — myself very much included.

In the main, the report from Cathy Fooks is what you’d expect. It lists the many challenges that Ontario’s long-term-care homes struggled with during the first wave of the pandemic. Roughly two-thirds of the province’s fatalities occurred in LTC homes — which was to be expected, given COVID-19’s lopsided lethality among older populations and the virus’s proven affinity for spreading in congregant settings. It also recaps the many challenges that contributed to the particular crisis in LTC homes: insufficient testing, inadequate supplies of PPE, a rush to reinforce the hospital system first and above all else. All combined to turn too many of our LTC homes into disaster sites.

But, and this is the shame of it, the system was already screaming out for help even before the pandemic. We didn’t listen. We’re still barely listening.

There’s a line in the report that struck me with almost physical force. I’m not prone to exaggerate or even to display much in the way of emotion. But I quite literally sat back in my chair when I was reading the report’s executive summary. It notes that, from March until July, almost half the calls to the ombudsman were related to COVID-19 (48 per cent, to be precise). That sounds like a lot until your brain catches up with the enormity of that statement. Even during a pandemic involving a virus that is highly and cruelly lethal among the elderly, that spreads alarmingly effectively in institutional settings, and that produced a crisis to severe it required the emergency deployment of the armed forces, the tragedy of COVID-19 produced only about half the problems Ontarians were facing in the system.

To be fair, the ombudsman has responsibility for more than just the LTC system — some of the calls and written submissions would have related to other elements of the broader health-care system. (Though the report does note that the number of complaints specifically regarding the LTC system grew at the fastest rate.) But the figure was still a kick to the seat of the pants. I know our LTC system better than most. I’ve had relatives spend their last days in it. I’ve written about it extensively before, including for TVO.org. But until I read those words in the report, I have to confess that I’d given less thought than I should have to all the other challenges in the system — the ones that pre-date the pandemic. The pandemic loomed so large it squeezed out most everything else even in minds that ought to have known better.

The old problems remain. The old problems are real. Indeed, in some cases, they’re worse now. In our rush to shore up the failings in the LTC system (and the medical system broadly — more on that in a minute), we can’t lose sight of the fact that our hospitals and LTC homes were struggling before COVID-19. And even parts of the system unaffected by the pandemic’s direct touch have still been hurt by it. 

That is a point addressed in the report. Not all our LTC homes had outbreaks of COVID-19, but all had to react to the threat. That meant, primarily, major restrictions on visitors. Families were suddenly cut off from loved ones inside; elderly relatives sometimes died alone — not necessarily even of COVID-19 — because, to avoid risk of transmission, visitors were not allowed inside. The report notes that changes have been made to permit visitors and increase awareness among family members about who is (and is not) permitted to visit. That’s good. But if you lost a loved one and were unable to visit, Ontario getting its act together now will be of little comfort.

The report is not intended as a blueprint for the total renewal of the obviously struggling system. It’s a recap of what happened and an update on what has already been done — with the second wave arriving, the timing on that front is excellent. And there is a welcome mix of good news and promising recommendations. As noted above, the overall situation in our health-care system is better relative to the first wave, at least in terms of preparedness regarding COVID-19. Supplies of personal protective equipment are improving. Personnel are better trained. The public is more informed. Indeed, COVID-19 itself is better understood. Some of the report’s recommendations, especially the one proposing pairing each LTC home with a medical institution for assistance with infection control and emergency response, if required by an outbreak, make excellent sense. Others, which seek to ensure that essential caregivers can still visit loved ones even amid a major outbreak, are not just smart. They’re humane. 

This is all good news — and should be expedited. The second wave has already arrived, and reports of outbreaks in LTC homes are already rising, so we don’t have time to waste. But the report isn’t the definitive word on the first wave, nor a perfect, complete blueprint for surviving the second (and, God forbid, still further ones). If anything, it’s just another reminder that our LTC system was in bad shape even before the pandemic, will be in bad shape after it, and is too often forgotten.

Even by those of us, myself included, who really ought to know better. I’d like to promise “never again.” But, after the last seven months, that would be hard to believe, wouldn’t it?

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