Long-term care is a disaster that Ontario can’t hide from anymore

OPINION: Successive governments in this province have tried to obfuscate and to deny the sector’s problems. It’s time for politicians and voters alike to demand transparency and change
By John Michael McGrath - Published on May 27, 2020
Merrilee Fullerton, Ontario's minister of long-term care, answers questions about the Canadian military report released on May 26. (Nathan Denette/CP)

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Anyone at Queen’s Park who claims to have been surprised by the revelations in Tuesday’s report from Canadian Forces personnel is lying to you. Ontario’s leadership is taking this report seriously not because of the content itself — we’ll get to that — but because of where it came from. Families, unions, and individual workers themselves all raised alarms about the treatment of residents in long-term-care homes well before COVID-19 came to town, and various news outlets in this country have regularly run features, or whole series, about the deficiencies in LTC.

But soldiers carry more weight with the government than do mere workers, or their patients, or their families. The fact that the soldiers had already started to talk to reporters — Global News had been seeking comment from the Prime Minister’s Office when Justin Trudeau started the giant news boulder rolling toward Queen’s Park on Tuesday morning — meant that this wasn’t something that either Ottawa or Queen’s Park was going to be able to keep secret for long, even if that’s always and everywhere the first instinct of elected officials. (We’re all just assuming that the federal government won’t prosecute either the soldiers who talked or the reporters they talked to, but that’s never guaranteed in this country.)

So, for now, we know something of what Canadian Forces members saw when they went into five of the province’s worst-hit LTC homes: residents abused when they weren’t being neglected, filth and vermin, staff afraid to access basic supplies because of budget constraints, staff resorting to paying out of their own pockets to feed their patients.

Oh, and there’s also a global pandemic, and these homes are all struggling with the basic measures necessary to try to contain the disease that’s devastating our elderly and infirm populations.

This is Premier Doug Ford’s responsibility, and there will be a judgment to come about whether and how his government’s actions made this policy worse than it needed to be. Certainly, critics were raising all sorts of alarms late last year about the funding levels for long-term care. More immediately, it’s simply not up for debate that Ontario’s response to COVID-19 has been more lackadaisical and scattershot than British Columbia’s; that province’s public-health office took over staffing at some LTC homes early on to contain the spread of the disease. 

Specialists in the field will no doubt argue about the details of what was and wasn’t necessary, but the numbers are clear: of the three biggest provinces most exposed to international travel before COVID-19, thousands of people are dead in Ontario and Quebec and only 161 in B.C. — about one-fifth as many souls have perished per capita there as in Ontario. It will be surprising indeed if B.C.’s early action on LTC homes isn’t a big part of that story.

But if Ontario — and the Ford government — thought it could simply muddle through the crisis in long-term care, that was simply the latest chapter in a long tale of governments trying to hide the ball from the public and get through the next election without having the entire system explode on them.

The Liberals came into power in 2003 lamenting the Harris-Eves government’s lack of investment in LTC homes, and, sure enough, they spent some money to build some new homes and fill them with new beds. And then they moved on to other priorities. By 2019, the Financial Accountability Officer was able to report that, between 2011 and 2018, the province’s population of people over 75 had grown by 20 per cent, while the number of long-term-care beds had grown only 0.8 per cent.

The Liberals had their reasons, including a sincere belief that the province would be better served if they emphasized home care instead of long-term care (if your relative is receiving care at home instead of being warehoused in one of this province’s LTC homes, you can be grateful for that). But they also shielded the sector from real oversight and accountability. Instead of putting the sector under the oversight of the Ontario ombudsman — an independent officer of the legislature who makes a habit of exposing the failures of government — they created the toothless patient-ombudsman position.

(MPP John Fraser, currently leading the Liberals in the legislature, said Wednesday morning at Queen’s Park he’s willing to support putting oversight of long-term care in the hands of a properly independent, effective ombudsman if the current government or the next one wants to.)

After the Progressive Conservatives were elected in 2018 — surprise! They, as the Liberals had before them, discovered that there was a massive backlog in long-term care and decided that the answer was new construction. But the same FAO report that had highlighted the lack of progress under the Liberals showed that the Tories had goals but no ambition: waiting lists for LTC beds would be just as long after Ford’s new beds were in the system, because — check it out — Ontario’s population keeps getting older every day.

The common thread for a generation or more has been a province that can’t make long-term care a consistent focus. The sector has been run on a shoestring budget and kept as much as possible outside the public service. When things go wrong, the response has been to obfuscate and to deny the problems while shielding the sector from extensive regulation or real transparency so that fewer problems come to light in the first place.

Economists talk about “revealed preferences” — when our buying choices reveal a truth about our wants and desires that we wouldn’t otherwise want to admit. There are revealed preferences in government, too: we could have built a better, safer, more humane LTC system, but we — voters and politicians alike — wanted different things from our government, including lower taxes and more glamorous spending.

We got what we wanted. But it was never sustainable, and now it has collapsed in the most spectacular fashion imaginable — with Canadian Forces soldiers marching in as body bags are wheeled out. What we choose next will reveal much about us all.

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