In March, the Ontario patient ombudsman’s office was preparing to release the recommendations from its first-ever systemic investigations into patient care. Then COVID-19 arrived, and the office, which reports to the provincial minister of health, abruptly switched gears.
The four-year-old organization advocates for fairness in the province’s hospitals, long-term-care facilities, and home- and community-care programs. But, since the arrival of COVID-19, the organizations it monitors have been consumed with their response to the crisis. “It would be inappropriate for us to continue to press ahead with certain investigations in that atmosphere,” says Craig Thompson, the office’s executive director.
Calls from people asking for help navigating the health-care system increased, so the office suspended some investigations and redeployed its investigative resources to respond to COVID-19-related complaints and inquiries, which, as of April 16, totalled about 100. “People are really at their wit’s end trying to understand ‘Who do I call?’ ‘Where do I go?’ ‘What's available to me?’” Thompson says. The office also sped up the pace of its complaints tracking and analysis to help support the health ministry’s planning and response.
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"For every one complaint, there's a whole series of people who have the problem or are experiencing the issue but haven't complained about it or are still making use of the existing complaint systems that are in place,” Thompson says.
Yesterday, the office issued a call for complaints in the province's long-term-care sector, asking “staff, family members, caregivers and residents to disclose situations where they feel the safety of long-term care home residents and staff may be in significant jeopardy.”
TVO.org spoke with Thompson prior to the announcement to find out more about the office’s role in managing the crisis and the concerns it’s hearing from patients during the COVID-19 pandemic.
TVO.org: How has the COVID-19 pandemic changed the nature of the calls you’re getting?
Craig Thompson: Our complaints, in terms of volumes, are staying relatively consistent over the last month. But what we are seeing is a shift in the nature of the calls. So the calls are very much now — more than a third — about COVID-19.
The other part of it is that, typically, we would be seeing the hospital sector taking up 70 per cent of our complaints, with long-term care and home care making up another 20 (10 per cent was outside our jurisdiction). We're still getting the majority of complaints about the hospital sector, but we're getting more complaints now about long-term-care homes and home care relative to what we have seen in the past.
TVO.org: What type of COVID-19-related issues are people complaining about?
Thompson: There has been quite a bit of confusion as to what is meant by an essential visitor [in public hospitals and long-term-care facilities]. These visitation restrictions that are coming from the Ontario chief medical officer of health, they really caught people off guard.
People who would have been supporting their loved one in a very profound way — daily, maybe weekly, and sometimes augmenting the care that's being given — are no longer able to do that. That's created calls from people who are in a lot of distress and really trying to understand what is going on and why are they not deemed to be an essential visitor. Then they also don't have eyes on their loved one in these hospitals and long-term-care homes, so that just raises the anxiety.
Another thing that we've seen is around PPE, personal protective equipment. It's been confusing for people because the directives come out from the chief medical officer of health, and then the devil's in the interpretation of those directives. People are confused when they might see a home-care worker or a PSW [personal support worker] in a long-term-care home not wearing PPE. And the question is, “Well why aren't you wearing PPE?” Or when they start wearing PPE — “Why are you wearing PPE?”
The other theme is around home-care service reduction. So, in the lead up to what was anticipated to be the surge, hospitals were creating capacity by safely discharging patients to home. Obviously that would then put a burden on the home-care system because you would have more residents or more clients who are accessing that system.
We also recognized — and we called this out in our year-three report — that there is a shortage of PSWs in Ontario. This has just exacerbated this whole [pandemic] situation.
TVO.org: The impact of COVID-19 on people in long-term care has raised awareness of the many issues surrounding the treatment of people in these facilities. Can you comment?
Thompson: The fact that this epidemic is now savaging long-term care is one of the saddest outcomes right now. And, you're right, it has shone a light on this sector's vulnerability. People, if they weren't, they certainly are aware [now] of the vulnerabilities in long-term care and the issues of the lack of PSWs [and] compensation for workers. The fact that some workers have to work at multiple long-term-care homes is something that people might not have understood. Now, in the context of a pandemic, you look at that, and you go, “Well, that's probably not a good thing to have that in place.” I think that's why the government has pivoted and made a change in that.
Complaints for us have [been] pointing toward the shortage of PSWs working in long-term care and home care. A lot of the challenges that home care and long-term care are having today is just not having the resources to be able to scale to a — well, I don't know if they ever could have the potential to scale to the impact of a pandemic. But also they are running very much on the edge in terms of having no ability to scale to any kind of crisis and support.
From our standpoint, the complaints that we saw were pushing us toward [the conclusion of] a resourcing problem, particularly around PSWs. I think, now, this pandemic is not only highlighting that aspect of it — but it highlights whole other aspects around PPE, in terms of resources around personal protective equipment, the ability to respond to these kinds of crises, even though this one is quite unusual, and it's never happened before.
TVO.org: Historically, we’ve seen several tragic instances of institutional living failing the people it was supposed to support: Indigenous children, people with developmental disabilities. Now we're seeing it failing our elders, and many are calling for a drastic system overhaul. Should we scrap long-term-care facilities altogether?
Thompson: Well, I have a mom in long-term care. I have a father in retirement living. These are their homes. Can we do a better job of taking care of our elders and taking care of and making sure that those places are better resourced? For sure.
But I think there's a place for it. There was a place for it with my family in terms of how we could care for my mom who suffers from dementia. So I really don't know what that other alternative would look like, but can we do a better job? Absolutely.
TVO.org: Is there anything else you'd like to add?
Thompson: This stems from a visit that I had when I was out in London and visited the long-term-care homes and the community-health centre and other charitable organizations that are providing care. I'm just profoundly grateful that those folks are there during the work that they're doing. We're just that little bit removed from it, but we hear the stories, and while they're under a lot of distress, we are getting good co-operation from the hospitals and long-term care and home care. So we're very impressed by that.
We're very happy that everyone's still trying to keep everybody safe. We're very grateful that the system is working as hard as it is to try to respond to such a catastrophic situation.
This interview has been condensed and edited for length and clarity.
This is one in a series of stories about issues affecting southwestern Ontario. It's brought to you with the assistance of faculty and students from Western University’s Faculty of Information and Media Studies.
Ontario Hubs are made possible by the Barry and Laurie Green Family Charitable Trust & Goldie Feldman.