Transcript: Fighting a Second Wave in Long-Term Care Homes | Nov 25, 2020

Steve sits in the studio. He's slim, clean-shaven, in his fifties, with short curly brown hair. He's wearing a gray suit, white shirt, and spotted brown tie.

A caption on screen reads "Long-term care's second wave of COVID-19. @spaikin, @theagenda."

Steve says BY FAR, THE MOST DEATHS FROM COVID-19 IN ONTARIO HAVE BEEN SENIORS IN LONG-TERM CARE. THE SITUATION WAS SO BAD, THE PROVINCE HAD TO ASK FOR THE MILITARY TO BE CALLED IN. NOW, WITH A SECOND WAVE BEARING DOWN, HAVE WE DONE ENOUGH TO PROTECT THOSE LIVING OR WORKING IN THOSE SETTINGS? LET'S GET INTO THAT, AND AS IS OUR CUSTOM ON THIS PROGRAM, WE'LL INTRODUCE OUR GUESTS FROM FURTHEST AWAY TO CLOSEST TO OUR STUDIO IN THAT ORDER, SO: IN INNISFIL, ONTARIO: SHARLEEN STEWART, PRESIDENT OF SEIU HEALTHCARE, THE UNION THAT REPRESENTS MORE THAN 60,000 FRONTLINE HEALTHCARE WORKERS IN THIS PROVINCE...

Sharleen is in her early sixties, with long wavy blond hair. She's wearing a black blazer and a thin necklace.

Steve continues IN STREETSVILLE, MISSISSAUGA: DR. AMIT ARYA, PALLIATIVE CARE DOCTOR WHO SPECIALIZES IN LONG-TERM CARE AND HOLDS A JOINT FACULTY APPOINTMENT IN THE DIVISION OF PALLIATIVE CARE AT McMASTER UNIVERSITY IN HAMILTON AND THE UNIVERSITY OF TORONTO...

Amit is in his thirties, clean-shaven, with wavy brown hair. He's wearing glasses and a checkered shirt.

Steve continues IN THE ST. LAWRENCE MARKET NEIGHBOURHOOD OF THE PROVINCIAL CAPITAL, THERE'S: DONNA DUNCAN, CHIEF EXECUTIVE OFFICER AT THE ONTARIO LONG-TERM CARE ASSOCIATION...

Donna is in her fifties, with chin-length blond hair. She's wearing glasses and a printed black sweater.

Steve continues AND IN THE DOWNTOWN CORE: DR. SAMIR SINHA, DIRECTOR OF GERIATRICS AT SINAI HEALTH AND THE UNIVERSITY HEALTH NETWORK...

Samir is in his forties, clean-shaven, with short black hair. He's wearing a blue shirt and a white lab coat.

Steve continues IT'S REALLY GOOD OF ALL FOUR OF YOU TO MAKE SOME TIME FOR US AND OUR VIEWERS AND LISTENERS TONIGHT HERE ON TVO. I WANT TO START JUST BY PUTTING UP SOME FACTS THAT WILL SET UP THE DISCUSSION TO COME AND, SHELDON, IF YOU WOULD, LET'S BRING THAT GRAPHIC UP. LONG-TERM CARE DEATHS ACCOUNT FOR TWO-THIRDS OF THE DEATHS FROM COVID-19 IN THIS PROVINCE.

A slate appears on screen, with the title "Long-term care and COVID-19. Second wave stats."

Steve reads data from the slate and says
THERE ARE 626 LONG-TERM CARE HOMES IN ONTARIO, OF WHICH MORE THAN 400 HAVE HAD OUTBREAKS. NOW, A REMINDER: ONE CASE IS CONSIDERED AN OUTBREAK. AT THE START OF THIS WEEK, 101 HOMES HAD OUTBREAKS. THAT'S ABOUT 16 percent OF THE PROVINCE'S HOMES. AND AS OF MONDAY OF THIS WEEK, THERE WERE 528 RESIDENTS AND 467 STAFF MEMBERS WITH THE VIRUS. NOW, LET'S START WITH THIS: THE PROVINCE'S OFFICIAL LINE IS: YES, WE'RE INTO A SECOND WAVE OF COVID-19, BUT WE DID LEARN A LOT OF LESSONS THE FIRST TIME AROUND. AND THEREFORE WE'RE DOING MUCH BETTER THIS TIME ROUND. I WANT TO START WITH A BASIC QUESTION: TRUE OR FALSE? DR. SINHA, START US OFF.

The caption changes to "Samir Sinha. Sinai Health."

Samir says WELL I THINK THE SECOND WAVE WE'RE SEEING MORE DEATHS AGAIN, WE'RE SEEING MORE OUTBREAKS, AND SADLY WE'RE SEEING A LOT OF THE ISSUES THAT WEREN'T ADDRESSED IN THE FIRST WAVE THAT ARE CREEPING BACK TO HIT US AGAIN IN THE SECOND WAVE AND IT'S UNPARALLELED LEVELS OF COMMUNITY TRANSMISSION AND THE STAFFING ISSUES THAT REALLY HAVEN'T BEEN RESOLVED THAT ARE THE ACHILLES HEEL OF A GOOD PANDEMIC RESPONSE. THAT'S WHY I THINK WE'RE SEEING OUTBREAKS AGAIN AND PREVENTABLE DEATHS ONCE AGAIN?

Steve says SHARLEEN STEWART, TRUE OR FALSE?

The caption changes to "Sharleen Stewart. SEIU Healthcare."

Sharleen says THEY DIDN'T DO ENOUGH PREPAREDNESS OVER THE SUMMER. THE THINGS THAT THEY DID WERE VERBAL COMMITMENTS, BUT WE'RE NOT SEEING THE ACTIONS IMPLEMENTED INSIDE THE HOMES. WE'RE SEEING MORE CRITICAL STAFF SHORTAGE. IT'S BEEN REPORTED THAT 30 percent OF THE STAFF THAT WERE THERE DURING THE FIRST WAVE ARE NOT RETURNING DURING THE SECOND WAVE. SO IT IS WORSE. I MEAN, SOME OF THE LESSONS LEARNED, LIKE THE LOW WAGES, THERE WAS A COMMITMENT TO ADDRESS THAT, BUT THE PIECEMEALING WAY THAT WE'RE DEALING WITH THIS PANDEMIC IS NOT MAKING ANY IMPROVEMENT. THINGS ARE ACTUALLY WORSE.

Steve says DR. ARYA, WHAT WOULD YOU SAY, TRUE OR FALSE?

The caption changes to "Amit Arya. McMaster University."

Amit says I WOULD AGREE WITH THE OTHER PANELISTS OUR RESPONSE HAS BEEN PIECEMEAL AND TOO LATE IN A LOT OF THE HOMES THAT HAVE COVID-19 OUTBREAKS. REALLY IT'S FALSE. WE COULD HAVE DONE MUCH BETTER OVER THE SUMMER AND LEARNED EVEN FROM OTHER PROVINCES THAT HAD A MUCH BETTER RESPONSE.

Steve says WELL, DONNA DUNCAN, I'VE LEFT YOU FOR THE END FOR OBVIOUS REASONS. I WANTED YOU TO HEAR WHAT EVERYBODY ELSE HAD TO SAY FIRST. HOW DO YOU WEIGH IN ON THIS?

The caption changes to "Donna Duncan. Ontario Long Term Care Association."
Then, it changes again to "Lessons learned?"

Donna says WE'RE CERTAINLY BETTER OFF IN KNOWING ABOUT ASYMPTOMATIC SPREAD AND PPE AND TESTING BUT WE HAVE A CRITICAL STAFF SHORTAGE AND WE KNOW THE ROOT CAUSES IN WAVE ONE, WHERE WE HAD COMMUNITY SPREAD, OLD BUILDINGS, AND STAFFING SHORTAGES. SO WE HAVE A LOT TO DO TO STABILIZE THE SECTOR.

Steve says TELL ME WHAT YOU THINK, DONNA, HAS CHANGED IN TERMS OF HOW LONG-TERM CARE HOMES ARE BETTER PREPARED THIS TIME AROUND THAN DURING THE FIRST WAVE? WHAT'S DIFFERENT NOW?

Donna says CERTAINLY THE RESPONSE WITH HELP IS MUCH FASTER THIS TIME. IN THE FIRST WAVE, IT WASN'T UNTIL THE MIDDLE OF APRIL THAT WE WERE ABLE TO GET REINFORCEMENTS IN. CERTAINLY WE'VE BEEN WORKING WITH THE GOVERNMENT TO SAY, WE CAN'T WAIT DAYS, WE CAN'T WAIT WEEKS, WE CAN'T WAIT MONTHS, AND WE HAVE A HEALTH ISSUE ESCALATING WE NEED HELP RIGHT AWAY, AND WORKING WITH HOSPITALS AND LOCAL COMMUNITIES ESPECIALLY WHERE WE HAVE LARGE OUTBREAKS. THAT HELPS GOING IN MORE QUICKLY AND WE NEED THAT.

Steve says SAMIR, WE KNOW THAT WHEN THE CANADIAN MILITARY WAS CALLED IN EARLIER THIS YEAR, THAT REPORT REALLY REVEALED SOME PRETTY HORRIFYING STUFF. IN FACT, I THINK PREMIER FORD SAID AT THE TIME IT WAS THE SCARIEST REPORT HE HAD EVER SEEN, HEART WRENCHING I THINK ACTUALLY IS MORE ACCURATE OF WHAT HE SAID. IN YOUR VIEW, SINCE THEN, WHAT'S CHANGED?

Samir says THERE'S BEEN A GREATER RECOGNITION ABOUT HOW VULNERABLE LONG-TERM CARE HOMES ARE. AS YOU'VE MENTIONED, WE'VE SEEN THE MAJORITY NOW HAVE EXPERIENCED AN OUTBREAK AND WE'VE SEEN OVER 2300 DEATHS NOW OCCURRING IN THESE SETTINGS. SO THIS IS A REAL CHALLENGE THAT WE'VE REALLY HAD TO STRUGGLE WITH. BUT I THINK THE KEY IS THAT THE GOVERNMENT IS MAKING COMMITMENTS, YOU KNOW, THEY'RE SAYING WE RECOGNIZE WE HAVE TO IMPROVE STAFFING, WE RECOGNIZE WE NEED MORE SUPPORTS FOR THE SECTOR, WE HAVE TO INCREASE THE LEVELS OF CARE WE'RE PROVIDING. THE KEY IS, HOW DO WE ACTUALLY MAKE THOSE STRUCTURAL COMMITMENTS HAPPEN QUICKLY AND IN A TIMELY WAY, AND REALLY CHANGE THE OVERALL CULTURE OF LONG-TERM CARE WHERE WE SAW IN THAT MILITARY REPORT, STAFF TALKING ABOUT A CULTURE OF FEAR, STAFF BEING TOLD BY SOME OPERATORS, DON'T USE THE PPE, IT'S TOO EXPENSIVE, FOR EXAMPLE, AND A CULTURE WHERE STAFF JUST FEEL THAT THEY'RE NOT BEING SUPPORTED. SO SHARLEEN SAID, 30 percent, ONE IN THREE OF THE 100,000 STAFF MEMBERS THAT WERE WORKING PERHAPS IN OUR HOMES IN THE FIRST WAVE ARE NOT RETURNING. THAT'S A HUGE PROBLEM AND THAT REALLY TELLS US THAT A LOT OF PEOPLE, STAFF INCLUDED, ARE LOSING CONFIDENCE IN THE SECTOR, AND WE HAVE TO CHANGE THAT QUICKLY.

Steve says SHARLEEN, HOW MUCH OF THAT HAPPENED? HOW MUCH OF STAFF BEING TOLD "DON'T USE PPE, IT'S TOO EXPENSIVE, USE IT SPARINGLY," HOW MUCH OF THAT DO WE REALLY HEAR?

The caption changes to "Sharleen Stewart, @SharleenStewart."

Sharleen says UNFORTUNATELY, IT STILL DOES HAPPEN AND, AGAIN, WITH THE OUTBREAKS, THE ABILITY TO GET A HOLD OF HIGHER GRADE, LIKE N-95, IS STILL A CHALLENGE. THE INFECTION PREVENTION CONTROL MEASURES IN THE HOMES, BECAUSE OF THE CRISIS IN THE STAFFING, IS NOT GOOD ENOUGH. THEY'VE GOT STAFF WORKING ON MULTIPLE FLOORS, USING THE SAME MASKS THAT THEY'VE USED ON, SAY, AN INFECTED FLOOR. BECAUSE OF THE STAFFING SHORTAGES, THEY HAVE TO SPREAD THOSE STAFF AMONG MANY FLOORS, AND THAT IS A BAD WAY TO CONTAIN A VIRUS OR A PRESUMED VIRUS.

Steve says YOU KNOW, HAVING SAID THAT, AMIT, I DO REMEMBER BRIAN MULRONEY SAYING DON'T COMPARE ME TO THE ALMIGHTY, COMPARE ME TO THE ALTERNATIVE. SO LET'S FIND OUT RELATIVELY SPEAKING HOW ONTARIO IS DOING VIS-A-VIS OTHER PROVINCES. ON THAT SCORE, WHAT DO YOU FIND?

The caption changes to "Amit Arya, @AmitAryaMD."

Amit says I THINK REALLY THE GOLD STANDARD THAT WE CAN COMPARE OURSELVES TO IS BRITISH COLUMBIA, WHICH ACTED VERY EARLY ON IN THE PANDEMIC, BACK IN MARCH, TO TAKE CRITICAL ACTION. THEY ACTED DECISIVELY WITH CLEAR COMMUNICATION FOR THE ENTIRE LONG-TERM CARE SECTOR. SPECIFICALLY WHEN IT CAME TO PUBLIC HEALTH SUPPORTS, INFECTION CONTROL AND PREVENTION, ALONG WITH STAFFING. WHAT THEY DID IS THEY NATIONALIZED THE LONG-TERM CARE SECTOR, WHICH MEANS THAT THE GOVERNMENT ACTUALLY HIRED ALL PIPELINE LONG-TERM CARE WORKERS, MADE SURE THAT THEY WERE ONLY WORKING IN ONE HOME, BEING PAID A DECENT LIVING WAGE, BENEFITS, AND SICK LEAVE. AND CONSEQUENTLY, THROUGH THE FIRST WAVE, WHAT HAPPENED IS THAT THEY HAVE HALF OF THE LONG-TERM CARE SECTOR BUT HAD ONE-TENTH OF THE DEATHS. HERE IN ONTARIO WE STILL HAVE THIS LOOPHOLE IN THE DIRECTIVE WHERE AGENCY STAFF CAN ACTUALLY STILL MOVE BETWEEN HOMES.

Steve says HMM. I'VE HEARD CONFLICTING THINGS... DONNA, MAYBE I SHOULD GO TO YOU ON THIS. I'VE HEARD CONFLICTING THINGS ON OWNERSHIP STYLE, AS TO WHETHER OR NOT A HOME OWNED BY THE PUBLIC, OPERATED BY THE PUBLIC, AS OPPOSED TO PRIVATELY MAKES A DIFFERENCE IN OUTCOMES. WHAT CAN YOU TELL US ON THAT?

The caption changes to "Donna Duncan, @DLDunc416."

Donna says SO CERTAINLY, STEVE, THE RESEARCH THAT WE'VE DONE WOULD DEMONSTRATE THAT THERE IS NO DIFFERENCE WITH OWNERSHIP. OWNERSHIP IS NOT A FACTOR, AND CERTAINLY IN THIS WAVE, WE ARE SEEING MUNICIPAL AND MORE NON-PROFIT HOMES BEING IMPACTED BY THIS. THE KEY INDICATORS ARE COMMUNITY SPREAD, OLD BUILDINGS, STAFFING SHORTAGES... THESE ARE REALLY THE CRITICAL ROOT CAUSES, AND WE NEED TO FOCUS ON, TO SAMIR'S POINT, HOW ARE WE GOING TO FIX THESE ISSUES RIGHT NOW AND QUICKLY, RESTART CONFIDENCE IN THIS SECTOR, SO WE CAN ENSURE THAT WE'VE GOT THE STAFF WE NEED TO KEEP OUR RESIDENTS SAFE.

Steve says AMIT, CAN YOU COME BACK ON THAT? AGAIN, I HAVE HEARD THE SAME CONFLICTING THINGS ABOUT WHETHER OWNERSHIP STYLE MATTERS. YOU SEEM TO SAY IN BRITISH COLUMBIA THAT IT DOES. DOES IT REALLY?

Amit says YEAH. SO, I MEAN, OF COURSE, IT'S NOT THE ONLY FACTOR, AND DONNA IS ABSOLUTELY RIGHT, THAT THERE ARE SORT OF HOMES THAT ARE NOT-FOR-PROFIT OR MUNICIPAL THAT ARE HAVING A HARD TIME AND ACTUALLY WEREN'T PROVIDING PROPER CARE EVEN BEFORE THE PANDEMIC, AND THERE'S VERY GOOD FOR-PROFIT HOMES AS WELL. BUT, OF COURSE, FOR-PROFIT STATUS IS A CRITICAL ISSUE THAT HAS COME UP DURING THIS PANDEMIC AND IT NEEDS TO BE ADDRESSED. I MEAN, WE KNOW THAT PRIVATE FOR-PROFIT HOMES HAD A POOR QUALITY OF CARE IN GENERAL BEFORE THE PANDEMIC, WITH A HIGHER RATE OF HOSPITALIZATIONS AND DEATHS, AND THEY ALSO DISPROPORTIONATELY HAVE MORE DEATHS AT THIS TIME DURING THE SECOND WAVE AND THE FIRST WAVE.

Steve says SHARLEEN, WHERE DO YOU COME DOWN ON THIS ISSUE OF WHETHER OWNERSHIP MODE MATTERS?

Sharleen says ABSOLUTELY. I MEAN, OVER THIS FIRST WAVE, WE'VE GOT LOTS OF DATA, LOTS OF STATISTICS. IT'S PROVEN THAT THE FOR-PROFIT HOMES HAVE 17 percent FEWER STAFF, AND THAT WAS BEFORE THE PANDEMIC. IT'S WORSE NOW. SO THE FACTS ARE THERE. I DON'T AGREE WITH DONNA. I MEAN, THE FOR-PROFITS, YES, OF COURSE THERE'S BEEN SOME GOOD ONES, BUT STRANGELY ENOUGH, THE ONES THAT WERE SPARED DURING THE FIRST WAVE ARE SEEING INFECTIONS NOW AND THE DATA IS ALL THERE. THEY DO HIRE FEWER STAFF. THAT'S A RESULT OF THE CONSEQUENCES OF HOW MANY INFECTIONS AND DEATHS OCCURRED INSIDE THOSE FOR-PROFIT HOMES. AND AGAIN, RIGHT NOW THERE IS SUPPORT COMING IN, BUT WHERE'S IT COMING FROM? THE PUBLIC SECTOR. HOSPITALS ARE COMING IN TO SUPPORT THOSE HOMES. SO WE NEED TO MAKE THAT A PERMANENT WAY OF DELIVERING CARE, NOT JUST WHEN THERE'S A CRISIS GOING ON IN LONG-TERM CARE.

Steve says SAMIR, JUST BEFORE I GET YOU TO COMMENT ON THAT, LET ME... SHELDON, OUR DIRECTOR SHELDON OSMOND HERE, CAN I CALL AN AUDIBLE? LET'S GO TO THE BOTTOM OF PAGE 3 AND BRING UP THIS GRAPHIC HERE FROM THE TORONTO STAR ANALYSIS FROM EARLIER THIS MONTH. HERE'S WHAT THE STAR FOUND WHEN THEY LOOKED INTO THIS. THEY DISCOVERED THAT...

A quote appears on screen, under the title "Spreading fast in for-profit LTC homes." The quote reads "AMONG HOMES WITH AT LEAST ONE CONFIRMED INFECTION SINCE AUGUST 1ST, THE STAR'S ANALYSIS SHOWS FOR-PROFIT HOMES HAVE STRUGGLED TO STOP THE SPREAD OF THE VIRUS. RESIDENTS IN FOR-PROFIT HOMES HAVE BEEN MORE THAN THREE TIMES AS LIKELY TO CATCH COVID-19 AS THOSE IN A NON-PROFIT FACILITY. AND FOR-PROFITS HAVE SEEN MORE THAN TWICE AS MANY STAFF INFECTIONS PER BED. RESIDENT DEATHS HAVE BEEN MORE COMMON TOO."
Quoted from Toronto Star. November 13, 2020.

Steve says NOW, WHAT THAT ANALYSIS I DON'T THINK SUGGESTS, OR WHAT IT DOESN'T INDICATE, IS WHETHER OR NOT THESE ARE OLDER FOR-PROFIT HOMES VERSUS NEWER NOT-FOR-PROFIT HOMES. IT SUGGESTS THAT THE OWNERSHIP MODEL IS THE REASON FOR THESE HIGHER RATES. WHAT CAN YOU TELL US ON THAT?

The caption changes to "Samir Sinha, @DrSamirSinha."
Then, it changes again to "Private versus Public."

Samir says WHAT WE DO KNOW IS A COLLEAGUE OF MINE, DR. STALL AND OTHERS, WERE WORKING PARTNERSHIP WITH THE MINISTRY TO DO A STUDY, AND DONNA AND THE MINISTER OF LONG-TERM CARE, MERRILEE FULLERTON, HAVE TALKED ABOUT THIS STUDY. WHAT IT REALLY SHOWED WAS THAT COMMUNITY TRANSMISSION IS THE BIGGEST RISK FACTOR THAT WILL DETERMINE WHETHER A HOME GETS INTO OUTBREAK, REGARDLESS OF OWNERSHIP STATUS. BUT WHAT THE CLEAR SIGNAL FROM THE PAPERS ARE SHOWING WAS THAT ACTUALLY IF YOU ARE A FOR-PROFIT HOME, YOU'RE MORE LIKELY TO HAVE A LARGER OUTBREAK AND A LARGER NUMBER OF DEATHS. AND LARGELY A LOT OF THE FACTORS WERE RELATED TO CHAIN OWNERSHIP, IF YOU'RE PART OF A BIG CHAIN, AND MANY OF THESE CHAINS ACTUALLY OWN OLDER HOMES. SO WE HAVE TO REMEMBER THAT ONE IN THREE PEOPLE LIVING IN ONTARIO LONG-TERM CARE HOMES IS ACTUALLY LIVING IN A FOUR-BEDDED ROOM. THESE ARE BUILDINGS OVER 50 YEARS OLD, THAT HAVE NOT BEEN DEVELOPED. MANY OF THE NOT-FOR-PROFIT MUNICIPAL PROVIDERS HAVE DEVELOPED THEIR BEDS SO THEY'RE UP TO MODERN STANDARDS. ABOUT 50 percent OF THE FOR-PRO OF THE BEDS IN ONTARIO HAVE NOT BEEN REDEVELOPED AND THAT'S A PROBLEM BECAUSE THEN YOU'RE PACKING PEOPLE INTO CROWDED ROOMS AND THERE HASN'T BEEN A LOT OF MOVEMENT, FRANKLY, OVER THE PAST FEW MONTHS IN ACTUALLY DE-CROWDING THESE HOMES. WE'VE KEPT [inaudible] WE STILL HAVE FOUR TO A ROOM AND SOME OF THE SPECTACULAR OUTBREAKS YET AGAIN ARE IN THESE OLDER CROWDED HOMES THAT THEY WERE LITERALLY LIKE KINDLING THAT WE THREW A MATCH IN AND WE KNEW THIS WAS GOING TO HAPPEN. WE HAD THE DATA, WE DIDN'T ACT DEFINITELY, ESPECIALLY AROUND THE STAFFING ISSUE. THESE ARE THE CHALLENGES. AND THIS IS WHAT THE DATA TOLD US WE NEEDED TO DO.

The caption changes to "Watch us anytime: tvo.org, Twitter: @theagenda, Facebook Live, YouTube."

Steve says SHARLEEN, I'M GOING TO COME BACK TO YOU ONE MORE TIME. THIS IS THE THING I'M TRYING TO GET TO THE BOTTOM OF THE OWNERSHIP MODEL ITSELF, THE PRIVATE VERSUS NOT-FOR-PROFIT IS THE ISSUE HERE, OR IS IT THE FACT THAT MANY OF THE, AS DR. SINHA PUTS IT, MANY OF THE PLACES WHERE IT'S LIKE KINDLING HAPPEN TO BE PRIVATELY OWNED, BUT THAT'S NOT THE ISSUE, IT'S ACTUALLY THE FACT IT'S FOUR TO A ROOM, IT'S THAT THEY'RE OLDER, ALL OF THOSE ISSUES. HELP US UNDERSTAND.

Sharleen says IT'S A COMBINATION OF ALL OF THAT. AGAIN, IT'S SO SIMPLY PUT, DEFINITELY IT GOES BACK TO STAFFING. I MEAN, BUILDING NEW HOMES, YES, THEY'RE NEEDED. AGAIN, IF YOU DO NOT HAVE THE STAFF TO WORK IN THOSE HOMES, THEN WE'RE STILL GOING TO HAVE THE SAME PROBLEM EXISTING. THE FACT THAT THE FOR-PROFIT HOMES, I MEAN, TAKE A LOOK AT THE... THEY TAKE THE PUBLIC MONEY THAT'S GIVEN TO THEM TO TAKE CARE OF SENIORS, THEY TAKE FROM THAT MONEY, AND THEY PAY THE SHAREHOLDERS. NOW, THAT MEANS THAT THERE HAS TO BE CUTS SOMEWHERE. WHERE'S THE FIRST PLACE THAT THEY DO IT? THEY DO IT IN STAFFING. WHY AREN'T THEY TAKING A LOOK AT IMPROVING SOME OF THEIR OWN STRUCTURES AS WELL? SO AGAIN I SAY IT'S A COMBINATION OF ALL OF IT, BUT STILL, THE SHINIEST NEW MODEL WITHOUT PROPER STAFFING, WE'RE STILL GOING TO HAVE PROBLEMS.

Steve says I DO WANT TO PICK UP ON THAT ISSUE OF STAFFING AND, DONNA, I'LL GO TO YOU FIRST ON THIS ONE. WE LEARNED 17 YEARS AGO WITH SARS THAT ONE OF THE BEST WAYS TO ENCOURAGE A VIRUS TO BE AS CONTAGIOUS AS POSSIBLE WAS TO HAVE, YOU KNOW, PERSONAL SERVICE WORKERS AND LONG-TERM CARE HOMEWORKERS WORK IN AS MANY HOMES AS POSSIBLE. AND SO THE RECOMMENDATIONS CAME OUT: ONE WORKER PER ONE HOME. AND THAT'S HOW YOU NIP THIS THING IN THE BUD. WHAT I NEED TO KNOW TODAY IS WHETHER OR NOT THAT PROTOCOL IS BEING FOLLOWED ACROSS THE PROVINCE OF ONTARIO. DO WE STILL HAVE ONE PSW PER LONG-TERM CARE HOME, AS HAS BEEN RECOMMENDED FOR 17 YEARS?

Donna says WELL, CERTAINLY IN THE FIRST WAVE, WE MOVED TO ONE SINGLE SITE FOR STAFF. I BELIEVE AMIT MENTIONED THAT AGENCY STAFF ARE NOT SUBJECT TO THAT. BUT WITH THIS WAVE, WE REALLY ARE ABIDING WITH THAT. AS SHARLEEN SAYS, WE DO HAVE A CRITICAL STAFFING SHORTAGE RIGHT NOW AND WE ARE WORKING VERY, VERY HARD WITH GOVERNMENT TO TRY AND START OUR RESERVES, I WOULD SAY, BECAUSE IF WE DON'T HAVE PEOPLE, WE CAN'T KEEP PEOPLE SAFE.

Steve says AMIT, DO WE HAVE A SITUATION IN ONTARIO TODAY WHERE IT'S ONE STAFF WORKER TO ONE HOME ONLY, OR ARE THEY STILL WORKING... OR ARE TOO MANY STILL WORKING IN MULTIPLE HOMES?

Amit says WELL, THE HONEST ANSWER IS WE DON'T KNOW BECAUSE THIS IS NOT BEING TRACKED BY THE MINISTRY. BUT IT'S OBVIOUS THAT THIS WOULD INCREASE THE SPREAD OF THE VIRUS, AND AS SHARLEEN AND DR. SINHA HAVE SAID, WE'RE IN THE MIDDLE OF A CRITICAL STAFFING SHORTAGE AT THIS TIME, AND WE SHOULD HAVE DONE SO MUCH MORE THROUGH THE SUMMER TO MAKE SURE THAT ALL HEALTH WORKERS IN THESE HOMES WERE FULL TIME, BEING PAID A DECENT LIVING WAGE AND WERE ONLY WORKING IN ONE HOME. CONDITIONS OF WORK DETERMINE THE CONDITIONS OF CARE.

Steve says SHARLEEN, I SAW THE PREMIER STAND AT THE PODIUM DURING ONE OF HIS DAILY BRIEFINGS AND SAY WE'RE GOING TO OFFER LUMP SUM BENEFITS TO PEOPLE WHO GO INTO THE PERSONAL SUPPORT WORKER PROFESSION, WE'RE GOING TO UP THEIR PAY, WE'RE GOING TO DO WHAT WE CAN TO MAKE SURE THEY ONLY WORK IN ONE LOCATION PER PERSON. IS THAT NOT HAVING AN IMPACT?

Sharleen says IT'S HAVING A NEGATIVE IMPACT, QUITE HONESTLY. I MEAN, THE FACT THAT THE PERMANENT WORKERS THAT WERE THERE BEFORE THE PANDEMIC, 68 percent OF THEM HAVE REPORTED TO US THAT THEY ARE FINANCIALLY IN WORSE CONDITION THAN THEY WERE BEFORE. IN THEIR WORDS, THEY'RE BEING EXPLOITED. AND THE PREDOMINANTLY IT'S WOMEN. THEY ARE MAKING LESS MONEY THAN THEY DID PRE-PANDEMIC BECAUSE THEY ARE CONFINED TO ONE HOME. ONE OF THE THINGS I ENCOURAGED THE GOVERNMENT TO DO IS, LIKE B.C., KEEP THEM WHOLE. GIVE THEM A UNIVERSAL WAGE RATE AND GIVE THEM FULL-TIME WORK. THE FACT THAT THE AGENCY STAFF DO NOT HAVE TO FOLLOW THE SAME RULES AND CONDITIONS AS THE PERMANENT STAFF... AND I'M NOT SAYING FULL TIME, BUT THE PERMANENT STAFF IN THERE... IS A REAL PROBLEM. SO THIS HAS NOT ATTRACTED... LIKE I SAID, 30 percent OF THESE WORKERS FEEL LIKE THEY ARE JUST BEING LEFT OUT. AND TO SAY THAT WE'LL GIVE YOU A WAGE INCREASE TO RECOGNIZE THAT YOU ARE POORLY PAID BUT WE'RE ONLY GOING TO DO IT FOR SIX MONTHS AND THEN PUT YOU BACK INTO POVERTY, THEY'RE NOT ACCEPTING THAT ANYMORE. AND THEN INSTEAD OF INCREASING THE WAGES, THEY'RE INTRODUCING LOWER PAID, LOWER TRAINED STAFF TO COME IN THERE. THEY'RE GOING BACKWARDS. EVERYBODY IS RACING TO THE BOTTOM INSTEAD OF DEALING WITH THE ISSUE. STOP EXPLOITING THESE PREDOMINANTLY WOMEN, PAY THEM WHAT THEY'RE WORTH, GIVE THEM FULL-TIME JOBS WITH BENEFITS AND WATCH HOW THE SYSTEM IMPROVES ITSELF.

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Steve says DR. SINHA, THROUGH THE CORNER OF MY EYE I SAW YOU NODDING THROUGH MUCH OF THAT. WHAT CAN YOU ADD?

Samir says QUEBEC ANNOUNCED IN MAY THEY LOST PERSONAL SUPPORT WORKERS SO THEY WENT OUT DELIBERATELY. THEY SAID WE'RE GOING TO PROMISE FULL-TIME WORK. WE'RE ACTUALLY GOING TO HIRE... THEY HIRED 10,000 PEOPLE. THEY RECOGNIZED THAT FOR THESE WOMEN, TO ACTUALLY TAKE A FEW MONTHS TO DO TRAINING, HOW ARE YOU GOING TO PUT FOOD ON THE TABLE? SO THEY PAID THEM FOR THEIR TIME AND TRAINING AND THEN THEY GUARANTEED THEM A WAGE RATE OF AT LEAST 26 dollars AN HOUR AND THAT WAS 10,000 NEW FRONT LINE STAFF BY SEPTEMBER AND WE HAVE LESS HOMES IN QUEBEC IN OUTBREAK AND WE HAD LESS HOMES IN QUEBEC IN OUTBREAK THAN ONTARIO DURING THE FIRST WAVE, AND NOW WE'VE FLIPPED THAT, OF COURSE. THERE ARE KEY WAYS IN WHICH WE COULD STABILIZE OUR STAFFING. B.C. AND QUEBEC... B.C. IS EVEN HIRING 7500 NEW WORKERS. AS SHARLEEN SAID, WHAT THEY DID WAS THEY GUARANTEED EVERYONE SINGLE SITE FULL-TIME PAY AND THEY MADE SURE THAT EVERYONE WAS BEING PAID AN EQUAL TOP-LEVEL RATE, AND THAT REALLY DID FAVOURS. BECAUSE THAT COST B.C. 10 MILLION dollars A MONTH. SO 120 MILLION dollars A YEAR. AND DONNA WITH CORRECT ME IF I'M WRONG, BUT I THINK WE SPENT 1 BILLION dollars, YOU KNOW, IN ONTARIO TRYING TO SHORE UP OUR LONG-TERM CARE HOMES, AND FRANKLY, WE HAVE 2300 PEOPLE DEAD, TEN TIMES WHAT B.C. HAS. SO DO THE MATH AND SEE HOW HALF-ASSED KIND OF LIMITED APPROACHES DON'T REALLY GET US THAT FAR.

Steve says DONNA, DO YOU WANT TO WEIGH IN?

Donna says WELL, ABSOLUTELY. WE HAVE A LOT OF WORK TO DO ON OUR STAFFING, AND WE SAW WHAT WAS HAPPENING IN OTHER PROVINCES THROUGHOUT THE SUMMER MONTHS. WE LOST TIME. WE LOST TIME. WE NEED TO STABILIZE THE WORKFORCE. WE NEED TO RESPECT THOSE EMPLOYEES WHO HAVE STAYED AND WORKED THROUGH. BONUSES FOR PEOPLE WHO ARE NEW COMING IN DOESN'T RECOGNIZE THE WORK AND THE COMMITMENT OF OUR FRONT LINE STAFF WHO HAVE WORKED IN OUR HOMES FOR YEARS. WE NEED TO VALIDATE THEM. WE NEED TO MAKE SURE THAT WE'RE GETTING THESE NEW COMPENSATION MODELS IN PLACE. TO SHARLEEN'S POINT, WE HAVE HAD LOTS OF ANNOUNCEMENTS BUT WE HAVEN'T SEEN THE CASH FLOW.

Steve says LET ME FOLLOW UP ON THAT, DONNA. I MEAN, I'M CERTAINLY SENSING A CONSENSUS HERE ABOUT WHAT IT WOULD TAKE FOR IMPROVEMENT. IF WE KNOW WHAT IT WOULD TAKE, WHY ARE WE NOT DOING IT?

Donna says THAT'S A GREAT QUESTION. CERTAINLY WE'VE BEEN ADVOCATING AND WORKING WITH OUR COLLEGES OVER THE SUMMER MONTHS, HOW DO WE BUILD IN EXPERIENTIAL LEARNING INTO OUR HOMES? WHY CAN'T WE HAVE PAID POSITIONS FOR PSW STUDENTS TO COME IN AND LEARN ON THE JOB AND GET BOTH THEIR PRACTICAL AND ACADEMIC LEARNING IN THE HOME IN REAL TIME? WHY CAN'T WE DO THAT?

Steve says WHAT'S THE ANSWER? WHY CAN'T WE DO THAT?

Donna says I DON'T HAVE THE ANSWER. I WISH I KNEW. I'VE BEEN ASKING. BECAUSE IT SEEMS OTHER PROVINCES HAVE DONE IT. WE'VE CERTAINLY DONE IT IN OTHER SECTORS. IF THERE'S A WILL, THERE'S A WAY, AND LET'S JUST CLEAR OUT THE WEEDS AND MAKE THIS HAPPEN.

Steve says AMIT, LET ME FIND OUT FROM YOU, WHAT ARE YOU HEARING FROM RESIDENTS TODAY IN LONG-TERM CARE HOMES IN THIS PROVINCE ABOUT HOW RELATIVELY SAFE OR UNSAFE THEY FEEL NOW?

Amit says WELL, THEY'RE VERY SCARED, YOU KNOW, BECAUSE SOME OF THE CRITICAL CHANGES THAT WE NEEDED TO HAVE HAPPEN HAVEN'T HAPPENED. I MEAN, I'M A PALLIATIVE CARE PHYSICIAN WHO WORKS FRONT LINE IN THESE LONG-TERM CARE HOMES AND HAS WORKED IN HOMES WITH LARGE-SCALE COVID-19 OUTBREAKS, AND A FUNDAMENTAL PROBLEM THAT HAPPENS WHEN HOMES GO INTO OUTBREAK IS THAT YOU HAVE THIS VIRUS, WHICH IS OF COURSE SPREADING VERY RAPIDLY, AND THIS VIRUS CAUSES... I MEAN, IT CAN CAUSE RAPID DECLINE IN RESIDENTS IN TERMS OF THEIR HEALTH, WHERE THEY CAN DEVELOP BREATHLESSNESS OR DELIRIUM, AND THEY NEED CLOSE MONITORING. AND BASICALLY THEY NEED MORE CARE AND NOT LESS DURING AN OUTBREAK. AND THAT'S NOT HAPPENING BECAUSE WHAT HAPPENS IS THAT THE STAFFING LEVELS PLUMMET AT THAT TIME BECAUSE MANY OF THE STAFF UNFORTUNATELY FALL ILL THEMSELVES AND ARE SICK AT HOME, YOU KNOW, AND ISOLATING. AS SOMEONE WHO HAS LED THESE RESPONSE TEAMS INTO HOMES, I MEAN, WHAT WE REALLY SAW IS THAT THERE JUST WEREN'T ENOUGH STAFF IN THESE HOMES AND WE ACTUALLY NEED A RESERVE FORCE READY TO STEP IN AT THE FIRST SIGN OF ANY TROUBLE IN THESE HOMES, WHETHER IT'S A HOSPITAL RESPONSE TEAM OR A COMMUNITY-BASED MEDICAL TEAM, YOU KNOW, THE THRESHOLD FOR INTERVENTION HAS TO BE VERY LOW AND WE HAVE TO DO ALL WE CAN TO PROTECT THE WELL-BEING AND LIVES OF OUR SENIORS.

Steve says AMIT, QUEBEC GOT 10,000 NEW PEOPLE PRETTY MUCH WITH THE SNAP OF A FINGER. WHAT DO WE NEED IN ONTARIO? HOW MANY?

Amit says YEAH. SO I THINK WE ABSOLUTELY NEED TO DO MUCH MORE. I CAN TELL YOU THAT EXPERTS AND FAMILY-CAREGIVERS, ADVOCATE AND RESEARCHERS HAVE BEEN CALLING FOR DECADES FOR FOUR HOURS OF HANDS-ON DIRECT CARE PER RESIDENT PER DAY. THE AVERAGE PROGNOSIS, THE AVERAGE LIFE EXPECTANCY IN THESE LONG-TERM CARE HOMES IS 18 MONTHS, AND OUR PROVINCE'S COMMITMENT IS TO MAKE THAT HAPPEN IN FOUR TO FIVE YEARS. I MEAN, HOW DO YOU THINK THAT MAKES RESIDENTS AND FAMILY CARE-GIVERS FEEL? I MEAN, IT'S ATROCIOUS. WE NEED TO STEP UP AND HAVE PERMANENT FUNDING AND A TIME LINE TO MAKE THIS HAPPEN NOW. I MEAN, THIS IS AN EMERGENCY, RIGHT? WHAT'S REALLY HAPPENING IS THAT THERE'S NOT ENOUGH STAFF TO DO CRITICAL DUTIES LIKE BATHING AND FEEDING AND ALSO MONITOR PEOPLE MEDICALLY. SO THERE NEEDS TO BE MUCH MORE PROACTIVE ACTION AND INVESTMENT, AND IF WE TALK ABOUT THE TRAGEDIES THAT HAVE HAPPENED AND WE SAY NEVER AGAIN, THAT MEANS ACTION HAS TO HAPPEN TODAY.

Steve says SAMIR, I DO WANT TO FOLLOW UP ON THIS ISSUE OF FOUR HOURS OF HANDS-ON CARE PER DAY PER RESIDENT. AGAIN, I SAW THE PREMIER GO TO THE PODIUM DURING ONE OF HIS DAILY BRIEFINGS AND COMMIT TO MAKING THAT HAPPEN. NOW, HE DIDN'T SAY IT WOULD HAPPEN TOMORROW BUT HE DID SAY THEY WOULD GET THERE. SOON. WHAT'S THE STATUS OF THAT PROMISE RIGHT NOW?

Samir says WELL, HERE'S THE CHALLENGE. RIGHT NOW IN AN ONTARIO LONG-TERM CARE HOME, WE PROVIDE ABOUT 2.75 HOURS OF DIRECT HANDS-ON CARE A DAY. IT WAS ACTUALLY THE ONTARIO GOVERNMENT'S OWN STAFFING COMMISSION THAT CAME OUT BACK IN I THINK ABOUT JUNE-ISH AND ACTUALLY SAID FOUR HOURS A DAY IS WHERE WE NEED TO GO. THE LONG-TERM CARE COMMISSION WAS NOT ASKED TO MAKE ANY RECOMMENDATIONS AT ALL, YOU KNOW, FROM THEIR WORK. THEY CAME OUT WITH INTERIM RECOMMENDATIONS A WEEK BEFORE THE BUDGET AND SAID, STOP STUDYING THE STUDY. MOVE ON FOUR HOURS A DAY. I WAS THRILLED WHEN I SAW THE PRE-BUDGET ANNOUNCEMENT SAYING WE'RE GOING TO DO IT. WE'RE GOING TO MOVE BY 2024-2025, FOUR HOURS A DAY, AND THEN BUDGET DAY HAPPENED. NOT A SINGLE DOLLAR FOR THAT LINE ITEM. THE PREMIER WAS ASKED: WHAT'S GOING ON? THEY SAID WE'RE COMMITTED TO IT. THE MINISTER OF FINANCE SAID, WE'LL GET THE MONEY WHEN WE NEED IT. WELL, YOU CAN HEAR WE NEED THE MONEY NOW. AND I THINK EVEN IF WE JUST SAID 1.6 BILLION dollar TOP-UP ON WHAT WE CURRENTLY FUND TO REACH THAT FOUR HOURS A DAY. SO IF WE HAVE THE MONEY, AND APPARENTLY WE HAVE LOTS OF MONEY LYING AROUND, LET'S GET THIS DONE SO THAT WE'RE NOT STRUGGLING AND HAVING THE SAME CONVERSATION FOR WAVE 3.

Steve says LET ME DO A FOLLOW-UP WITH YOU ON THAT. YOU'RE QUITE RIGHT, THERE WAS NOTHING SPECIFIC. THERE WAS NO SPECIFIC LINE ITEM IN THE BUDGET THAT SAID, THIS IS FOR FOUR HOURS HANDS-ON CARE PER RESIDENT PER DAY. BUT THE FINANCE MINISTER DID SAY, I WILL FIND THE MONEY WHEN WE ARE READY TO GO. HE HAS 3 BILLION IN A CONTINGENCY ACCOUNT NOT TO MENTION 9 BILLION IN ANOTHER FUND THAT HE GOT FROM THE FEDERAL GOVERNMENT. WHAT'S HOLDING THIS UP, DO YOU THINK?

Samir says I HAVE NO CLUE. RIGHT NOW YOU HEAR WE ACTUALLY HAVE... WE HAVE STAFFING SHORTAGES ALL OVER THE PLACE. I KNOW THAT ABOUT 80 percent OF OUR HOMES, WE'RE STRUGGLING WITH STAFFING BEFORE THE PANDEMIC STARTED AND THE AVERAGE TIME THAT A PERSON SPENDS WORKING ON THE FRONT LINES IN LONG-TERM CARE IS SOMETIMES ABOUT 18 MONTHS. SO WE'RE NOT DOING A GREAT ENOUGH JOB AND WE'RE JUST BURNING THROUGH STAFFING AND BURNING UP GOODWILL, AND THE CHALLENGE IS THAT NOW WE DID SOME SURVEYS OVER THE SUMMER THROUGH THE NATIONAL INSTITUTE ON AGING AND WE FOUND THAT 78 percent OF ONTARIANS SAY THEY'D RATHER RECEIVE CARE IN THEIR OWN HOMES THAN IN A LONG-TERM CARE HOME. 100 PERCENT OF PEOPLE 65 AND OLDER SAY I WANT TO STAY AT HOME FOR AS LONG AS POSSIBLE. I THINK THE PUBLIC HAVE FRANKLY BEEN LOSING CONFIDENCE IN OUR LONG-TERM CARE SYSTEM AND I THINK OUR STAFF ARE TOO, AND THAT'S HARD TO RECLAIM OVER TIME. SO THERE'S NO TIME LIKE THE PRESENT TO GET STARTED.

Steve says DONNA, WHAT'S YOUR UNDERSTANDING OF WHERE THE FOUR-HOUR COMMITMENT IS AT TODAY?

Donna says THEY'RE PLANNING. THE MINISTRY'S PLANNING. THEY'RE CERTAINLY WORKING ON HOW TO GET THAT FIRST EXTRA HOUR OF CARE IN PLACE, TOSAMIR'S POINT, OUR CHALLENGE IS GOING TO BE GETTING THE PEOPLE TO PROVIDE THAT CARE. IT TAKES FOUR YEARS TO TRAIN A NURSE. WE KNOW THE ENVIRONMENT MATTERS AS WELL IN TERMS OF GETTING OUR STAFFING IN AND IT TAKES THREE TO FIVE YEARS TO BUILD A NEW HOME. WE NEED TO GROW PEOPLE AND NEW BUILDINGS AND WE NEED TO RESTORE CONFIDENCE. THE POPULATION OVER 80 IN ONTARIO IS GOING TO DOUBLE IN THE NEXT 15 YEARS, AND UNFORTUNATELY NOT EVERYONE'S GOING TO HAVE... BE ABLE TO AGE AT HOME. SO WE KNOW WE'VE GOT TO GET THE PIECES IN PLACE BUT WE NEED TO GET THROUGH WAVE TWO AND BE READY FOR WAVE THREE AND WE NEED TO ATTRACT A NEW WORK FORCE AS QUICKLY AS POSSIBLE AND UPSKILL THE ONE WE HAVE, TO SHARLEEN'S POINT, WE NEED MORE SKILLS, NOT LESS, AND WE NEED MORE PEOPLE.

Steve says SHARLEEN, THIS IS A GOVERNMENT THAT FREQUENTLY SAYS, YOU KNOW, WE ARE TEARING DOWN REGULATIONS. WE ARE DAMMING THE TORPEDOES, IF YOU LIKE, WE ARE MAKING SURE WE CAN GET THIS STUFF DONE LICKETY SPLIT IN RECORD TIME. DO YOU SEE THAT HAPPENING?

Sharleen says NO. THAT'S WHY WORKERS ARE LEAVING. THEY HAVE NO CONFIDENCE IN THE WORDS THAT ARE COMING OUT OF THE PREMIER'S MOUTH ANYMORE. THEY'RE NICE WORDS, BUT THE ACTION, THEY DON'T SEE IT. IT'S THE FRONT LINE WORKERS, PREDOMINANTLY WOMEN, WHO ARE CARRYING THE BURDEN OF THIS CRISIS, AND THEY'RE NOT GOING TO DO IT. I MEAN, FOUR HOURS OF CARE. YES, IT'S BEEN DECADES WE'VE BEEN ASKING FOR THAT. BUT, AGAIN, THERE'S NOT ENOUGH STAFF TO PROVIDE EVEN THOSE FOUR HOURS OF CARE. TO SAY IT AND NOT BEING ABLE TO COMPLEMENT IT. ONE OF THE RESIDENTS SAID HE WOULD BE DEAD BY THE TIME THERE WAS AN INCREASE IN THAT. WITH THE LEVELS INCREASING IN SENIORS CARE, WE MIGHT NEED FIVE HOURS IN FOUR OR FIVE YEARS, NOT FOUR. IT NEEDS POLITICAL COURAGE.

Steve says IF YOU LOOK AT THE NUMBERS, YOU GO FROM 2.7 HOURS PER RESIDENT A DAY TO FOUR HOURS A DAY, THAT MAY NOT, FROM 2.75 TO 4 MAY NOT LOOK LIKE A BIG INCREASE. WHAT CAN YOU DO IN FOUR HOURS THAT YOU CAN'T DO IN 2.75?

The caption changes to "Mitigating the spread."

Samir says IT'S THE IDEA... THINK ABOUT THE TYPICAL RESIDENT IN A LONG-TERM CARE FACILITY IN ONTARIO. 95 percent HAVE COGNITIVE IMPAIRMENT. 70 percent HAVE DEMENTIA. WE TALK ABOUT HAVING CHALLENGES WITH BATHING, DRESSING, FEEDING, TOILETING. THESE ARE PEOPLE WHO NEED INCREDIBLY HIGH LEVELS OF CARE. AND RIGHT NOW, WITH 2.75 HOURS OF CARE, A LOT OF THINGS JUST AREN'T GETTING DONE, AND WE HEAR THIS REPEATEDLY AND DR. ARYA WAS JUST MENTIONING, FOR EXAMPLE, WHEN THERE'S AN OUTBREAK AND THERE'S EVEN LESS STAFF AVAILABLE, LESS THINGS GET DONE, LIKE FEEDING, DRESSING, IN AN APPROPRIATE WAY. WHAT WE HAVE TO RECOGNIZE IS THAT THE COMPLEXITY OF THE RESIDENTS WHO ARE LIVING IN THESE SETTINGS HAS INCREASED, AND SO THIS MEANS WE NEED MORE FRONT LINE PERSONAL SUPPORT WORKER TIME. WE NEED MORE RPN TIME, WE NEED MORE RN TIME. THIS IS THE TIME THAT WE NEED. AND FRANKLY, AND WE'RE TALKING ABOUT TENS OF THOUSANDS OF WORKERS THAT WOULD ACTUALLY NEED TO MAKE UP THAT FOUR-HOUR COMMITMENT. BUT, AGAIN, I DON'T UNDERSTAND WHY QUEBEC, OUR PROVINCE NEXT DOOR, COULD GO OUT AND IN THREE MONTHS STAFF UP 10,000 NEW PEOPLE. THEY SHOWED IT COULD BE DONE. SO I'M NOT SURE WHY WE NEED TO CONTINUE THINKING AND PLANNING, AND AS THE LONG-TERM CARE COMMISSION SAID, STOP STUDYING THE STUDY. JUST GET ON AND DO IT, BECAUSE FRANKLY, WE'RE SEEING... WE HAVE 300 MORE PEOPLE DEAD NOW IN THE SECOND WAVE, AND I DON'T KNOW WHEN WE'RE GOING TO FINALLY PULL THE TRIGGER AND PUT OUT A SHINGLE AND SAY, WE'RE HIRING, WE'RE READY. LET'S GET THIS DONE.

The caption changes to "Watch us anytime: tvo.org, Twitter: @theagenda, Facebook Live, YouTube."

Steve says AMIT, WE HAVE THE MINISTER OF LONG-TERM CARE COMING ON AFTER YOU FOUR. I'M ALL EARS FOR QUESTIONS YOU WANT TO ASK HER OR WHAT YOU HAVE ON YOUR WISH LIST FOR HER. FIRE AWAY.

Amit says I THINK THERE'S A LOT OF THINGS THAT WE'VE ALL TALKED ABOUT TODAY THAT ARE SO IMPORTANT. I MEAN, WE'VE GOT TO MAKE SURE THAT WE ADDRESS THE STAFFING CRISIS. I MEAN, THAT'S THE FIRST STEP THAT WE ALL AGREE ON AND WE'VE SPOKEN ABOUT. ALL THE HEALTH WORKERS NEED TO ONLY BE WORKING IN ONE HOME, THEY NEED TO BE FULL TIME, THEY NEED TO BE GIVEN A DECENT LIVING WAGE, SICK LEAVE AND BENEFITS. WE NEED TO MOVE TO THE FOUR HOURS CARE STANDARD THAT EVERYBODY HAS BEEN ASKING ABOUT. WE ALSO NEED TO MAKE SURE THAT WE ENSHRINE THE RIGHTS OF ESSENTIAL FAMILY CARE-GIVERS UNDER THE LAW TO MAKE SURE THAT WHAT HAPPENED IN THE FIRST WAVE, WHERE PEOPLE COULDN'T EVEN SEE THEIR LOVED ONES FOR SIX MONTHS, NEVER HAPPENS AGAIN. WE HAVE TO MAKE SURE THAT WE HAVE HOSPITAL AND COMMUNITY-BASED MEDICAL TEAMS ON STANDBY READY TO STEP IN WITH A VERY LOW THRESHOLD OF INTERVENTION, AND FOR THAT TO HAPPEN, WE NEED FULL TRANSPARENCY FROM ALL HOMES AS TO WHAT'S GOING ON INSIDE SO THAT CRITICAL HELP CAN BE PROVIDED. WE NEED TO HOLD ALL LONG-TERM CARE HOMES, ESPECIALLY PRIVATE FOR-PROFIT LONG-TERM CARE HOMES, ACCOUNTABLE FOR TAX DOLLARS SPENT AS WELL AS QUALITY OF CARE, AND, YOU KNOW, I'LL BE HONEST WITH YOU, YOU KNOW, LIKE WITH EVERYONE LISTENING AND WATCHING TODAY, THAT I THINK AT THIS POINT IN THE PANDEMIC, MONTHS IN WE JUST KEEP ON HEARING NUMBERS AND DEATHS DAY AFTER DAY. BUT THESE PEOPLE ARE MUCH MORE THAN COLD, HARD NUMBERS. I MEAN, THEY'RE HUMAN BEINGS. THEY'RE SOMEBODY'S PARENT, GRANDPARENT, AUNTS AND UNCLES. THEY HAVE REAL LIFE STORIES THAT WE CAN ALL LEARN FROM AND THEY DESERVE ABSOLUTE DIGNITY AND RESPECT AT THIS TIME. I MEAN, WE HAVE TO REDESIGN OUR WHOLE LONG-TERM CARE SYSTEM TO MAKE SURE THAT WE GIVE SENIORS THE LIFE THEY DESERVE AND THE TIME IS NOW.

Steve says THAT'S A GOOD EXHAUSTIVE LIST. SHARLEEN, WHAT WOULD YOU ADD TO THAT LIST OF THINGS THAT I SHOULD BE ASKING THE MINISTER ABOUT WHEN SHE COMES IN AFTER THIS?

Sharleen says WELL, AGAIN... I MEAN, WELL SAID. WE JUST ABSOLUTELY HAVE TO STOP THE EXPLOITATION OF WOMEN IN LONG-TERM CARE. WE HAVE TO PROVIDE THEM, LIKE WE HEARD, THE CONDITIONS OF WORK DEFINITELY DO REFLECT THE CONDITIONS OF CARE. AND UNTIL WE RESPECT THE WORKERS IN THERE FOR THE WORK THAT WE DO, PAY THEM FULL-TIME WAGES, GIVE THEM BENEFITS AND SICK TIME, GIVE THEM ONE JOB, THAT WILL BE, AS I... SEE, AS I SAID, TREMENDOUS RESULTS, AND AS I SAID IT TAKES A POLITICAL WILL TO DO IT, TO STAND UP TO POWER, TO FOR-PROFIT CORPORATIONS AND SAY NO. GIVE THEM THE RESPECT AND DIGNITY THEY DESERVE. AS THE DOCTOR SAID, THESE SENIOR CITIZENS HAVE GIVEN TO OUR COUNTRY. WE NEED TO GIVE IT BACK TO THEM.

Steve says I HAVE ABOUT A MINUTE LEFT. 30 SECONDS TO DR. SINHA AND 30 SECONDS TO DONNA DUNCAN. GO AHEAD, DR. SINHA.

Samir says WE HAVE A VERY DEDICATED MINISTER FOR LONG-TERM CARE AND I WOULD SAY WHAT'S HOLDING HER BACK FROM GETTING THESE THINGS DONE? WHAT DOES SHE THINK SHE NEEDS FROM ALL OF US TO GET ACTION NOW? WE HAVE OUR LISTS AND I WANT TO KNOW WHAT'S THE BARRIER FOR HER TO DO THESE THINGS?

Steve says THAT I WILL ASK. DONNA DUNCAN, LAST WORD TO YOU.

Donna says JUST TO ECHO SAMIR'S... HOW CAN WE HELP? WE'RE GOING TO DO THIS. WE ALL HAVE TO DO IT TOGETHER, AND CERTAINLY WE'VE HEARD A LOT OF COMMON REFRAINS TODAY. LET'S BUILD A PROCESS, PUT A STAKE IN THE GROUND, SAY BY THIS DATE, THIS WILL HAPPEN, CLEAR OUT ALL THE IMPEDIMENTS AND LET'S JUST GO. WHAT DOES SHE NEED FROM US TO MAKE THAT HAPPEN? WE'RE HERE TO HELP.

The caption changes to "Producer: Cara Stern, @carastern."

Steve says I WANT TO THANK FOUR OF THE MOST THOUGHTFUL VOICES ON THIS ISSUE FOR GATHERING FOR US TONIGHT ON TVO, SHARLEEN STEWART, DR. ARYA, DONNA DUNCAN, SAMIR SINHA. GREAT OF ALL OF YOU TO SHARE SO MUCH TIME WITH US AND OUR VIEWERS THIS EVENING. TAKE CARE EVERYBODY.

All the guests say THANK YOU.

Watch: Fighting a Second Wave in Long-Term Care Homes