Ontario is pouring more than $500M into long-term care, but enhanced inspections aren't part of the plan

Advocates for Ontario's long-term care sector say the province's latest plan to shield residents from a second wave of COVID-19 is missing a critically important element: more frequent and thorough inspections of homes.

The Ford government announced on Tuesday more than $500 million in new funding to protect long-term care, the bulk of which will be used to help homes hire workers, purchase equipment and prevent infections.

However, the plan does not contain any measures to improve inspections or the enforcement of safety regulations, which advocates describe as an ongoing shortcoming that endangered residents when widespread long-term care outbreaks began in the spring.

"The whole inspection idea has been a problem for a long, long time," said Carol Dueck, chair of the Family Council Network 4 Advocacy, which focuses on long-term care.

Dueck described a "lack of consistency from home to home" when it comes to safety measures. She said proactive, annual inspections are needed to ensure that homes are following safety protocols and protecting residents during the current resurgence of cases.

"The inspection process has gotten to a point where it's beyond being useful in certain areas," added Lisa Levin, CEO of AdvantAge Ontario, a senior-care advocacy group.

In 2018, the Ontario government stopped conducting annual, unannounced and comprehensive inspections of homes in favour of a system in which inspectors instead investigate specific complaints at least once per year. The province says the change was spurred by a recommendation from Ontario's auditor general.

"This framework allows us to ensure that every home is inspected at least once, and that beyond that, we can prioritize homes based on risk," said the Ministry of Long-Term Care in a statement.

Ontario NDP leader Andrea Horwath has also called on the province to reinstate annual, comprehensive inspections. She said doing so will allow Ontario to "catch problems before they become the source of a second wave of infections in each home."

Homes were not inspected when COVID-19 first arrived

The change in strategy means that the vast majority of Ontario's long-term care homes have not been subject to a comprehensive inspection since 2018. That period without thorough inspections includes January and February of this year, when the first cases of COVID-19 began appearing in the province.

(You can look up the date of a specific home's last annual inspection here)

By April, the province's long-term care sector had become the deadly epicentre of Ontario's crisis. According to provincial figures, 1,833 long-term care residents and eight workers have died of COVID-19 during the pandemic.

While the rate of cases and deaths in long-term care have slowed considerably since the spring, outbreaks in homes are rising again.

There are 40 long-term care facilities with active COVID-19 outbreaks, compared to a low of 10 in mid-August. There were 276 homes with an outbreak during the peak of the crisis in May.

"I really wish it would slow down, but I don't see that happening," said Levin of the recent uptick in outbreaks.

New LTC commission examining inspection practices

Questions and concerns around the province's inspection regime have become a focus of the newly formed commission examining the spread of COVID-19 in long-term care settings.

A senior manager in the province's inspections division told the commission earlier this month that proactive, annual inspections are no longer being conducted due to the Ministry of Long-Term Care's updated strategy. She also said resource constraints would make such inspections difficult to perform.

"Resource availability was a concern," Pamela Chou told the commission on Sept. 15, when asked to confirm that comprehensive annual reviews were no longer happening.

"Proactive inspections do take [a] significant amount of resource time."

Of the 2,882 long-term care inspections performed in 2019, only 77 were considered proactive rather than reactive investigations related to a specific complaint. Of those 77, only 27 "resident quality inspections" were performed, which are the type of annual inspections that were once mandated annually.

With no indication that comprehensive inspections will return to the province's COVID-19 prevention plans, advocates fear that another long-term care crisis could be looming.

"The angst, of course, is there, that it's not going to hold if we've got a tsunami-type wave," said Dueck.