Ontario long-term care homes with poor care records are getting tax dollars to expand
A CBC analysis shows enforcement and accountability measures lacking since the new Fixing Long-Term Care Act
While the Ontario government says it's on track to hit its target of 30,000 new long-term care beds by 2028, a CBC News analysis of government records found several of the homes that plan to expand with taxpayer support are run by operators with repeated violations or poor outcomes through the pandemic.
Minister of Long-Term Care Paul Calandra says he is confident that homes will be compliant with new accountability and oversight tools introduced in their legislation, the Fixing Long Term Care Act, which came into effect in April 2022.
However, some measures designed to fix problems in Ontario long-term care since the pandemic appear to fall far short of what the province promised, with fines applied inconsistently and proactive inspections only happening in a fraction of the homes.
CBC News looked at the monetary penalties issued from April 2022 to the beginning of May 2023, and examined each home's inspection reports which detail the specifics of the violations. Those reports were then compared to some homes with similar repeated violations who haven't received fines.
CBC also compared proactive inspection counts before and after the pandemic, and found that where homes used to get a proactive inspection once a year before they were cancelled in 2018, only a fraction have had proactive inspections since reinstating them in 2022.
Meanwhile, as part of the push to hit its target for new long-term care beds, the province is paying for expansions at homes run by operators with some of the worst COVID outcomes.
Calandra remains confident in the homes the ministry has supported, he told CBC in an interview.
"The regulations that we have put into the Fixing Long Term Care Act, the standards that we put into that, far exceed anything that was being done prior," said Calandra.
"We're going to make significant investments but the standards are going to be the highest in North America."
But Jane Meadus, a lawyer with the Advocacy Centre for the Elderly says the province shouldn't be so quick to trust the operators that she says have failed seniors in the past.
"I think that you [should] have to show that you have a good track record in order to get these expansions and get this extra money," said Meadus, refering to the subsidies for expansion.
"I think they shouldn't be rewarded," she said. "In fact, I don't think they should be getting licences."
Only some homes seeing penalties for breaking rules
Early in the pandemic, Premier Doug Ford said he "wouldn't hesitate to pull licences" after the military was called in to some homes struggling to keep their residents alive. The Canadian Armed Forces reported cockroaches and filthy conditions inside homes, with some residents dying of dehydration rather than COVID.
But instead of pulling licences, his government opted to revamp the Long-Term Care Homes Act to increase oversight and enforcement measures with the expectation that they would bring any bad actors into compliance.
One of those enforcement measures was "administrative monetary penalties" (AMPs) for failure to comply with the act. It also included potential fines of up to $1 million for corporations that failed to follow the law.
CBC found most penalties were $1,100 or $5,500 regardless of the type of offence, which ranged anywhere from poor handwashing to physical abuse of residents by staff.
Most infractions were for infection prevention and control failures, medication errors, poor skin and wound care and staff-to-resident abuse. The charges compounded the more times the offence was repeated, but didn't reach more than $16,500 — a far cry from the million-dollar maximum the ministry touted in its new act.
"I really am concerned that they're not using the tools that they said that they put in the legislation," Meadus said, adding that the new Fixing Long-Term Care Act was supposed to make it easier for the government to lay fines.
More inspectors, fewer proactive inspections
Another enforcement measure the province set forth in 2022 was to bring back proactive inspections of long-term care homes. A previous CBC analysis of inspection reports found that inspectors used to do comprehensive proactive inspections of nearly every home each year, but stopped them in 2018 — a move the ministry said was meant to fix a backlog of reactive inspections triggered by complaints and critical incidents.
From 2015 to 2017, the Ministry was averaging over 600 proactive inspections annually. In the 14 months since bringing a new version of proactive inspections back, as of June 20, the Ministry has only managed to do 105.
"I think that because we're not doing these full inspections, we have yet to see the full range of really what's going on in long-term care today," said Meadus. She says if the province isn't consistently inspecting each home in a comprehensive, proactive manner, monetary penalties fall short as an enforcement tool.
"The operators, I think, feel that they can sort of get away with a lot of things because there hasn't been consequences of any real sort at all," said Meadus.
"They're getting more money, they're getting new buildings, which the province is funding, and they're getting extra licences, more beds, so nothing has happened in that realm."
The Ontario government has committed $6.4 billion to build 30,000 more long term care beds by 2028, and to upgrade 28,000 more. The Ontario Ministry normally gives construction subsidies to homes to upgrade, ranging from $20.53 to $23.78 per bed, per day, paid to the operator on a monthly basis for a period of 25 years.
But now, if projects manage to start construction by Aug. 31, 2023, they will receive an additional subsidy of up to $35 per bed, per day, for 25 years.
Homes with poor COVID outcomes now expanding
The lack of consequences for homes with some of the worst death rates through the pandemic is particularly upsetting to those who lost loved ones there.
Seventy residents died at Orchard Villa, a long-term care home in Pickering, Ont., in the first wave of the pandemic. The fact that the government is pushing forward an expansion that would see the home take on more residents and receive millions in taxpayer subsidies adds insult to injury for Cathy Parkes, whose father Paul was one of the first to die there.
"The amount of profit that that is going to bring in when they're not actually shown that they've changed anything is unbelievable to me," said Parkes. "They continue to make their profit and behave in the same way and it's a free pass. And it's a free pass at the expense of people like my father."
Conditions got so bad at Orchard Villa during the pandemic that the military was deployed there and to four other Ontario homes. A report from the Canadian Armed Forces revealed a chaotic scene of residents sleeping on bare mattresses because of lack of supplies, a resident's broken hip not being addressed by staff, and residents being fed laying down in their beds which led to a choking incident that "may have contributed to a resident's death."
Families who were able to remove their sick loved ones and bring them to hospital reported they were suffering from malnutrition and dehydration.
Orchard Villa is owned by Southbridge Care Homes, a for-profit chain with over 30 homes across the province. Those homes that were exposed to COVID had a death rate more than double the provincial average and triple that of non-profit homes, according to a previous CBC analysis after the first wave of COVID.
Orchard Villa had 14 non-compliances in their last posted inspection in January 2023. This included infection prevention and control failures and failure to report critical incidents — both of which the home had already been written up for in 2022. Still, there were no monetary penalties issued.
"They've had three years to make really significant changes and they haven't," said Parkes. "I'm not sure how you reward that with a 30-year licence."
CBC contacted Southbridge multiple times for comment, but received no response.
More inspections, fines coming in fall: Calandra
Ontario Minister of Long-Term Care Paul Calandra has voiced his support of Orchard Villa's expansion plans publicly, and told CBC in an interview that he's confident his Fixing Long-Term Care Act will bring accountability and oversight.
"Orchard Villa in particular, in Pickering, should have been torn down long before the pandemic hit," said the minister. "We're going to build a new state-of-the-art home, we're going to build infection prevention and control that is built into all of our new homes as part of the standard."
Calandra also said more proactive inspections are coming when the newly hired inspectors are trained up by the fall — and bigger fines will come then. He said he'll be working with care providers to ensure the homes the government has invested in will follow the regulations.
"We explained to them we're going to make significant investments, but the standards are going to be the highest in North America," he said. "I will hold every home accountable to meeting those very, very high standards."
Minister's Zoning Orders bypass community opposition to projects
The province has already granted Southbridge hundreds of new bed licenses at least three Southbridge homes, and has issued Minister's Zoning Orders (MZOs) for three more Southbridge homes. These orders bypass any municipal or community opposition and allow the company to get building right away.
There have been 19 MZOs issued to long-term care homes since 2018.
"Nobody is saying that these homes shouldn't be built, we're saying that there is a huge problem in the management of the homes," said Jane Meadus.
"They don't have a track record ... and so why are we allowing them to have, you know, millions and millions of dollars of money? A new building is not going to fix poor care," she said.
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With files from Albert Leung