Nursing homes with repeated violations continue to break law, despite Ontario's promise to crack down

Ontario long-term care homes continue to break the law without facing serious penalties, with egregious consequences for seniors in the province.

"We need to really overhaul the inspection regime and make sure that we are properly holding to account, frankly, the slew of bad actors that exist in this sector," said Vivian Stamatopoulos, an associate teaching professor at Ontario Tech University and an advocate on long-term care issues.

After a year that revealed the cracks in the long-term care system, with 3,773 residents dying of COVID-19 in Ontario nursing homes, politicians promised better conditions for those living in long-term care. But some homes continue to be cited by provincial inspectors for serious violations of Ontario's Long-Term Care Act.

Last year, a CBC Marketplace investigation looking at thousands of provincial inspection reports revealed that 85 per cent of homes had broken the same section of the act repeatedly in a five-year period. Most faced no repercussions.

At Orchard Villa in Pickering, Ont., for example, 70 residents died of COVID-19 in the spring and early summer of 2020, the deadliest outbreak of the first wave in the province. Since then, the home has been cited twice for infection-prevention and control violations — once in November 2020, and once in April this year. 

"It's like nothing's changed," said Cathy Parkes, whose father Paul died in last year's outbreak. "You know, you take your eyes off for one second and things go back to the way they were."

When a home is found to have broken a section of the Long-Term Care Homes Act that regulates it, the most common action taken by inspectors is a written notice, where the home is notified that they have done something wrong and asked to fix it.

Thousands of these notices are handed out each year, but often the problems persist.

"I think there is a level of comfort in knowing that there are no repercussions," said Parkes.

Sometimes an infraction simply results in a Voluntary Plan of Correction, which, as the name suggests, is not a mandatory action. The province can also issue Compliance Orders, which guarantee a return visit from inspectors to see if the problem has been fixed. 

According to a CBC analysis of inspection reports posted on the government's website, from 2015 to 2019 there were more than 30,000 infractions recorded by inspectors. Of those, just over half resulted in Voluntary Plans of Correction, and only about one in six resulted in Compliance Orders.

The most serious actions, Director's Referrals, are issued in less than one per cent of infractions. They can result in things like mandatory directives to put a home under new management (a tool that has been used in homes struggling with COVID-19), and revocation of a licence. In 2017, the Ministry revoked the licence of a care home in Trout Creek, Ont., because of ongoing issues with management and care.

There is a provision that would have allowed inspectors to require homes to pay an administrative penalty if they've broken the law and haven't fixed the issue when inspectors return to check. It was added to Ontario's legislation in 2017, but was never enacted, so no homes have faced such financial penalties.

"There are no consequences for noncompliance other than a written warning, which produces no incentive for these homes to actually change their behaviour and do better," Stamatopoulos said.

A recent report from Ontario's Auditor General recommended fines be instituted. However, the government said it wanted to take a more supportive rather than punitive approach to overseeing homes.

Home with repeated violations continues to be cited

In response to the Marketplace investigation in October 2020, Long-Term Care Minister Merrilee Fullerton said there was no tolerance for abuse or neglect in Ontario homes.

Yet cases continue even in homes where issues have been flagged many times before.

Craiglee Nursing Home in Scarborough, Ont., for example, had documented cases of abuse in 2016 and 2017. The home has also had repeated violations for neglect, lack of infection control, medication errors, and poor skin and wound care, according to provincial inspection reports spanning 2015 to the present.

Von and his partner Mary say they didn't know about the infractions when they moved Von's mother Kostadinka into the home in 2017 (CBC has agreed to only use their first names, because they fear retaliation for speaking out). Kostadinka lived in Craiglee until her family witnessed abuse and rough care on video from a camera they had placed in her room.

Von had her transferred to a different long-term care home, where she died in 2019.

After Kostadinka left Craiglee, there were two additional documented cases of abuse in 2020. One was physical, the other financial involving a worker who asked a resident for money.

"Nothing has changed," said Von. "Nothing has changed. Even when we did the interview last year, we've seen how many recurrences there are and it just keeps happening and happening."

A fifth case was documented during an inspection in early March this year. The report says a worker, "used physical force during the provision of care, which caused physical injury to the resident."

Reading the latest report is difficult, Mary said.

"It takes me right back to watching and seeing [those videos]," she said. "I can picture exactly what's happening in this writing. I can see it because that trauma never goes away. It's PTSD. It's still there every year, always, it's going to always stay with you. So reading that, I can see it, and I'm so scared for that person."

Homes with repeated issues are being allowed to operate as normal, when instead they should face harsher penalties, including potentially having their licences revoked, said Doly Begum, the NDP Member of Provincial Parliament for the area that includes Craiglee Nursing Home.

"What is the result when we have all of these homes that are able to get away with such neglect, such abuse? There needs to be real consequences. And unfortunately, right now there is no oversight for that," Begum said.

Company, government respond

Stamatopoulos has been calling for the removal of for-profit facilities from the long-term care system, which she and other advocates believe would improve conditions. For-profit companies had higher COVID-19 death rates last year than non-profit and municipal homes in the province. 

"Until we start to reduce and remove the profits from this sector and actually start to penalize and revoke licences for bad actors, nothing is going to change," Stamatopoulos  said.

The Minister of Long-Term care declined CBC's request for an interview about homes where repeat offences have recently been documented.

A statement from the spokesperson for the Minister of Long-Term Care said homes must report any information about serious harm to a resident to the ministry, and potential criminal offences to police. 

"There is zero tolerance for abuse or neglect of residents in Ontario's long-term care homes," the statement said, echoing the minister's comments in October. 

Southbridge Care Homes, which owns 27 for-profit long term care homes in the province including Orchard Villa and Craiglee Nursing Home, also says it has, "absolutely zero tolerance for abuse or neglect." It adds that it fired employees after an internal investigation into the abuse Kostadinka faced.

The company said "appropriate disciplinary action was taken" in the case of documented abuse in March 2021. It added that staff have also, "implemented a number of measures and changes over the past year," with respect to infection prevention and control (IPAC) at Orchard Villa.

"We have a dedicated, full-time IPAC lead on-site and our epidemiologist is on-site regularly," said Candace Chartier, the company's chief seniors' advocate and strategic partnerships officer, in an email.

For the families that lost loved ones under horrific circumstances, it's hard to hear about ongoing issues. Many have turned to advocacy, lobbying for better conditions. Parkes says she wants national standards for long-term care, with consequences for those who break them.

"I think that it's going to take more people like me, just an average everyday Ontarian, who speaks up for something that they see as wrong," she said.

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