- Written by Gordon Prentice
The coronavirus pandemic has brutally exposed shortcomings in many of the long-term care homes in Ontario.
But the Premier, Doug Ford, seems reluctant to accept that he is in any way responsible. In a press release today he tells us that he is fixing “what he inherited”.
"As Premier, it's my job to push the system. Fixing what we inherited starts with strong leadership through this crisis and beyond to protect and care for our long-term care residents."
Yesterday, in the wake of the devastating report from the Canadian military, we learned the Province would be deploying inspection teams to long-term care homes and will be taking over the management of five of them.
Clearly, this crisis in long-term care has been brewing for years but for Ford to suggest he comes with clean hands to a problem he inherited is fanciful.
We know from a CBC report last month that the Ford Government scaled back comprehensive annual inspections of nursing homes to only a handful in 2019.
“…only nine out of 626 homes in Ontario actually received so-called resident quality inspections (RQIs).”
CBC News reviewed inspection reports from the last five years for all long-term care homes in the Province and found that while most received a comprehensive resident quality inspection in 2015, 2016 and 2017, the number dropped to just over half in 2018 and just nine last year.”
Who ordered the change in the inspection regime?
Why did the inspection regime change so dramatically – away from unannounced comprehensive inspections to complaint and critical incident driven inspections? What was the rationale? And who ordered the change in the inspection regime?
Newmarket-Aurora MPP Christine Elliott is Minister of Health and Ford’s Deputy. She gave up responsibility for long-term care on 31 August 2019 to a hived-off and stand-alone Ministry of Long-Term Care under Dr Merilee Fullerton.
Fullerton said this week that since the Ford Government was elected (in June 2018) long-term facilities across Ontario have been inspected nearly 3,000 times.
“The inspections, if you did them every five minutes it wouldn’t have changed the crises in staffing in our long-term care homes.”
What is to stop the government giving LTC home inspectors the power to comment on the inadequacy of staffing levels if that is what they find?
Cutting red tape
We know that the Ford Government was keen to lighten the administrative burdens on Long-Term Care Home licensees. Streamlining the licensing process was all part of the agenda to cut red tape and “make it easier for business to operate”.
The Ministry of Long-term Care explains:
“The Long-Term Care Home Quality Inspection Program (LQIP) safeguards residents’ well-being by continuously inspecting complaints and critical incidents, and by ensuring that all Homes are inspected at least once per year…
This is achieved by performing unannounced inspections and enforcement measures as required, and ensuring that actions taken by the government are transparent. The MOHLTC (Ministry of Health/Ministry of Long Term Care) conducts complaint, critical incident, follow up, comprehensive and other types of inspections…”
To be clear, comprehensive inspections do not occur annually and have been dramatically cut back.
Local Long-Term Care
In Newmarket-Aurora there are six long-term care homes – four in Newmarket and two in Aurora. Four are for-profit (Eagle Terrace, Mackenzie Place, Chartwell Aurora and the Willows Estate LTC Home) and two are not for profit (Southlake Residential Care Village and York Region’s Newmarket Health Centre.)
(1) In Newmarket, Revera’s 70 bed for-profit LTC home at Eagle Terrace last had a Resident Quality Inspection on 27 November 2017 when three written notices of non-compliance with the provisions of the Long-Term Care Act were issued. The home has seen one Covid-19 death. The complaints and critical incidents inspections are here.
(2) Revera's 93 bed Mackenzie Place in Newmarket last had a full belt and braces inspection on 26 October 2017 when four instances of non-compliance with the provisions of the Long-Term Care act were found. The complaints and critical incidents inspections are here. 15 residents have died of Covid-19.
(3) At York Region’s municipal 132 bed Newmarket Health Centre LTC Home there has been no Covid-19 outbreak. It last had a full RQI inspection on 12 October 2017. The complaints and critical incidents inspections are here.
(4) In Southlake Residential not-for-profit home, managed by Extendicare, the last RQI was on 7 February 2019. The 224 bed home received 17 written notices of non-compliance. There was a Covid-19 outbreak there but no deaths. The complaints and critical incidents inspections are here.
(5) In Aurora, the for-profit Chartwell Aurora LTC Residence with 235 beds last had a full RQI inspection on 11 January 2018 when seven written notices of non-compliance were issued. The complaints and critical incidents inspections are here. 11 residents have died of Covid-19.
(6) The for-profit Willows Estate LTC Home in Aurora with 84 beds had its last RQI inspection on 9 August 2018 when 12 written notices of non-compliance were issued. There has been no Covid-19 outbreak here. The complaints and critical incidents inspections are here.
You cannot read these reports and not appreciate the immense responsibility that rests on the shoulders of those looking after frail and vulnerable people who are unable to look after themselves.
Staff in long-term care homes need proper support with good pay and working conditions - and there must be enough of them to do the job. But let us also understand that the regulatory regime must be relentless with a return to unannounced, random inspections including stiff penalties for non-compliance.
Doug Ford and Christine Elliott could fix that tomorrow if they chose.
And whatever else they inherited that needs fixing.
Update on 29 May 2020: Inspectors refused to enter care homes says Ford. And from the Toronto Star: Inspectors refused to go in. The Globe and Mail reports that Revera Inc has been fully owned by PSP Investments since 2006. The Public Sector Pensions Investments Board is a Federal Crown Corporation that invests and manages the pensions savings of public servants including members of the Canadian Armed Forces and RCMP. From Global News: Who owns the 5 Ontario long-term care homes cited by military for extreme neglect, abuse?
Note: Southlake Residential Care Village is managed by Extendicare which is a for-profit long-term care home provider. The Ministry of Long Term Care inspection report has Southlake Residential down as a not-for-profit.
Update on 30 May 2020: Ontario makes further amendments to regulations affecting care homes. From the Toronto Star: City run long-term care homes have seen fewer Covid-19 deaths. Are staff wages the reason?
Update on 2 June 2020: Patient Ombudsman opens investigation into long-term care homes. Newmarket-Aurora MPP and Minister of Health, Christine Elliott, was appointed by the Liberal Government in 2015 to be the Province's first patient ombudsman but then quit to run for the PCs in 2018. The CBC's Mike Crawley tells us (on 25 February 2020) that the Ford Government had not filled the Patient Ombudsman position since forming the Government in June 2018.
Update on 10 June 2020: From the CBC: The risk of dying is higher in for-profit long-term care homes.
Update on 9 August 2020: From Newmarket Today: The Perils of Profit in Seniors' Housing.
- Written by Gordon Prentice
In August 2018 contractors employed by the York Catholic District School Board to reconstruct the car park at the Canadian Martyrs Elementary School in London Road, Newmarket used heavy machinery to compact the ground, sending massive shock waves through adjacent homes in Harrison Drive and causing damage. No-one was warned beforehand. The Board denies liability and says residents should claim against their own home insurance policies and their insurers would, in turn, claim against the contractor’s insurer. This proved impossible as insurance companies do not insure against earth movement. The Director of Education, Mr Ab Falconi, decided home owners should foot the bill for the damage caused by the School Board's contractor.
The Director moves on
Ab Falconi, the Director of Education at the York Catholic District School Board, is retiring in August (photo right).
Newmarket Today records Mr Falconi's huge accomplishments in his two years at the helm.
Clearly, he has left his mark on Catholic education but not, alas, on the School Board’s records and information management policy which, to this day, rests on a manual that has not been updated since 1997.
I hope the new Director of Education opens a file on complaints. Remarkably, in this day and age, the School Board doesn't keep any records of complaints. They have no way of knowing who has ever complained about anything.
And it’s not as if the York Catholic District School Board never gets complaints.
When construction vibration from the Catholic Martyr’s Elementary School damaged adjacent properties in Harrison Drive, Newmarket in August 2018 residents complained – and were left to repair the damage out of their own pockets.
Hopefully the Town of Newmarket will do the right thing and protect its residents from rogue organisations that damage people’s property and walk away. It happens more often than you'd think.
The Town is to consider a possible by-law on property damage caused by construction vibration later this year, sometime between July and September. The promised report has slipped before but no worries, the coronavirus has put a spoke in many of the departmental work plans.
More time needed
The revised workplan tells us:
“Additional time needed to liaise with Legal Services to ensure there is a legal means to require/enforce the recommended measures.”
Over a year ago, in March 2019, a report from Planning staff went before councillors which said this:
“Over the course of the review, staff contacted numerous municipalities to determine how they deal with vibration issues from construction activities in their communities.
Of the responses, it appears few municipalities (with the exception of the City of Toronto) have standard requirements for vibration considerations and only require review when a development proposal is in proximity to a rail line.”
Toronto has had a Vibration By Law since 2008. Perhaps we can learn from them.
- Written by Gordon Prentice
Bob Forrest’s calculated and deliberate decision to order the destruction of one of Newmarket’s most historic buildings is without precedent in Ontario. And he got off with a smack on the wrist.
The Town decided not to prosecute, reaching agreement with him without going to Court. He was very lucky.
On the evening of 9 October 2019, the Simpson Building in the Town’s historic Main Street was unlawfully demolished. The storied building, dating from the 1840s, was the apothecary of Ontario’s first female pharmacist, Anne Mary Simpson. It lay smack bang in the middle of the Town’s only Heritage Conservation District.
I contacted each of the 54 Ontario municipalities with Heritage Conservation Districts (HCD) and heard back from every one of them. Many, like Newmarket, have a single HCD. But at the other end of the spectrum we have Ottawa and Toronto with 20 each.
I wanted to know if any of these municipalities had ever brought a prosecution under S42(1)(2) of the Ontario Heritage Act and/or S8 of the Building Code Act for an unlawful demolition within a Heritage Conservation District. (Click on the "Read more" link below.)
Only two reported unlawful demolitions in their Heritage Conservation Districts where prosecutions were brought under the Ontario Heritage Act. But even in those cases the circumstances were very different from those in Newmarket.
Forrest knew exactly what he was doing. As part of the process for securing planning permission for his condo in the middle of the old downtown he ended up commissioning not one but two Heritage Impact Assessments on his Main Street properties. He was aware of the historic importance of the building.
Looking back, what happened was an avoidable tragedy. However, a new report from the Town’s planning staff gives us hope that nothing like it will ever be allowed to happen again.
The Town’s new Heritage Planner, Patricia Cho, pledges to beef-up the enforcement of the Property Standards By-Law
“to better ensure compliance with heritage provisions”.
The report tells us heritage buildings should be protected against demolition by neglect. In future, planning staff with cultural heritage expertise will accompany enforcement officers when inspecting heritage buildings.
This deserves a round of applause but it must be carried through in practice.
The shocking truth is that Bob Forrest’s empty heritage buildings on Main Street were allowed to decay for years before our very eyes. We got used to seeing blue tarpaulins flapping in the wind, supposedly protecting the interiors from the elements.
Since those days we have mercifully seen a change of guard in the Planning Department. And the former Mayor, a keen supporter of Bob Forrest’s condo plan, is now MP for Newmarket-Aurora and out of things.
I see grounds for optimism.
- Written by Gordon Prentice
Why did Newmarket-Aurora MP, Tony Van Bynen, miss the key House of Commons Health Committee meeting yesterday concerning the crisis in long-term care? Instead he travels 412km to Ottawa to read a question about agriculture from a script, which lasts 25 seconds.
I suppose it is a question of priorities.
This is Van Bynen’s zinger:
“Mr. Speaker, my understanding is that the Conservative government cut $400 million in 2013 from the AgriStability fund and the business risk management programs. Why is it now, when we are improving the program, that this is such a significant improvement?”
This gobbledegook has, apparently, some relevance to Bill C-16 which amends the Canadian Dairy Commission Act to increase the Commission’s borrowing powers. The Bill is supported by all Parties in the House and there is no need for a roll-call vote.
To cover for him while he is away in Ottawa, Van Bynen asks Markham-Stouffville MP, Helena Jaczek, (Liberal) to take his place. (The Standing Orders of the House of Commons allow for the appointment of “acting members”.)
Knows her onions
Helena Jaczek certainly knows her onions. She is a medical doctor by training and was the Minister for Community and Social Services in Kathleen Wynne’s Liberal Government from 2014-2018 and Ontario’s Minister of Health and Long-Term Care in 2018.
She asks a series of pertinent questions. She wants to know, for example, what the Federal Government should be doing to assist in the redevelopment of long-term care homes which are outdated and no longer fit for purpose. We are told that homes with more modern designs have had greater success in preventing the spread of Covid-19.
I watch the entire three-hour committee session and, though the technology played up from time to time, I find it informative and learn a lot.
Sticking to the script
Sadly, we don’t get the chance to see Van Bynen at work, quizzing the experts on how we should tackle the crisis in long-term care. What issues would he raise? Would he express a point of view? Would he ask penetrating follow-up questions based on what he had just heard? Or would he stay safe, metronomically sticking to a script?
Van Bynen had lots of material to draw on. One of the worst outbreaks in the whole of York Region is in his Newmarket-Aurora riding at Revera’s Mackenzie Place in George Street.
This is what Newmarket Today tells us in its latest update:
Outbreaks remain active at five facilities in Newmarket, including at Mackenzie Place, which has one of the most severe outbreaks in long-term care homes in the region with 80 residents and 24 health-care workers testing positive, as well as 11 deaths.
I now know what my MP thinks about ancient Conservative cuts to the AgriStability fund and the business risk management programs.
But I don’t have a clue on how he would go about fixing the crisis in long-term care and whether the private sector should still have a role.
Update on 15 May 2020: From Newmarket Today: Two more deaths at Mackenzie Place bringing the total to 13.
Update on 16 May 2020: from the Toronto Star: for-profit nursing home chains make big payouts to shareholders, execs.
Update on 18 May 2020: Latest on the local impact of Covid-19 from Newmarket Today:
"Fourteen residents of Mackenzie Place have died as a result of the outbreak that continues to have the highest number of COVID-19 cases in the region, with 80 residents and 24 health-care workers at the 93-bed home testing positive."
How Tony Van Bynen MP spends his time. Tweeting furiously. Signalling non-stop activity.
- Written by Gordon Prentice
The coronavirus has taken a terrible toll at one Newmarket long-term care home, Mackenzie Place, a short walk from where I live.
A couple of weeks ago I noticed a colourful poster on the dining room window telling passers-by:
“Heroes walk through these doors every day”.
Containing the virus
The staff work valiantly to contain the virus but it spreads relentlessly. By May 8th Newmarket Today was reporting 11 deaths at the home. 78 residents and 23 staff had tested positive.
This is the biggest outbreak in York Region.
I find myself wondering why the virus cannot be contained.
The interim guidance on how to control Covid-19, published by the Public Health Agency of Canada over one month ago, on 8th April, was reassuring.
Belt and braces
To me, the guidance seemed like a real belt and braces job, spelling out the steps that should be taken to keep residents and staff safe.
However, I now learn from Jodi Hall, the Chair of the Canadian Association of Long-Term Care, that the guidance from Public Health Canada is “basically impossible” to follow in many care homes which have outdated facilities.
Many homes have “four-bed, hospital-like wards with residents separated only by a curtain”. In these circumstances, preventing cross infections is challenging.
Mackenzie Place is owned and operated by Revera, one of a number of private sector providers of long-term care.
Four times more likely
Over the weekend, the Toronto Star reported that Covid-19 deaths in Ontario are far higher in for-profit nursing homes. Its analysis
“shows residents in the province’s for-profit facilities are four times more likely to become infected and die from the virus as those in municipally operated homes.”
If this is true it is deeply worrying and begs the fundamental question of whether the private sector should be in the business of long-term care at all.
Pat Armstrong, a Distinguished Research Professor of Sociology at York University, believes long-term care should lie in the public sector. She gave her reasons to the CBC’s Michael Enright in a fascinating conversation on his Sunday Edition on 26 April. Meals and staffing are prime candidates for cost control.
Professor Armstrong paints a picture of what long-term care can be like given imagination and resources. She points to examples overseas, in Scandinavia, where long-term care offers residents a fulfilling and stimulating life.
Questions and Answers
I hope these themes can be explored by the House of Commons Health Committee when it meets on Wednesday, 13 May 2020. It will be webcast from 4pm-7pm and Pat Armstrong and Judi Hall are amongst the witnesses.
Newmarket-Aurora MP, Tony Van Bynen, is a member of the Committee and I hope he will explore the public/private issue in the time he has available.
But if this is outside the Committee's terms of reference for the current inquiry - and it may be - he may wish to focus on the guidance from Public Health Canada which is, apparently, in many settings impossible to follow.
Update on 12 May 2020: From the Toronto Star: National Standards of Care Needed says Federal Minister. And Martin Reg Cohn argues that accountablity and responsibility matter more than ownership. Cohn writes:
"The Ford government decided last year to end comprehensive annual inspections, opting instead for a complaint-based model — as if seniors suffering from dementia, or without extended families, can truly benefit from the premier’s fetish for snitch lines or online web forms. There is no excuse for not regulating and inspecting comprehensively, annually and aggressively."
Update on 13 May 2020: The Province says it is taking steps to better protect residents and staff in long-term care homes. And the Toronto Star calls for a public inquiry into the crisis in long-term care.
Update on 19 May 2020: Province announces independent inquiry into long-term care.
Update on 21 May 2020: From the Toronto Star: Long-term Care - Ontario needs the real deal.
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