The impact of COVID-19 on residents of Ontario’s long-term care homes has shocked many, including politicians. But it has not surprised those who have been warning for years that the system is broken.

“Sadly, I can’t say I was hugely surprised, but maybe by the numbers,” said Jane Meadus, a lawyer with the Advocacy Centre for the Elderly, regarding the scope of the pandemic in long-term care homes.

Families, advocates for the elderly and others have long warned that staffing levels are inadequate, staff members are underpaid and homes desperately need upgrading.

About 30,000 of the province’s 78,000 long-term care beds are scheduled for redevelopment — meaning they don’t meet standards for safety and infection control. Those include homes in which four residents share rooms, some of which were among the hardest hit by COVID-19.

The Conservative government has committed to building 15,000 new beds but, as has been the case for years, progress is slow.

Meadus says the system must be transformed. “We know a number of things that have to change.”

High on that list are more up-to-date facilities to replace 30,000 beds that don’t meet standards. That should happen quickly, and with federal government help, says Lisa Levin, CEO of AdvantAge Ontario, which represents not-for-profit homes in the province.

“I just want to make sure that we are not going to sit around studying the issue and thinking about it. We need action and we need it fast. We already know there are many shortcomings in the system that we have talked about for years, so why are we waiting?”

Natalie Mehra, executive director of the Ontario Health Coalition, says there must be a discussion about who gets those redeveloped beds: the private corporations that now own the majority of long-term care homes in the province, or the not-for-profits. Researchers and journalists from the Toronto Star have found that privately run homes — some of whom have paid millions in dividends in recent years and whose top executives earn millions — have had the highest rates of COVID-19.

Levin of AdvantAge Ontario said it is too early to assess the difference between the way not-for-profit and for-profit homes managed the pandemic, but that should be part of a review. Previous research found that non-profit homes provide a better level of care, she said.

Staffing is another long-recognized weakness at provincial long-term care homes. Staff members are generally poorly paid and few are offered full-time hours and benefits, which makes it difficult to attract and keep people on what are difficult and sometimes dangerous jobs.

Staff members frequently work at multiple locations to earn a living, something that was a factor in the spread of COVID-19 to many long-term care homes in the province. The provincial government did not take action to temporarily ban work at more than one location until weeks into the lockdown.

But even the pre-pandemic normal in homes was inadequate, say those who have worked in and studied long-term care homes. One former executive said she conducted a study to see how long it took a personal support worker to get a resident up, dressed and showered. The finding was 15-20 minutes, but most PSWs working in long-term care have five or six minutes. During the pandemic, with fewer staff and more complications due to isolation and sickness, many of the jobs workers are expected to do would be virtually impossible, many say.

Advocates have also called for more professionals — nurses and nurse practitioners — in long-term care homes and regulated minimum hours of care per patient, which would require higher staffing levels. There is currently a private members’ bill before the Ontario legislature calling for a minimum care standard of four hours — something long requested by families and others.

Mehra of the Ontario Health Coalition agrees that working conditions, and pay, have to improve for personal support workers and others in long-term care.

She wants to see a reasonable, minimum wage set for the sector and that a percentage of staff have to be full-time.

She noted there has long been a consensus that something must be done to deal with staffing shortages in long-term care homes, and yet it can take workers up to a decade to get full-time hours.

Before the pandemic, the Ontario government appointed a panel to come up with a personal support worker staffing strategy to address chronic staff shortages. That panel is expected to produce a report in the coming weeks.

The pandemic has exposed other shortcomings in long-term care homes, including lack of access to personal protective equipment and lack of proper infection control. Infection control problems are at least partly related to staff shortages

Critics say some of the changes needed in long-term care should begin immediately. But lessons learned from the pandemic will be crucial to further improve the system and protect long-term care residents from future outbreaks or pandemics.

Meadus says that requires an independent inquiry that includes public hearings — not just a commission that the provincial government has committed to launch.

Among other things, an inquiry could look at how personal protective equipment was distributed to long-term care homes and in what numbers; what kind of training staff had with proper use of PPE; and the impact of no-visitor rules that have kept family caretakers and privately hired personal support workers out of homes, at the same time volunteers were asked to work.

Meadus said it is also crucial to better understand why some homes had small outbreaks and no deaths, while others saw COVID-19 spread like wildfire if there is to be permanent change in long-term care homes.

“We have to hear the full story of what happened and why things went better in some places and why other places didn’t do well.”

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