Fullerton’s office did not respond to a request for comment.

The Ontario Health Coalition has issued a series of critical reports on the long-term care system, including one in December that highlighted a shortage of personal support workers.

Natalie Mehra, executive director of the coalition, said that, predictably, those staff shortages became critical during the pandemic. “They should have known,” she said. “It stretches the bounds of credibility for the minister to say she was unaware. I find it beyond belief.”

Early last week, Ford told reporters he was shocked by the revelations of a Canadian military report based on the experience of soldiers inside some of Ontario’s worst-hit long-term care homes. The report alleged that soldiers encountered “horrific conditions,” including cockroach infestations, poor infection control, aggressive staff behaviour and inattention to residents’ needs at five homes in southern Ontario.

“It was the worst report, most heart-wrenching report I have ever read in my entire life,” Ford said. “Until yesterday morning, we didn’t know the full extent of what these homes, what these residents, were dealing with.”
Long-term care advocates, however, point to a large and detailed body of information that should have informed government ministers and their decision-making, including:

• Inspection reports. Fullerton has said nearly 3,000 inspection reports have been conducted inside the province’s long-term care homes since June 2018. Those reports have catalogued a host of problems. A 2015 ministry report found that unaddressed problems in LTC home reports were “most often related to completion of the LTC home plan of care, infection prevention and control, the Residents’ Bill of Rights, skin and wound care, dining and snack service, and communication and response.”

At Carlingview Manor in Ottawa, where 53 residents have died of COVID-19, recent inspection reports identified a persistent cockroach problem, a resident care plan that was not being followed and an unreported instance of sexual abuse by one resident against another.

• The province’s inspection system is based on a risk-management approach. It means the province uses a risk management “framework” to sort long-term care homes into high-, medium- and low-risk categories based on their inspection and compliance histories, management turnover and other risk factors.

In Ottawa, more than one-third of long-term care homes were flagged as medium-risk in 2018, but the province has refused to publicly identify which homes were on that list.

• Long-term care homes are also categorized by the building standards that each facility meets. There are five basic categories: new beds, A, B, C and D. New beds account for more than half of Ontario’s 77,000 LTC beds; their design standards do not allow for three- or four-bed ward rooms.

Those classified as “A” beds were built before 1998, but come close to current design standards, while those in category B exceed the 1972 design standards. There remains in Ontario a substantial number of C beds, which meet 1972 standards, and upgraded D beds, which do not. For the past decade, the province has been pursuing a renewal strategy to redevelop B, C and D beds.

The 1972 design standards stipulate that a four-bed room requires a minimum of 305-square feet. Almonte Country Haven, which opened in 1981, is categorized as a C building and includes four-bed ward rooms with shared bathrooms. More than one-third of its residents — 28 people — have died from COVID-19.

Ontario’s auditor general issued reports on the province’s long-term care system in 2015 and 2019. The reports pointed to problems with the sugar and nutritional content of meals and highlighted issues with a backlogged complaints and inspections system. Those reports joined a stack of other reports from inquests, newspapers and organizations such as the Ontario Health Coalition and the union representing LTC workers, SEIU Healthcare, that all pointed to system failings.

Jane Meadus, staff lawyer at the Advocacy Centre for the Elderly, said anyone familiar with the reports knew what damage the pandemic would wreak on long-term care. “We knew right from the get-go this was going to be a problem: These homes are not equipped, they’re not staffed properly,” Meadus said. “The system was propped up by family members going in and giving care, and private care givers. Now you’ve taken all of that out.”

The Ford government, she said, also curtailed the number of comprehensive annual LTC home inspections, known as resident quality inspections. “If you don’t look, you won’t find,” Meadus said.

The government has never cracked down on poor-performing long-term care homes, Meadus added, because they need the beds to address lengthy waiting lists, and to relieve the pressure on hospitals, which often devote beds to people who should be in nursing homes: “It means there’s no impetus for those homes to change because they can always fill their beds.”

Ontario spent $4.4 billion on long-term care last year.