Ontario’s long-term care sector and the ministry that oversees it were not “prepared or equipped” to manage the long list of problems caused by the Covid-19 pandemic. This, in conclusion, is the result that emerges from the new report of the Auditor-General of the province.

The long-term care pandemic response and readiness report, published yesterday by Auditor-General Bonnie Lysyk, states that as the new coronavirus began devastating the province’s long-term care homes in March 2020, it was obvious that “infection prevention, detection and patient care actions were necessary – and needed quickly – to prevent staggering mortality rates” in the LTC sector.

But none of this happened. What happened instead was a massacre of elderly people. The first cases of Covid-19 were detected in four LTC homes on March 17 last year. From March 2020 to the end of the year, 76% of nursing homes in Ontario reported Covid-19 cases among residents and staff. So far, 3,756 residents and 11 staff members of the province’s long-term care system have died. “Given the long-standing nature of these problems and the risks of serious outcomes, it is necessary to maintain the attention of decision-makers focused on what needs to change, even though vaccines have helped significantly reduce Covid-19 outbreaks and deaths in nursing homes,” Lysyk wrote.

According to the Auditor-General, the directives given to the sector by the province and Dr. David Williams, Chief Medical Officer of Health, have not been clear. “There could have been more clarity and guidance from the chief medical officer of health – Lysyk said – their actions inadvertently complicated matters.”

The report states that in particular, three problems caused the carnage that took place in these facilities.

The first is that, despite the specific recommendations made by a group of experts after the Sars outbreak in 2003, insufficient action has been taken to prepare for the ‘next time’.

The second is that the concerns raised over more than a decade about the systemic weaknesses in the sector have not been addressed while thirdly, the lack of integration with the health sector has not allowed these structures to fully benefit from the necessary life-saving skills.

Many specific problems had an impact on residents, the report states: the elderly, for example, lived in rooms with three or four occupants, nursing homes did not have staff and staff training to properly care for residents was insufficient. In addition, there was a lack of constant prevention and control of infections even before the pandemic.  A “problematic enforcement” culminated in the ministry’s interruption of proactive and comprehensive house inspections in autumn 2018.

And what’s more, Lysyk’s report points out, the ban on families visiting these homes during the pandemic has eliminated residents of a valuable source of care. “The measure was intended to control Covid-19 outbreaks by limiting the number of people entering homes – the report states – however, this lack of contact has resulted in an emotional and physical cost for residents and their families, in many cases resulting in deterioration of the physical and mental condition of the elderly”.

The report makes several recommendations, including the need for the ministry to review the licensing process for long-stay nursing homes so that operators are required to renovate their facilities within a realistic time frame but which must in any case be “short and defined”.

Another recommendation is to examine whether the province’s plan to add about 45,000 beds by 2028 will be enough to meet future needs.

These were the findings of Lysyk’s report, which Long Term Care Minister Merrilee Fullerton welcomed without blinking. After thanking the auditor-general, Fullerton pointed the finger at the previous government. “The leader of the opposition sat in this chamber and had the opportunity for many years to address what she knew and she didn’t and neither did the government of the day – Fullerton told Ontario NDP Leader Andrea Horwath – It is our government that has taken responsibility for this sector so badly neglected for many years under the people sitting right there and I will take no lessons from you as I work to repair long-term care and support staff, residents and families while you neglected it.”

Bonnie Lysyk said she is “cautiously optimistic” about the implementation of her recommendations and minister Fullerton’s intention “to fix things.” “There are a lot of problems in the system that need to be solved,” Lysyk concluded.