Susanna Kelley (Moderator): Despite a scathing report from the Commission on Long-Term Care and one from the Auditor General, the Minister in charge, Merrilee Fullerton, has refused to apologize for the massive number of deaths in seniors’ homes due to COVID-19. Where does Ontario need to go from here to fix the crisis in long term care? We asked Sarbjit Kaur, David Wills and Chris Loreto.

Sarbjit Kaur:

Who will fix the crisis in long-term care (LTC)?

It has to be the current government. Premier Ford and his government are in power and it’s their job. They’ve had plenty of time and warnings now — they failed our seniors in the first wave and again in the second. No amount of excuses or blaming past governments will give them cover for that.

We can’t get around investing in LTC and health. There’s no way to provide quality care when profit is the motive. There’s certainly room for models that incorporate private providers, however we’ve seen in LTC it’s not working. We can’t continue to experiment with our seniors to try and cut costs. They deserve better.

David Wills:

I agree, the system needs to be re-thought.

Given what LTC residents have gone through, we can all agree we need to do better. Not just in Ontario, but in Canada. It’s too important to outsource.

We have two scathing reports that provide a roadmap. Plus, looking at the data, it was shocking to see how much better public LTC homes did versus private.

If there is a role for private homes, they need stronger regulation, more oversight and much higher standards to protect the people who work there and provide the care. Too many private companies focused on the bottom line at the expense of care.

This is an opportunity for the government to do something bold and transformative. Tweaks will not do it.

Chris Loreto:

First off, I want to thank the Commissioners for the report they produced. It was thoughtful and thought provoking and provides a solid roadmap for the government to follow in investing in the care our seniors and their families deserve.

Many of the recommendations are in line with measures that this government has already taken, including developing thousands of new long-term care spaces, urgently implementing a new staffing plan, and investing in stronger infection control measures in homes.

The report recommends accelerating the implementation of the government’s historic staffing plan, which is being backed with real dollars and real investment in training of Personal Support Workers and other critical healthcare workers.

The point that I found the most fascinating and troubling in the report was that from 2011 to 2018, the population of those over 75 increased 20% while the supply of long-term care beds only increased 0.8% — a net gain of 611 beds.

It was also during this time that the Liberal Wynne government decided to move to a “lighter touch” inspection approach for homes. They cut our seniors to the benefit of their other pet projects that only benefitted their friends.

The Ford government recognized this problem and that is why it committed to renewing 15,000 beds and creating 15,000 new beds by the middle of this decade.

The government is well on its way to deliver on this commitment, but the building of new beds continues to face hurdles, from the cost of land to build new facilities to NIMBYism that is actually making getting local approvals difficult to achieve.

But the building of new beds and the renewal of existing beds is only part of the challenge, as the Commission notes.

The report goes on to say that if the province continues to care for seniors the way that it does that some 96,000 to 115,000 new beds will be needed by 2041 to accommodate demand.

This is clearly unsustainable, so we need to be looking at new models of care — care that includes keeping people in their homes longer, with quality care being provided in the home.

Sarbjit Kaur:

I agree that more beds and a model that stacks our seniors on top of each other is not the answer. That’s why the previous Liberal government made exactly the kinds of investments Chris is talking about — to keep seniors at home longer and provide in home care. It’s more cost effective in the long term and has better outcomes. The investments that the Liberals made in health, education and LTC were very large. That’s just a fact.

We all have to work with budgets and a larger conversation needs to be had about how we fund what we need, but labour costs and the quality that comes with properly paid workers is essential for LTC to improve.

We have Personal Support Workers (PSWs) moving from home to home because they’re working part time at multiple jobs. Some were living in shelters because the cost of living is too high in the places they work. Training without providing a living wage is useless.

The main reason people privatize is to save on labour costs. And when you cut there, you see the results: they’re not good. Again, despite all the lip service, our essential workers that we rely on to deliver the care are not being supported.

David Wills:

Blaming Kathleen Wynne is convenient, but an argument of “we suck less than a previous government” does not help, and may not be accurate.

We don’t need more of the same. We need better. And that starts with the public model that did so much better than the profit model.

The report also said a lack of leadership and accountability carried a lot of the blame. Let’s fix that.

Look at the actions. Private operators continue to get subsidies for empty beds. Inspections were cancelled. Private companies accepted COVID-19 benefits, paid out to shareholders, and did nothing to improve working conditions. We must do better.

The big question is whether you would be comfortable putting a loved one into a LTC care home under the current system. The answer is a resounding no.

Vaccines, not government action, saved our seniors from the third wave. And the plan now seems to be just hoping we don’t ever face a pandemic again. That’s not good enough.

Better home care — yes. Living wage and better working conditions — yes. Paid sick days for all — yes.

And it all starts from the top, including accountability from a Minister who seems to think she did nothing wrong. We must do better.

Chris Loreto:

I have to get partisan because the Wynne and Trudeau Liberals have done nothing for long-term care.

The Wynne/McGuinty Liberals starved our hospitals with zero percent operating increases, didn’t build any long-term care beds, and did little to actually invest in home and community- based care.

They spent their time building LHIN bureaucracies that did nothing to actually integrate care.

Those are just the facts — facts that left Premier Ford and his team with a big mess to clean up.

To David’s point about public versus private long-term care homes, the Commission provides a useful reframing of the tired old NDP anti-private sector rhetoric. The Commission notes the need to ensure that long term care facilities are operated by mission driven entities — entities for whom their core business is providing long-term care.

Here they recommend moving to a P3 model where the private sector is enlisted to build the facilities with the operations delivered by mission driven organizations — be they private, not for profit or public.

This is sensible and long overdue. This also entails reforming the capital and operating funding models which have not been updated since Mike Harris was Premier.

The recommendations of the Commission are straight-forward and practical. The recommendations include a mix of approaches to better pandemic planning and coordination, infection control procedures and protocols, system integration through the acceleration of the implementation of OHTs and procurement reform.

It is a lot for government and the system to take on, but the Commission should be used as a road map for a reinvigorated and separate Ministry of Long-Term Care.

I also believe that the federal government needs to come to the table in a sustained manner, increasing its contribution to health care to 35%, and including long-term care as a fundamental component of the Canada Health Transfer.

It’s time for the feds to step up too.

I do want to end by taking this opportunity to give a shout out to my sister and cousin who are nurses in long-term care facilities. My sister was pulled from Windsor to crisscross the GTA to support homes that were overwhelmed by COVID-19 during waves one and two. I hope the implementation of this report’s recommendations honour her and her colleagues’ heroism during COVID-19.

Chris Loreto is the 1st Vice President of the Ontario PC Party and previously served as Chief of Staff to Ontario’s Attorney General and Minister Responsible for Native Affairs in the Harris government. He is currently Principal at StrategyCorp.  David Wills is a Senior Vice President at Media Profile. He worked as NDP political staff at Queen’s Park and provides counsel to federal, provincial and municipal elected officials. Sarbjit Kaur has worked in Liberal politics for 20 years, including as Director of Communications to a cabinet minister in the McGuinty government. She is a former journalist and currently co -founder of KPW Communications.

The ONW Salon: Who Will Fix the Crisis in Long Term Care?

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