Bleeding infections left to fester. Cockroach infestations. Residents left in soiled diapers and force-fed, causing audible choking.
The Canadian Armed Forces (CAF) issued a harrowing report on the five long-term care homes in which they were called upon to help manage COVID-19 outbreaks. Their report revealed conditions Premier Doug Ford said were "heartbreaking," "disgusting," and could end in criminal charges.
The full extent of the revelations is impossible to summarize, but some include:
- Staffing levels are so dire that residents are "often sedated with narcotics when they are likely just sad or depressed," since no one can care for them.
- Burnout is endemic among staff. Many have no time off, and haven't seen their family in weeks. "Regular arguments" are witnessed between staffers.
- Some staff engage in "aggressive" behaviour such as "not stopping or slowing when residents complained of pain, pulling residents, aggressive transfers...degrading or inappropriate comments directed at residents etc."
- Some staff give families "inaccurate" information about their loved one's feeding, pain levels and general condition.
- Staff are scared to use supplies that cost money, often fearing for their jobs.
- Medical supplies are reused "even after sterility has been obviously compromised." The example given was a "catheter pulled out and on the floor for an undetermined amount of time."
- "Very poor" catheter care in general, including nearly a dozen incidents of "bleeding fungal infections."
- Residents are left in soiled diapers, "leading to skin breakdown."
- "Significant gross fecal contamination was noted in numerous patient rooms."
- New staff are poorly or not at all trained.
- Residents get pressure ulcers from little to no turning in their beds.
- There is no mandatory independent verification of narcotics, leading to a "high risk of dosing error."
- Residents were heard crying for help with staff not responding in some cases for over two hours.
- Residents sometimes go unbathed for "several weeks."
- "Inappropriate PPE use noted throughout all staffing levels (doctors included)."
Four out of the five homes — Eatonville Care Centre, Hawthorne Place Care Centre, Orchard Villa and Altamont Care Community — are privately owned and for-profit, a factor that has been repeatedly shown to result in worse care on average. The last, Grace Manor, is run as a non-profit.
All of the facilities' last resident quality inspections — unannounced, comprehensive inspections which are supposed to be yearly — were conducted in 2017 or 2018. The Ford government completed only a handful of these inspections last year, CBC reported in April.
Ford promised "justice" and "accountability" to the families of residents affected by the conditions in the homes. The province is investigating the army's findings, and will share the results with police, he said. Ontario has referred one death at Orchard Villa to the provincial coroner, who is investigating it, the ministry of long-term care said. It is described in the report as a failure to sit a resident up for feeding, resulting in "code blue due to choking during feeding while supine — staff unable to dislodge food or revive resident."
“I know the public wants answers. And I promise you, my commitment to the people of Ontario is that I will get those answers," Ford said.
The five homes have seen "significant improvements" in the issues outlined in the report, Long-Term Care Minister Merrilee Fullerton said. But Ford asked the army to extend their mission for another 30 days, to make sure they continue to improve. He also called for federal support as the province works to fix the "broken system."
Ford said reading the report was the hardest thing he's done as premier, and that he personally ordered the report be made public.
"You need to know exactly what I know," he said.
He added that the buck stops with him as premier, and that he takes full responsibility — though he noted repeatedly that the system was "broken" when his government inherited it.
The CAF report raises questions about the state of long-term care in general. Ford was asked if conditions were this awful in these five homes, how can the province be sure similar situations aren't playing out in the hundreds of others across the province.
“I don’t believe it’s just five. We have to do a deep, deep dive into all the homes,” Ford said, asking for federal financial support to complete the task.
Ford also brought up the independent commission the government is planning for September, promising to fix the system, “no matter what cost it takes."
But the government is facing mounting pressure to commit to a full public inquiry of Ontario's long-term care system, instead of a commission, which could have less power and a narrower mandate. Ford again declined to commit to one, but said "everything's on the table."
“I’m not ruling out anything after reading this," he said, though he added that the immediate priority is stabilizing the homes.
The premier also appeared open to the idea of ending private ownership of long-term care facilities, bringing them under provincial jurisdiction like the rest of the health-care system. “If that’s what it takes, that’s what we will do," he said.
Ford, Fullerton and Health Minister Christine Elliott said they knew things were bad in long-term care before this report and were working to fix the issues — but insisted they did not know of the extent of the problems revealed in the CAF report. Fullerton said COVID-19 tipped some homes that were experiencing problems into full-blown crisis.
“We did everything we could. There is nothing we’ve held back,” Ford said.
The ministry of long-term care said the CAF's mandate did not include writing this report — members did it of their own volition.
"The purpose of this letter is to ensure that these observations do not go unnoticed by our chain of command, the Province of Ontario, and most importantly at the individual LTCF..." the report reads. It was forwarded to the province by federal Public Safety Minister Bill Blair, who in a letter to the Ford government said Ottawa has a "desire to work with your government toward a positive outcome" in the affected facilities.
One union representing thousands of nursing and retirement home workers said it has been "ringing the alarm bells throughout this entire crisis" about these issues.
"Unfortunately, we have had to fight the provincial government every step of the way to ensure long-term care companies were keeping workers and residents safe," said SEIU Healthcare President Sharleen Stewart in a statement.
Decisions to eliminate paid sick days, limit inspections in in long-term care and conduct some via phone — as well as failing to take action on staffing levels — contributed to the crisis, Stewart said.
The Ontario Hospital Association said the planned commission into long-term care "cannot wait."
"This review should happen immediately and while it must focus on long-term care, it should be broadened to prevent a siloed approach to the complex quality of care issues facing frail seniors. With the pandemic far from over and a second wave inevitable, remedial measures are needed now to prevent further tragedies from unfolding in the future," OHA CEO Anthony Dale said in a statement.
The advocacy group Ontario Health Coalition noted that it and other groups have also been raising similar concerns for years — including a lack of personal protective equipment, poor infection control and training, and the government's hesitancy to intervene in homes with "incompetent or negligent management."
“We are beyond frustrated,” OHC head Natalie Mehra said in a statement. “Thousands of staff and residents alike have been infected with COVID-19, almost 1,500 residents and staff have died, yet we are still waiting for a coherent coordinated plan from Ontario’s government to intervene actively in long-term care homes with outbreaks.”
The Ontario Long-Term Care Association reiterated the need for "urgently needed short-term interim solutions" such as more personal protective equipment, rapid testing, and more provincial investments in older homes for better infection controls, CEO Donna Duncan said in a statement.
NDP Leader Andrea Horwath called for Fullerton's resignation, saying it shouldn't have taken an armed forces report to reveal these conditions.
"The premier cannot pass the buck, finger-point, and express outrage about what his own government is doing on his watch. He has no choice to immediately require the resignation of Minister of Long Term Care Merillee Fullerton," she said in a statement.
Horwath repeated her call for a public inquiry and provincial takeovers of all unsafe homes.
“The conditions and treatment of seniors revealed in this report are outrageous, horrifying and saddening. The horror seniors in these homes are being forced to live is inhumane. It breaks my heart to think about what these people are living through even today, and how scared and outraged their families must be feeling right now. I can only imagine their anguish," she said.
Liberal Leader Steven Del Duca also called for a public inquiry, saying the issue is "more than just about five homes — we must ensure that every resident of long term care is treated with dignity and respect."
Green Leader Mike Schreiner backed the public inquiry call as well.
"It is shameful that political calculations are getting in the way of making the right decision to call an independent public inquiry," he said in a statement. "Passing the buck to the last government doesn’t cut it when you’ve been in power for two years and spent that time preoccupied with license plates and gas station stickers."