The PC government continues to stonewall the release of the most at-risk long-term care homes in Ontario although a new analysis shows that the 30 worst LTCs account for close to half of the coronavirus fatalities in the province.
Those 30 homes, based on an analysis of publicly available figures, paint a picture of some of the hardest-hit places in Canada. As of Tuesday, they account for a collective 1,007 deaths as the pandemic has ravaged long-term care homes in the province, where officials have struggled to ensure the safety of vulnerable seniors and the military has been mobilized to provide assistance.
The 1,007 fatalities in these 3o long-term care homes account for 70 per cent of the 1,445 fatalities in Ontario's 630 long-term care homes, and 44 per cent of the 2,276 fatalities across the province. The list of the worst long-term care homes, as judged by the number of fatalities in homes with an active outbreak, reveals that they are predominantly for-profit institutions, a majority are managed by four companies, and half of them have not received comprehensive inspections within the current government's mandate.
"This is horrifying," Opposition Leader Andrea Horwath said when informed by QP Briefing of the acute fatality total in a handful of long-term care homes. She argued that the government needs to take responsibility for what has happened in Ontario's long-term care homes, including actively informing the public of the "unfathomable" conditions and results.
"This falls at the feet of Mr. Ford and Ms. [Merrilee] Fullerton," she said of the premier and the long-term care minister, reiterating her call for Fullerton's resignation and for more transparency from the government.
The findings come as the government refuses to reveal its "red list" of the most high-risk long-term care homes in the province despite opposition calls and the mounting death toll. This list ranks the province's LTCs into three buckets, with red being the most at-risk, yellow showing medium risk and green showing homes that are meeting standards. This disclosure is provided in Quebec, which has also seen devastation in its long-term care homes.
The list of the 30 worst-hit homes is based on publicly available fatality information of homes with a current outbreak. It is not the government's red list, and the government has said that 19 homes are currently on its list and that it was previously 30.
In response to this story after publication, the spokesperson for Minister of Long-term Care Merrilee Fullerton, Gillian Sloggett, stated that they don't want to release the information in part so that inspections are as authentic as possible. "We want our inspectors to see exactly what the situations are on the ground. We don’t want to give any advance notice, because changes can be made, which might not be reflective of the actual situation in the home."
She added that the government is committed to openness, and pointed to Ontario's website where residents can learn more detailed facts and figures. "Open lines of communication are essential at this challenging time, and we are committed to being transparent with the people of Ontario."
The refusal to disclose the red list is despite Premier Doug Ford's April 2 promise to be forthright with Ontarians on health information. "I just want to be very clear: I'm always going to be transparent," he said at a press conference where he announced he would release data modelling figures. "I'm just going to be straight up with people, just tell 'em exactly what I know, no beating around the bush, no holding back figures, I want to be right upfront."
The government has offered two explanations as to why it has not released the red list. Firstly, Fullerton has said that the situation is "fluid," which Health Minister Christine Elliott elaborated on today. "The minister has also indicated that the lines between red and yellow can change on any given day," she said, referring to Fullerton. "We’re hoping that they're all going to move from yellow to green, but it is a very volatile situation, and the minister has indicated that she wouldn't think it fair to express on any given day what a situation was, when a day or so later it could change dramatically."
Judging by the metric of fatalities in the 30-worst long-term care homes with current outbreaks, there has been some movement over time. On May 26, 21 of the 30 long-term care homes with the most deaths were for-profits. But that increased to 24 by June 2 as some non-profits and one municipal home stabilized their situations, while some for-profit homes continued to struggle. Some homes, like the municipally run Seven Oaks, no longer have an outbreak.
None of the 30 worst long-term care homes with existing outbreaks are municipally run; those homes also receive a 25-per-cent top-up in funding from municipalities, which goes in part towards better staff ratios and higher wages. While some municipal homes have been hard hit, the fatality rate at for-profit homes has been four times worse, according to a Toronto Star data analysis. Non-profits have seen worse outcomes than municipal facilities but better than for-profits.
For-profit homes are overrepresented in the list of the hardest-hit long-term care homes. As of February 2019 they represent 58 per cent of the LTCs in the province but account for 80 per cent of the homes on the list of the worst 30 with active outbreaks. International studies also show that for-profit long-term care facilities have poorer outcomes, on average.
The other argument the government has offered more recently is that identifying the worst long-term care homes could tip them off as to surprise inspections.
Elliott also explained the government's thinking on that front on Thursday. "The minister of long-term care has indicated that she is concerned, especially now with the inspections that are needed in our long-term care homes, that there not be any indication of which ones will be selected because we want to see exactly what the situations are on the ground at that time. We don't want to give any advance notice, because changes can be made, which might not be reflective of what the actual situation is."
This approach comes after the government has faced significant criticism for changing its approach to long-term care inspections upon taking office. The CBC first reported that the government conducted only nine comprehensive long-term care inspections in 2019, although most of the province's 630 homes received them in 2015, 2016 and 2017.
Comprehensive inspections, otherwise known as RQIs, are unannounced inspections that look at the whole home with several inspectors over a period of four to five days. But the PC government has shifted to an emphasis on complaint-based inspections, which look at isolated incidents rather than the long-term care home as a whole, and which rely on the vigilance of families to work within the system on behalf of their loved ones.
Orchard Villa, a Pickering long-term care home that has seen 70 coronavirus-related fatalities, had seen a series of complaint-based inspections since the government took office in June 2018, with reports finding staff neglect, improper continence care and an inadequate supply of clean linen, among other issues. But the last time Orchard Villa received a comprehensive inspection report that looked at the home as a whole was March 2019, according to records.
Horwath doesn't buy the government's explanations as to why it won't release the red list despite the crisis that has seen so many deaths.
"Who is Mr. Ford protecting by not putting this list out there?" she asked, rhetorically.
She proceeded to suggest that the beneficiaries of this lack of disclosure were private companies, and pointed out that multiple PC insiders are actively lobbying on behalf of those companies. "Have they been in Mr. Ford's ear? Is Mr. Ford listening to their advice not to make this list public?"
The companies with the most entries on the list of the worst 30 long-term care homes are Sienna Living (five), Revera (four), Rykka (four), and Extendicare (three). Collectively, the four companies, which are among the largest in the sector, account for 16 of the 30 homes on the list. Former Ford campaign spokesperson Melissa Lantsman is registered to lobby on behalf of Extendicare, while former PC government staffers Lauren McDonald and Michael Wilson are lobbying for Revera.
Nine of the 10 worst homes with active outbreaks are for-profits. They are: Orchard Villa, Camilla Care Community, Carlingview Manor, Downsview Long Term Care Centre, Altamont Care Community, Forest Heights, Isabel and Arthur Meighen Manor, Hawthorne Place Care Center, Madonna Care Community, and Eatonville Care Centre.
Donna Duncan, the chief executive officer of the Ontario Long-Term Care Association, which represents for-profit and non-profit homes in the industry, has supported releasing the red list. But she wants the focus to be on short-term and long-term policy solutions that can best support seniors. "The OLTCA has been clear that code red homes should be supported, not stigmatized, and urgent solutions should be implemented immediately to get them back on track and further protect the majority of homes who have successfully kept COVID-19 out."
Iacovos Michael, a post-doctoral cancer researcher recently associated with the Swiss Institute for Experimental Cancer Research, said sharing more information with researchers and the public would be helpful.
"We should have full transparency from the government," he told QP Briefing. Michael has been working with fellow volunteers to compile and analyze public on Canadian health care risks due to the coronavirus, sometimes compiling them from news reports when government data isn't available.
1/12 This is sad and devastating. Almost 50% of the #COVID19 deaths in #Ontario were at nursing homes - RIP @fordnation #COVID19Ontario #LTC #pandemic @JohnTory @OntariosDoctors @ONThealth #onpoli pic.twitter.com/fZgZ3w807J
— Iacovos Michael (@IacovosMichael) April 8, 2020
He argued that the health care crisis is partially a data crisis too, and this can help explain why the level of Ontario positive tests has stayed steady rather than declined. "The fact that we have this plateau is in part because we don't have the right metrics."
Horwath said that Ontarians have a "right to know" the latest about at-risk long-term care homes. "They can know whether a restaurant has public health citations," she said, referring to how restaurants in Toronto are mandated to display the green, yellow or red results of public health inspections to inform the public. She didn't look fondly on the contrast that the government isn't providing this information when it comes to long-term care homes. "It shows no value for loved ones we have in long-term care."
With files from Jack Hauen