For a year, the Doug Ford government has been blaming the tragedy that played out in the province's long-term care homes on the historic neglect of the sector.
But the independent commission into the COVID-19 crisis in long-term care, struck by Ford nine months ago, has found the current government shares in that blame for a "slow and reactive" pandemic response.
The commission, led by retired associate chief justice Frank Marrocco, along with former Ontario Public Service executive Angela Coke, and former hospital CEO Dr. Jack Kitts, released its final report Friday evening. It details the systemic failures of long-term care in Ontario over decades, the failure of recent governments and the bureaucracy to prepare for a pandemic, the failure of the current government to recognize the danger the pandemic would pose to long-term care when it should have been clear, and the Ford government's failure to protect vulnerable residents when the virus breached their homes.
The commissioners interviewed more than 700 people, including the Chief Medical Officer of Health, the Minister of Health, and Minister of Long-Term Care in February. On the eve of those crucial meetings, the province dumped more than 200,000 records on the commission — documents it had been requesting for months.
Their report provides extensive recommendations for fixing the system, including reforming the business of long-term care to get profit-motivated entities out of caregiving roles. That means, according to the commission, relying on private-sector investment for the building and rebuilding of physical infrastructure but restricting the business of care to "mission-driven entities" be they for-profit or non-profit. Such an arrangement would be modelled after the hospital sector.
"Now is the time to revisit the delivery model for long-term care and adopt a better way to provide care for Ontario’s seniors," they wrote.
They also gave detailed recommendations on boosting staffing more quickly than the province is planning to, fixing the broken inspection and enforcement system, improving infection prevention and control practices, and providing counselling to the residents and staff who survived the horrific ordeal of the last year.
The commissioners' empathy for those people is made clear in their introductory remarks, in which they outline numbers that are "hard to comprehend": 15,000 resident COVID-19 cases and nearly 4,000 deaths, 6,700 staff cases of COVID-19, and 11 deaths.
"The numbers do not tell the stories of residents who begged for help and answers as life slowly drained from their bodies and light dimmed in their eyes," they wrote. "The numbers do not speak to the extreme heartbreak of families who peered into windows of long-term care homes to see their loved ones locked down like prisoners.
"They do not illustrate their constant pleas, many of which went unanswered, and the tireless efforts of some long-term care staff to protect and save them. The numbers do not reflect the incredible bravery, dedication and suffering experienced by long-term care staff and others who risked their own lives and worked countless days and nights to support and care for vulnerable residents amid the crisis."
Their account of what staff experienced is devastating.
"Staff told the commission about crying before, during and after work, vomiting in locker rooms from stress, and watching residents whom they loved die in great numbers," they wrote. "Often, they would then be required to wrap the resident in a body bag, put them on a stretcher, and wheel them outside to waiting funeral attendants.
"They described the guilt they felt in not being able to be with residents when they died, and the awful position of having to choose between staying home to keep themselves and their families safe and caring for the residents they knew well."
They quoted one staff member whose job used to be organizing recreational programs but ended up caring for dying residents: “For one resident, I sat at [his] bedside after he died with the iPad because the family wanted to see him one more time. So, I watched and listened as his wife and adult children spoke of their love and silently wept under my mask and face shield.”
The 300-page report details specific criticisms of the Ford government's pandemic response, with its comments on the failure to prepare for the impact of the second wave the most biting.
"Even with the lessons learned during the first wave, preparations for the second wave were not enough to prevent it from being worse," they wrote. "In fact, more long-term care residents died during the second wave than during the first. It is still unclear why this was so, despite the months both the province and the homes had to prepare."
The commission detailed three steps the province took and said none of them were in effect in time: partnerships with hospitals didn't take effect until partway through the second crisis, newly hired inspectors were still in training and funding to train additional staff announced too late to be of any use in the second wave.
The report is also highly critical of the province's chief medical officer of health, Dr. David Williams, finding he failed to heed warnings early in the pandemic that long-term care residents would be in danger because the virus was circulating in the community and spreading asymptomatically, concepts he was among the last to acknowledge.
It also criticizes his advice to long-term care homes on infection prevention and control, particularly the cohorting of infected patients as "unhelpful" and unclear.
The provincial government has not yet responded to the report.
On Friday afternoon, Premier Doug Ford said at a press conference he will welcome the report, however hard it will be to read.
"Because what happened in our long-term care homes, it was tragic, and it was terrible," he said. "But most of all, it can never be allowed to happen again. That's why I personally commissioned this report: to get answers to bring the long-standing problems to light, to do everything in my power to make sure that there's justice and answers for family members."
Ford also said he wouldn't make excuses for what happened, while also mentioning that he inherited problems in the system from "30 years of underinvestment from government after government, Liberal and Conservative."
"But none of that matters because I'm your premier today," he said. "And I don't want them to look back 20 years and say that we could have done more. So I will not stand here and try to make excuses or pass the blame. But I will stand here and tell you that I'm doing everything in my power as premier, and I'm sparing no expense to fix the system, to upgrade the homes that had been neglected for decades, to make the biggest single investment in the standard of care for our residents in a generation."
Ford was referring to the government's ongoing work to redevelop older long-term care homes and build new beds, as well as its commitment to increase the average hours of hands-on care residents get to four a day by 2025. While those improvements are welcomed even by the government's critics, they did not come in time to avert the tragedy of the last year.
The premier's comments struck a different tone than those of long-term care Minister Merrilee Fullerton earlier this week, following the release of the Auditor General's report on the COVID-19 crisis in long-term care. She said she was taking responsibility but likened her own role to running into a burning building to try to save people. She pinned the blame on the former Liberal government — and on the NDP that has not been in power in a quarter-century — and said of her own party: "We didn't start the fire."
Neither Fullerton nor Ford have spelled out exactly what they're taking responsibility for.
Meanwhile, the official opposition quickly slammed the government.
"Premier Doug Ford, Health Minister Christine Elliott and Minister of Long Term Care Merrilee Fullerton must be held accountable. Those executives and companies who allowed people to die needlessly, alone and in pain must be held accountable," said NDP Leader Andrea Horwath in a statement.
"The commission paints a picture of years of neglect, followed by devastating choices by the Ford government to cancel inspections, deny staff paid sick days, leave facilities brutally understaffed, forego infection prevention and control, and allow the COVID-19 virus to spread quickly while the government acted slowly. It also calls the privatized, for-profit model into question," she said.
Liberal Leader Steven Del Duca, who was a minister in the previous Liberal government that presided over the systemic issues identified in the report, offered a milder response, tweeting he accepts the recommendations and wants to "move forward urgently to take action to fix long-term care once and for all."
"Collectively, we have a responsibility to prioritize care over profit and to ensure that this kind of tragedy never happens again," he said.
The Ontario Hospital Association and Ontario Long-Term Care Association released a joint statement in response to the report, outlining their commitment to building a better system.
Joint @OntHospitalAssn @OLTCAnews statement welcoming the COVID-19 LTC Commission report. We are committed to working together & creating new ways to care for vulnerable seniors. Page 8 - “To care for those who once cared for us is one of the highest honours.” #onhealth #onpoli pic.twitter.com/22dM1QMdHQ
— Anthony Dale (@AnthonyDaleOHA) May 1, 2021
QP Briefing will provide further coverage of the report and the response to it in the days to come.