Rod Phillips acknowledges the Ford government is in a tight spot when it comes to long-term care.
"The challenge we have, quite frankly, is there's an urgency to this ... but at the same time we're talking about changes that are going to last for generations," said Phillips, in a one-on-one interview with QP Briefing. "So, we need to move quickly, but move smartly and so on."
On one hand, the pandemic laid the shortcomings of the long-term care system bare, forcing the Ontario government into immediate action. Before the second wave hit last fall, it already had become clear that the province's overcrowded and aging long-term care infrastructure was contributing to the rapid spread of the virus. The Ford government committed billions to the development and redevelopment of long-term care homes under the same model — and to the same companies — that have come under intense scrutiny and criticism during the pandemic.
On the other hand, the pandemic laid the shortcomings of the system bare, making the need to reform the system clear. And that takes time.
Over the course of the interview, Phillips spoke of potential changes to how long-term care is developed, operated and held accountable in Ontario.
He was speaking at the site of a soon-to-be-opened long-term care home in Ajax that is nearly completed, just over one year after the project was first announced.
It's an outlier, one of four long-term care homes being built under a new model and tested in a pilot project. It is being constructed using a mix of prefabricated and on-site construction, funded by the province, overseen by Infrastructure Ontario, on land owned by Lakeridge Health at the Ajax Pickering Hospital site.
And it's not just a new way of building; when it opens, it will be owned by the hospital and run by a non-profit entity.
"It's kind of amazing that they built this," said Phillips, gesturing to the six-storey building. "It's one of those things that you kind of wonder why we can't do this all the time."
He was referring to the construction time — the facility was built in 18 months rather than the four-to-six years that is typical in long-term care.
But he could have been speaking about the new model for financing and operating long-term care homes it's going to demonstrate. Phillips said the government is considering expanding on that model after examining the outcomes of these projects.
He spoke enthusiastically about using federal, provincial and municipal lands for these types of projects and how they could open up new models of care and innovative partnerships between long-term care and the broader health-care sector — one of the key recommendations from the independent commission on long-term care.
The commission also recommended an overhaul of the system that would allow private enterprise to invest in the building and hotelling aspects of long-term care, while keeping the care part of long-term care separate. Care, it concluded, should only be provided by entities that were not profit-driven. The model the government is piloting in Ajax is a little different but addresses many of the concerns raised by the commission.
Instead, the government has greenlit the development of about 20,000 long-term care beds under the old model, where long-term care companies — the majority for-profit — submit development and redevelopment proposals for homes, financed on their own, with the province committing the majority of the funding over decades down the road to help the owner-operators recoup their costs.
That model was essentially broken prior to the pandemic, with only 611 beds built over seven years. Last fall, the PC government decided to sweeten the pot, offering long-term care companies more money and more of it upfront to hurry projects along — a tactic that appears to have worked. But critics say that, in doing so, the government has wedded itself to the same companies and the same system that failed during the pandemic, rather than using the crisis as a catalyst for change.
Phillips defended that decision.
"We don't have a choice," he said. "We still have unacceptable waiting lists around the province. We have to move in terms of building and development, and we're going to continue doing that, and we're going to hit our objective of by 2028 building 30,000 beds. So yes, that makes it complicated."
Another complication, he acknowledged, is staffing. The government committed to a 45 per cent increase in staffing levels to bring the average hours of care that residents receive from 1.75 to 4 hours a day by 2025 while expanding the number of beds in the province.
Philips said he's seeing great enthusiasm from all sides — employers, unions and patients — for fixing the problem. He's been working with the federal government on using the immigration system to ladder in foreign-trained nurses as PSWs and the province has been doling out funding for training programs across the province.
But he acknowledged more needs to be done.
Asked whether the government would take action to improve working conditions and pay in long-term care to aid retention and recruitment, he offered no commitments but seemed to acknowledge the problem.
"We can't solve this problem if 30 per cent of the people who are entering the sector are leaving within a year," he said, "it's like filling a bucket of water and wondering why it's not getting full."
That said, he raised the same concerns various ministers of the Ford government have each time they've been called on to boost pay in long-term care: there's a human resources shortage across the health-care system that long-term care is one small part of, and luring workers from one sector to another doesn't really solve anything.
Understaffing is now understood to be one of the key causes of the crises that played out in long-term care homes in Ontario during the first two waves of the pandemic. Homes experienced staffing collapses when too many workers were infected, exposed, sick or scared and not replaced.
Provincial inspection reports detail skeleton staffing and resident neglect during outbreaks. Some include individual, but anonymized instances, as well as accounts of broad weight loss by residents in homes without enough hands. The Canadian Armed Forces, called in to assist some of the province's homes, alleged in internal meeting reports — since made public — that dozens of residents at two Toronto homes died from neglect, malnutrition and dehydration. Inspection reports on those two homes are expected to be released to the public in the coming weeks.
The various reports back up the stories of family members who've spoken out to the media about the stories of their loved ones' neglect and suffering, some of whom are also pursuing civil cases based on the same allegations.
Phillips acknowledged that families have shared those same stories and allegations with him as well.
And the tension between the need to fix the system and to quickly plug its holes is also playing out when it comes to accountability.
About one-third of the province's beds — some 26,000 — are up for licence renewal. The process is well underway and, so far, some homes that experienced devastating outbreaks during the pandemic, as well as others owned by some of the same LTC chains, have been approved for 30-year licence extensions along with their redevelopment plans.
Orchard Villa has been a flashpoint. The Pickering home saw 70 deaths and is the focus of devastation allegations of neglect from family members of residents who died. Those loved ones have organized a campaign to stop the licence renewal, which has not yet been approved.
They are joined by the provincial NDP, which issued a statement criticizing Phillips for holding a media event at the Ajax home while "just down the road families of those who died at Orchard Villa are still grieving, and survivors of deadly COVID outbreaks live in fear."
Phillips maintains that the decision to grant the Orchard Villa renewal, or not, will be made by the civil service.
However, he has also promised to overhaul the province's long-term care legislation this fall to make it easier for the province to hold bad actors in the long-term care sector accountable.
"When I talk about accountability, and I talk about enforcement, we need it to be not just in the rules but the reality, that oversight means oversight," he said, adding that the former Liberal government added monetary penalties for homes into the LTC legislation but never proclaimed them into force.
"It can't just be window dressing. It has to be enforcement. Enforcement means we need the team to do that. It means that we need to be able to do investigations," he said.
He'd been asked if he'll be willing to bar entire companies or chains from owning and operating long-term care homes in Ontario — perhaps prompted by discoveries made as part of any of the civil cases or potential criminal investigations that are in early stages today.
Phillips didn't directly answer but said he's been assured by his deputy minister that those proceedings are part of the province's licensing process. "But we obviously need to make sure that we have the right people with the right motives in such an important enterprise as long term care, whether they're municipalities, or they're not-for-profits, or they're for-profit entities."
Neither Phillips nor his predecessor, Merrilee Fullerton, have shown any appetite to remove for-profit companies from the long-term care system entirely, as the provincial NDP has been calling for. For the NDP, and for many family members who lost loved ones and have become activists, the profit motive in the system shares a large part of the blame for the suffering and neglect and nearly 4,000 deaths.
Asked who he blames, Phillips framed it differently.
"At the end of the day, all of us, government — all of us who are delivering care have to take responsibility for the fact that we have to deliver a system that delivers safety," he said. "And the reaction, because I've had this conversation with people who are most directly affected as they've lost family members, is that's what they want."
"They, frankly, want the system for the future to be better. So, obviously, a part of my focus is making sure that the system in the future is better," he continued, adding the staffing and redevelopment plans are about that. "But you know, we will have to make sure that we're accountable for the past as well."