The key to fixing the crisis in long-term care lies in the health-system transformation the province already has already begun, according to a new report.

Premier Doug Ford has said the COVID-19 pandemic has made it clear that long-term care (LTC) is broken — and after the pandemic, his government will review it, and fix it. As of Monday, there were 1,239 COVID-19 deaths in long-term care homes, according to ministry data.

That is the backdrop of a new report from the Registered Nurses Association of Ontario (RNAO) released Tuesday, the third in a series of reports over the last eight years focused on strengthening community health care dubbed "ECCO," or Enhancing Community Care for Ontarians.

"The devastating impact of the pandemic on LTC residents is a direct result of policy and political flaws in our health system that have, for decades, sidelined the LTC sector and left it neglected in government funding and in health transformation plans," the report says.

The RNAO supports the health transformation plan led by Health Minister Christine Elliott, which is based around the formation of dozens of Ontario Health Teams (OHTs) around the province. Those OHTs are made up of different kinds of health-care providers and will be responsible for organizing and delivering health care in their areas, once the transformation is complete. The goal is for health care to be better integrated.

Today, the first cohort of 24 OHTs have been established, and the plan is for more to be added until they cover they whole province.

One of the RNAO's key recommendations is that it should be mandatory for each of those teams to include long-term care, so it is better integrated into the health system.

"The impact on our long-term care sector is tragic, but the tragedy could have been diminished with faster action and earlier integration of this sector into health-system transformation. Currently, long-term care is not considered a mandatory component of Ontario Health Teams," said RNAO CEO Doris Grinspun in a press release. "To honour the lives lost of our mothers, fathers, grandmothers, grandfathers and other vulnerable and elderly Ontarians, we must integrate long-term care into our OHT structure and never again leave them on the sidelines."

At a press conference Tuesday, Health Minister Christine Elliott said most of the first wave of OHTs already include long-term care. "I don't think it's necessary to make it mandatory; it's happening naturally," she said.

The RNAO is also calling on the government to immediately fix the funding and staffing models for long-term care, but says the organization is working on a full report on long-term care that will provide more detail on those issues.

The forthcoming report "incorporates LTC homes and retirement homes as full partners in OHTs, and includes this sector in the health-care transformation agenda," the ECCO report says. "We address key elements of funding, staffing and care delivery with full attention to the horrific experiences the LTC sector has endured during the COVID-19 pandemic."

The report also calls for increasing funding to public health and calls on the government to freeze its plans to increase the municipal funding burden of public health. However, the RNAO supports the province's move to amalgamate public health units, which it says can help ensure each has sufficient expertise. The reformed public health units should be aligned with Ontario Healths Teams, the new Ontario Health regional offices, and municipal boundaries, and linkages should be created between those entities, the report states.

"It has become progressively apparent during the COVID-19 pandemic that further integrating primary care and public health will be an essential component of successful pandemic planning, mobilization and emergency response moving forward," the report says.

Recently, the NDP has been calling for the end of for-profit long-term care, based on reports of a higher rate of COVID-19 deaths in for-profit homes.

The RNAO report does not call for the abolishment of for-profit care, but supports lessening profit in the health-care system and asks the province to ensure the funding models for OHTs strengthen the public, not-for-profit nature of Ontario’s health system.

"Our health system cannot provide health services adequately if the provision of those services is dependent on profit," the report says. "Adequately resourced, a publicly funded and primarily not-for-profit model will ensure health care is provided to everyone, no matter their means. Not-for-profit delivery of health services is associated with better health outcomes and lower costs."

Overall, the report finds stronger community care would have helped Ontario respond to the pandemic and it blames the some of the province's failings on prioritizing hospital care above all else.

"COVID-19 also revealed a health system in Ontario that relies excessively on hospital care and neglects other sectors until it’s too late," it said. "Public health units performed unevenly and inconsistently. Primary care offices remained mostly closed. Home health care received little attention. And nursing homes and retirement homes received vigourous attention only after 500 lives had been lost. Outbreaks in shelters, correctional facilities, and Indigenous communities are only now being identified as we write this report."

Fix long-term care by integrating it into the health system: Registered nurses

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