"Interesting — you'll like this one," Ottawa Inner City Health Medical Director Dr. Jeff Turnbull told Ontario's long-term care commission.
"In one of our women's shelters, we had an outbreak of two people with COVID. And I said, 'Well, how would these people get COVID?' And it turns out that they live in a shelter, but they work outside of the shelter. They just can't earn enough money to afford Ottawa's rental circumstances. And where do they work? Long-term care. And so they brought COVID from a long-term care facility into the shelters where we had an outbreak," Turnbull said in his Dec. 16 presentation.
It's an example of two overlapping tragedies in Ontario with a common thread.
"This problem presents itself over and over again, this lack of a coordinated response. A lack of leadership, I think, is one of the ways we have articulated it," LTC commission head Frank Marrocco told Turnbull.
Experts and advocates say homelessness and the spread of COVID-19 through long-term care has been made worse by a lack of provincial leadership: on homelessness, long-term care staffing and paid sick days.
Turnbull told QP Briefing he was "surprised" by the outbreak, but that he should've seen it coming.
“Where do you work if you happen to be a newcomer, who's not well trained, and you don't have enough money? Well, you work in the long-term care sector as a PSW," he said.
"And those people had to work," he said, adding that they also may not get benefits or sick leave. "So they may be more likely to come to work with a fever."
Ontario needs to improve long-term care staffing, income and job stability, Turnbull said.
"The reality is those are our front lines, not doctors," he said.
Opposition parties laid the failure at the Ford government's feet.
NDP MPPs Joel Harden, Rima Berns-McGown and Suze Morrison said they were "horrified" by the news.
"We can’t fathom working long, dangerous, physically and emotionally devastating days in a long-term care home during this pandemic, then checking into a crowded shelter to sleep between shifts. We can’t fathom hearing Doug Ford call health care workers 'heroes,' then receiving a paycheque that can’t cover even the most basic of needs," they said in a release.
They repeated NDP calls for an end to private long-term care, a raise for LTC workers, a ban on evictions and paid sick days for essential workers.
It’s horrifying that frontline health care workers who put their own health at risk are paid such a low wage they cannot afford basic shelter.
This never should have happened.
If I were premier, long-term care workers would get the immediate raise to a living wage they deserve. https://t.co/eTBLoFtqu8— Andrea Horwath (@AndreaHorwath) January 7, 2021
This is heartbreaking and completely unacceptable, and should never happen in a province as wealthy as ON. Basic essentials like a living wage, and a roof over one's head should not be out of reach. #onpoli https://t.co/trvLabYq8P
— Steven Del Duca (@StevenDelDuca) January 7, 2021
Long-Term Care Minister Merrilee Fullerton's office declined to comment.
Many of the problems in long-term care that have led to the deaths of thousands of seniors in Ontario — overcrowding, mental health issues, jurisdictional confusion — are also present in homeless populations, Turnbull said.
The government's pandemic homelessness strategy so far has been to allocate money to local service managers "who are in the best position to understand local needs," the Ministry of Housing said in a statement — but that means the response has been created by separate, often competing units, Turnbull said.
“We have the shelters, we have social services, we have the municipality, we have Public Health, we have care providers, all with their finger in the pie, but nobody really running things and nobody coordinating a COVID response,” he said.
There are "so many cooks in the kitchen," he said, and "often those cooks don't get along, I have to tell you. They are looking after their own jurisdiction exclusively and not quite thinking about the better good for the whole group."
There was no plan to deal with a pandemic before COVID-19 hit, Turnbull said. “This was on the fly.”
Turnbull agreed with the ministry that aid efforts should be handled on a regional basis, since local experts know what their communities need.
“But you do need some kind of larger coordinating above us — that local coordinating group — that would say, 'OK, what do you need?' And we'd say, 'We need PPE.' And they say, 'Fine, you're going to have PPE coming to you tomorrow,” he told QPB.
Often, the strength of the institutional response comes down to the personalities of those involved, he said. He praised Wendy Muckle, the executive director of Ottawa Inner City Health — a "force of nature" who helped land a community centre and led its transformation into a medical facility that could support 120 COVID patients.
"Unfortunately you can't guarantee that it is going to be there in every place," Turnbull said.
The need to put someone in charge is "self-evident," he said. “You know, this is not rocket science. This is project management is what this is.”
Experts had been calling for a coordinated COVID-19 plan for homelessness — such as purchasing or expropriating unused condos and other spaces — since the first stages of the pandemic. Some cities have bought hotels as stop-gap measures, but by April it was already too late to stop the virus from tearing through shelters.
“We have massive overcrowding. So people are, you know, really cheek by jowl,” Turnbull told the commission.
Many people have chosen to sleep in tents outside rather than in shelters — even into the winter, he noted. While people feel safer and more comfortable sleeping outside, it makes it harder to deliver services, he said.
All the while, evictions in Ontario continue as cases spike far above where they were during the first moratorium, in March. An NDP motion to ban them once again passed unanimously last month, but the Tories have not moved forward with a plan yet.
Turnbull argued for that eviction ban to come back in an Ottawa Citizen op-ed with Advocacy Centre of Tenants Ontario Legal Services Director Kenneth Hale, and Ontario Alliance to End Homelessness Chair Kaite Burkholder Harris.
Turnbull said the commission was interested in his report because the rates of illness and death from the virus among unhoused people was lower than expected, based on their vulnerabilities.
"That's either because we're lucky, or because we did something right, or the homeless community has some degree of immunity. And I don't know the answer to any of those things, but I do know that we have a better track record than long-term care," he said.
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