'We didn’t start the fire': Minister deflects blame after AG's report on COVID-19 in long-term care

‘We didn’t start the fire’: Minister deflects blame after AG’s report on COVID-19 in long-term care

The Ford government claimed to be following the advice of the auditor general when it cut comprehensive inspections of long-term care homes shortly after taking office in 2018 — but in a special report, Bonnie Lysyk contradicts that and finds that the inspection gap left vulnerable residents at risk.

Lysyk released a special report, Pandemic Readiness and Response in Long-Term Care, Wednesday making 16 recommendations with "55 action items" stemming from the COVID-19 tragedy in care homes.

Overall, her conclusions are similar to those already highlighted by Ontario's long-term care commission, which is due to release its final report to the government this week, as well as other independent bodies and health experts: neither the government and long-term care homes were prepared for the pandemic, homes were severely overcrowded and understaffed, the government reacted slowly to the increasing crisis and offered confusing advice to homes' management, and the provincial inspection regime was flawed.

"There should be no surprises in the content and recommendation in this report," said Lysyk during a press conference. "Our work clearly confirmed that neither the Ministry of Long-Term Care nor the long-term care sector was sufficiently positioned, prepared or equipped to respond to the pandemic in an expedient and effective way."

Long-Term Care Minister Merrilee Fullerton pinned blame on the previous Liberal government for what she called "a broken system" that is facing staffing shortages and a lack of beds. Asked whether her government needs to take some responsibility for COVID-19 ravaging long-term care homes across the province, Fullerton said the province was initially dealing with a new virus, a shortage of personal protective equipment and testing reagents, no vaccines and a "sorely neglected" sector.

"Do I accept responsibility for all of that? I’m not a public health expert. I’m here to try and fix long-term care but if the building’s on fire and you’re running into it to try and save people, yeah, I think that’s pretty much what we tried to do, but we didn’t start the fire," she said, noting that the government is working to boost the amount of direct care residents get through a $4.9 billion commitment over four years while also funding new and redeveloped beds.

Her comments drew the ire of opposition parties and stakeholders, with NDP Leader Andrea Horwath saying she was "shocked" to see the minister "completely refuse to take any responsibility for the nightmare" long-term care residents lived through.

"They may not have started the fire, but they poured gasoline over it," Green Party Leader Mike Schreiner said.

Dr. Nathan Stall, a geriatrician and researcher at Sinai Health System, quoted Billy Joel's song: "We didn't start the fire, it was always burning," in response to Fullerton's comments.

"They didn't start the fire, but they allowed the fire to get out of control," said Stall. "They didn't appropriately contain the fire and they didn't act nearly with the speed or the seriousness with which this was required."

He acknowledged that there are long-standing "deficiencies" in the sector, but added that "there were ways that this could have not ended up in 4,000 long-term care residents dying, there were many ways." He said the auditor general's report highlighted some of these and that the province failed to fix the issues identified after the first wave like crowding, staffing and issues with infection prevention and control before the second wave.

"So yes, they didn't start the fire ... this was a neglected sector, but they also had been in power for nearly two years before the pandemic started, and there were ways to not allow the fire to burn down the whole house, and they failed to make those decisions," he said.

In her report, Lysyk contradicted the government's previous claim that its changes to the inspection regime were done on her advice and she highlighted the consequences of the inspection program's failures — poor infection prevention and control practices in homes that cost lives, not only during the pandemic but the regular flu seasons of years prior.

She said reducing proactive comprehensive inspections in 2018 and moving to a system that based inspections on complaints and critical incident reports also meant that the government's oversight of infection prevention and control (IPAC) measures in long-term care homes "decreased significantly."

Her report stated that between 2015 to 2017, comprehensive inspections identified approximately 179 instances of non-compliance with IPAC measures each year. There were 95 instances in 2018, when Lysyk noted comprehensive inspections went down by 40 per cent, and 52 in 2019 through complaint and critical incident system inspections.

In February, in response to an NDP question about reducing comprehensive inspections, Fullerton suggested the government's changes were in response to a 2015 report from the auditor general.

"When we look at the recommendations from the auditor general’s report in 2015, that was because there were 8,000 complaints or incidents that had not been acted upon. That’s why the auditor general provided recommendations in her 2015 report," Fullerton said. "That’s why we take action to not only do unannounced regular inspections, but we needed to clear 8,000 incident cases and complaints that had not been addressed by the previous government, also supported by your party."

But Lysyk's report on Wednesday said the government's move "is contrary" to the 2015 report, which she said recommended that the government "prioritize comprehensive inspections of higher-risk homes over lower-risk homes, based on factors such as complaints, critical incidents and compliance history" and determine how often it would conduct comprehensive inspections.

"The approach it adopted in fall 2018 ... prioritized the highest-risk issues as identified exclusively through complaints and critical incident reports," Lysyk's report stated. "Solely relying on complaints and critical incident reports to base inspections on cannot be considered an effective risk-based approach."

The auditor general also noted a lack of inspection staff, saying that there were 143 inspectors across various regional offices as of Dec. 31, but that there was 41 vacant positions.

Asked by QP Briefing how much of a role the inspection regime changes played in the devastation that occurred in long-term care during the pandemic, Lysyk said she thought "there was an impact."

"Those comprehensive inspections were pointing out that there were IPAC weaknesses in the home and the inspectors were to be going and getting those corrected and following up so during the year 2019 when there were maybe a couple ... they weren’t highlighting that," said Lysyk. "So then we enter into the pandemic time and those homes that perhaps could have benefited from some advice from those inspections didn’t receive that advice so they were even less prepared."

She said this meant the ministry would also have had less information on how those homes might perform on IPAC measures during the pandemic.

On Wednesday, Fullerton attributed the inspections change to a backlog of more than 8,000 critical incidents and complaints that she said her government "inherited" from the Liberals.

"We have heard what the auditor general has said in this area and are in the process of developing a plan to make inspections even more effective and resident-centred," she said without providing further details.

Lysyk's report said another issue was that long-term care homes "continued to be non-compliant with legislative requirements" and that the government hadn't implemented her office's recommendations to address repeated non-compliance which included consideration of fines or penalties for homes.

"In 2018, the province passed amendments to the Long-Term Care Homes Act, 2007 and Regulation 79/10 to allow fines and penalties. However, at the time of our 2020 continuous followup, the amendments had not yet been proclaimed," her report said.

Lysyk's report stated her office has "significant concerns" with the government taking a "supportive" rather than "punitive approach" to oversight.

She noted that while some issues could be addressed with a "supportive approach," others might need "the firmer hand of enforcement to ensure that homes are places where residents live with dignity and in security, safety and comfort, and where residents’ needs are met."

Her report also highlighted that from March 14 to May 8, inspectors performed "monitoring calls" to long-term care homes and took calls through the "Family Support Line" instead of in-person inspections at these sites. The document stated that homes weren't clearly told that inspectors were gathering information about things like personal protective equipment and staffing shortages rather than focusing on enforcement, so some homes were "wary" about sharing any issues they might be experiencing.

Not doing in-person inspections also made it difficult to verify the information they were being given or whether a home had corrected any non-compliance, the report said. It noted that homes did not consistently practise IPAC measures before the pandemic and that it was important to do so at all times given that 96.5 per cent of homes had reported an outbreak related to severe respiratory infections between January 2016 and December 2019.

Lysyk's report also touched on overcrowding in long-term care homes, which she said was heightened at the onset of the pandemic when alternate level of care (ALC) patients were transferred from hospitals to long-term care homes — something the government is turning to again as hospitals overflow.

The auditor general noted that 761 transfers happened in March 2020 — 50 per cent more than the average of 508 patients transferred per month in 2019.

This, along with other actions early on including "unclear" guidance from the chief medical officer of health "inadvertently complicated things," said Lysyk.

But she said she's hopeful that the government will follow her recommendations, noting that she met with Fullerton and thinks "there is intent on her part to make things right."

Dr. Doris Grinspun, CEO of the Registered Nurses' Association of Ontario (RNAO), welcomed Lysyk's audit on long-term care, saying the report backed many of the calls her organization has made in the past.

"What concerns me at this point ... is that despite all of these reports and the one coming on Friday from the commission, that they will be used by the current government to distract Ontarians from the fact that they’re doing nothing to ameliorate the situation," said Grinspun. She said the severity of the third wave, which has resulted in the government making plans to shift patients from hospitals to long-term care homes to deal with overflowing ICUs, was "all preventable."

"We don’t have a government, we do not have a functioning government in Ontario at this time," she said.

With files from Jessica Smith Cross

Sneh Duggal

Reporter, Queen's Park Briefing

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