Health expert testifies that long-term care policies weren't pursued due to the price tag

The government shot down multiple proposals designed to protect long-term care residents in a second wave due to costs, a health expert told the long-term care commission.

Dr. Allison McGeer, a University of Toronto and Mount Sinai Hospital infectious disease hospital, told the long-term care commission that in the summer months between the first and second wave health experts put together a number of proposals to protect vulnerable long-term care residents.

"A number of proposals went to the ministry about what could be done; and all of them were deemed by the ministry to be too expensive," said McGeer, who later clarified that she primarily meant the Ministry of Health in her remarks.

The government strongly rejected that notion in question period, saying it has undertaken all measures in order to protect long-term care homes during the pandemic, which has devastated elderly Ontarians.

McGeer acknowledged that the time frame in between the first and second wave — roughly the summer months and early fall of 2020 — made implementing the policies difficult. "Most of us, I think, who are more experienced in infection control, and know how deep the inadequacies are in the system, I think, looked at it and were confident that...it is not possible to change the behaviour of 75,000 staff members who, generally speaking, have deeply inadequate training and education in a four-month period. You're not going to change culture in an entire sector in that period of time."

But she said that the ministry had a false sense of confidence going into the second wave, believing it was better protected against potential harm than it was. "I think, in fairness to the ministry, because the ministry also thought that this problem had been solved, and they didn't think they needed to spend the money in order to do this." She went on to say that "there were a number of things that we chose not to do, because pretty much everybody got fooled into thinking that it was going to be okay in the second wave."

The second wave was even more devastating to long-term care residents than the first, despite the government's early promises to build an "iron ring" around the facilities. Almost 4,000 long-term care residents in Ontario have died related to COVID-19 causes during the pandemic.

McGeer outlined proposals that health experts believed would have helped, but did not get implemented. The proposal that was furthest along would have seen positive COVID-19 residents in long-term care moved out of the facility, modelled after best practices seen in other jurisdictions. "We talked, there was at least discussion, about systems for moving — as Hong Kong and Israel did — for moving positive patients out of long-term care or maybe even exposed patients out of long-term care," McGeer explained.

But the talks did not appear to go that far. "I don't know how far any of those discussions went with the ministry, but I think the sense among my IPAC colleagues was that there probably wasn't much point in trying to push those forward, because there was no hope that anything that cost that amount of money was going to be undertaken."

McGeer highlighting that money was an issue comes despite the government's repeated insistence that it has not been, with Premier Doug Ford once again saying in question period Tuesday morning that no expense was spared.

Long-Term Care Minister Merrilee Fullerton took umbrage at the suggestion from the NDP, based on McGeer's testimony, that the government was not willing to step up with the necessary funding. "I absolutely reject that mischaracterization of the actions of this government," Fullerton responded to Opposition Leader Andrea Horwath in an unparliamentary remark that was withdrawn.

Fullerton pointed the finger instead at the previous Liberal government. "As the minister of long-term care, I can tell you no expense was spared. Everything we did was in response to a crisis of staffing, a crisis of capacity, overcoming the structural inadequacies left behind by the previous government."

Horwath pushed back, arguing that the government was more interested in controlling the political fallout than addressing the policy concerns. "What’s missing is the iron ring the premier promised around long-term care, but there’s an iron ring around the premier when it comes to answering questions," she commented in question period.

In a statement following question period, the NDP leader expanded her thoughts on the matter. "Imagine how families whose loved ones got sick or died in long-term care will feel when they learn that Doug Ford could have done more to protect their parents and grandparents, but he chose not to spend the money,” she charged. She went on to pin the responsibility for long-term care deaths on the PCs for not providing further funding. “The Conservatives made a callous decision to put money ahead of public health — and some precious people died a preventable, lonely and painful death as a result."

Another policy idea proposed in between the first and second wave, according to geriatrician Dr. Samir Sinha, was to adopt the Quebec model of having an infection prevention and control team in each of Ontario's long-term care homes.

Sinha also highlighted that additional staffing in LTCs would have been helpful, as seen in Quebec. The government has previously objected to the comparison on the grounds that Quebec hired orderlies, not personal support workers. But Sinha said they are the same thing.

For good measure, Frank Marocco, the chair of the commission, clarified. "It's the English translation of the French — correct me if I'm wrong — it's the English translation of the French word for the person who does what a personal support worker does here in Ontario that gets you the word 'orderly'?" Sinha affirmed that was the case.