Nursing homes breaking the rules would see maximum fines doubled and the worst performers could face temporary takeovers under long-awaited legislation proposed in the wake of a pandemic that saw almost 4,000 vulnerable residents die.
The bill, called the Fixing Long-Term Care Act, follows angry and anguished calls from families of loved ones in long-term care and government watchdogs for reforms and repairs to a system Premier Doug Ford admits is “broken” from years of neglect, its weaknesses laid bare by COVID-19.
Long-Term Care Minister Rod Phillips said this is a “watershed moment” for long-term care in Ontario, where more than 15,000 residents living in close quarters and thousands more nursing home workers caught COVID.
“This, of course, is a highly emotional issue,” he told the Star’s editorial board Thursday, acknowledging there will be “skepticism” as to whether the reforms will bring the improvements and enforcement necessary.
“As my mother would have said, the proof will be in the pudding.”
The Ontario Health Coalition questioned why the Ford government it touting the new bill when it hasn’t already thrown the book at nursing homes with high pandemic death and infection rates.
“This government has for three years done nothing to hold any of the terrible operators to account despite already having powers … to fine, have provincial offences charged, suspend licences, revoke licences,” said executive director Natalie Mehra.
“Doubling fines sounds great but the existing heavy fines … have never been enforced.”
The legislation, if passed, would grant the government powers to appoint supervisors for troubled homes — as the province now does with dysfunctional school boards and hospitals.
“In any system there’s going to be some bad actors, and we will, as required, make sure that those actors feel the full force of these rules,” added Phillips, who lamented that only one charge has been laid by his ministry in the last 11 years but without a conviction.
“We expect quality of care and quality of life to be the focus.”
Under the new act, inspectors in Phillips’ ministry will have the same powers to lay charges on the spot as do inspectors from the ministries of labour and the environment. This week, the labour ministry revealed it has laid three Occupational Health and Safety Act charges against a London nursing home. The charges have not been tested in court.
The new nursing homes act also doubles maximum fines to $200,000 for individuals and $500,000 for corporations on a first offence and to $400,000 and $1 million for second offences.
Members of boards running for-profit nursing homes could be on the hook with maximum fines of $200,000 and $400,000 on first and second offences, with lower maximum fines of $4,000 for not-for-profit homes.
The higher fines are intended to get the attention of for-profit operators amid a push from some opposition parties and activists for them to be phased out of the system after several for-profit homes, such as Orchard Villa in Pickering, experienced severe outbreaks and high death tolls from COVID.
Ford called in Canadian Armed Forces medical teams to assist at the hardest-hit homes, where staffing levels dropped as low as 20 per cent because of illness and absenteeism. A military report later exposed horrible living conditions and poor care, such as residents force-fed to the point of choking, or malnourished and dehydrated.
“We have to have real financial teeth,” Phillips said, calling the penalties “an effective tool to correct organizations that are not fulfilling their obligations.”
Opposition parties said the government should have done more to drive for-profit companies out of the long-term care system and replace them with not-for-profits. Instead, some for-profit companies with bad COVID records are being awarded new beds as the system expands.
“Doug Ford isn’t getting tough on bad actors, he’s emboldening the worst offenders with more public money,” said Deputy New Democrat Leader Sara Singh.
Among other things, the bill would enshrine in law Ford’s promise to provide four hours of daily hands-on care to nursing home residents daily by 2025 and set interim targets; double the number of inspectors with new powers to lay charges on the spot; mandate a properly trained infection prevention and control lead for every home; require every home to improve palliative care and ban anyone convicted of an offence under the new law from working, volunteering or sitting on the board of any nursing home.
Palliative care is an important component because one-third of nursing home residents die every year in normal circumstance, said Phillips.
The legislation would replace the existing Long-Term Care Home Act passed in 2007, and a previous attempt at reform by Dalton McGuinty’s Liberal government.
Phillips is introducing the bill as long-term care homes continue to grapple with staffing shortages and the government scrambles to get more personal support workers and nurses in the pipeline to meet the four-hours-of-care standard, up from an average of under three hours today.
While the government has earmarked $4.9 billion to train and hire 27,000 more staff to meet the commitment, it vastly underestimates the number of personal support workers and nurses needed and does not have enough incentives in place to attract them, several critics said.
“For that to happen there has to be visible commitment to full-time jobs, higher pay that’s permanent for all staff and better working conditions to retain this very exhausted and overworked long-term care workforce,” said Candace Rennick of the Canadian Union of Public Employees.
The government has promised 30,000 new long-term care beds by 2028, with thousands already in development. But that growth will also fuel the need for more nursing home workers.
Health Minister Christine Elliott said Thursday that a taxpayer-funded top up of $3 hourly for 50,000 personal support workers in nursing homes will be extended to next March 31 to help attract and retain PSWs who perform the bulk of care for residents in nursing homes, such as toileting, bathing, grooming, dressing and feeding.
The same top-up is being provided to PSWs in home care and those in services for children, community and social services. Hospital PSWs will continue to get an extra $2 hourly.
Critics have been calling on the government to make the increases permanent to provide a sense of certainty instead of a series of temporary extensions. New Democrat Leader Andrea Horwath has promised to bump PSW wages by $5 hourly if elected premier next June 2.