Opinion | Over 3,800 dead, nurses quitting, and inhumane conditions: Ontario’s long-term care system is broken

More than 3,800 people died in Ontario’s long-term care (LTC) facilities during this pandemic, many in horrific and inhumane conditions, in environments infested with cockroaches and filth.

Some residents were not provided with enough food and water, and some died in their own feces and urine. Healthcare workers were traumatized to the point that thousands quit, never to return to the industry. Family members were forced to greet a locked parent or grandparent through a window, while watching helplessly as they wither away.

As healthcare workers who have witnessed the crisis in LTC first hand, we can no longer sit idle. COVID-19 exposed the cracks in an LTC system that has been understaffed and understaffed for far too long. We join with a more conscientious public than ever to draw attention to the plight of older people, people with disabilities, healthcare workers and caregivers.

We demand change.

On October 28, we were told that we would get this change with the Ontario government’s new bill, the “Long Term Remedy Act.” What we got was far from a plan to fix LTC. In fact, what we got was a plan to enforce an already broken LTC system, with not enough structural change needed to improve it.

A resident named Joyce greets as she stands with a staff member to watch supporters drive past the Orchard Villa Care home in Pickering, Ontario.  on Saturday, April 25, 2020.

The first important element was the promise of stricter enforcement including the hiring of new inspectors with police experience. While better supervision is undoubtedly required, it makes no sense to hire retired police officers as inspectors, rather than people with specialized training in the health care of older adults and people with disabilities. And remember, the LTC system has been created, funded, and enabled by successive governments, so further enforcement and punishment from the government alone will not solve all of the underlying problems with the system.

We cannot watch our way to fix LTC, but we can do more to address the underlying structural deficiencies of a system in crisis.

Regarding staffing, the law promises for the first time, in legislation, a target of an average of four hours of daily care per LTC resident by 2025. To meet this target, the government has committed to hiring thousands of new personal support workers (PSW). ) and nurses. But how will they do that when workers at many LTC facilities are poorly paid and lack basic labor standards like paid sick leave, with little means to challenge their employment relationship for fear of workplace retaliation? Poor working conditions in sectors such as LTC, critical for the care of the elderly and people with disabilities, has consequences. It means that we will continue to hemorrhage the workers we invested millions to hire.

Without a plan to end temp agency work, increase full-time jobs with adequate pay and benefits, we are concerned that the plan to hire more staff will eventually fail. Enforcement and fines will not address the nature of precarious work at LTC.

Nurses gather in Yonge-Dundas Square to protest Bill 124, a wage suppression legislation that negatively affects registered nurses, nurse practitioners and healthcare professionals.

Bill 124 is also one of the top reasons nurses are quitting, so how will we find more nurses to work in LTC? Nurses are ditching health care in droves because Bill 124 caps pay increases to less than 1 percent per year, less than the cost of living. We will only fix LTC staffing issues if Bill 124 is repealed as an incentive to attract skilled nursing staff to the industry. The government’s commitment to hiring 2,000 nurses is not enough to meet the needs of an aging resident population with increasingly complex needs.

To ensure the health and well-being of people in LTC, a minimum, not an average, of four daily hours of care per resident must be provided as soon as possible, with at least 45 percent of the care provided by qualified nurses. . In addition, there must be one nurse practitioner for every 120 residents. None of this is promised in the new legislation.

The pandemic has also revealed a dangerous contradiction between for-profit companies that have a primary obligation to extract wealth for shareholders and public funding of high-quality care for our most vulnerable. Alarmingly, the law offers no plan to phase out LTCs for profit. In fact, Ontario already has the highest proportion of for-profit LTC installations in Canada, at 58 percent, and the government is now allocating 140 of 220 new installations (about 64 percent) to for-profit companies. , in order to expand. your market share and guarantee your profits for years and decades to come.

It has been argued that nonprofit LTC facilities do not have the money saved to qualify for a mortgage to build new facilities, but this is simply because the nonprofit LTC invests all the money provided by the government in the attention. . For-profit LTC had the highest death rates during COVID-19 and is a form of care that continues to drain resources from a system that needs more investment. As a result, we are asking the Ontario government to remove impediments to the funding necessary to build new non-profit LTC facilities or renovate existing ones. This is the time to phase out LTCs for profit and also to end their influence on government policy.

The humanitarian crisis we witnessed in LTC during the pandemic was a tragedy. Now, we have the potential to turn that tragedy into the kind of impulse that can fix the system forever. The starting point should be to urgently fix critical issues like understaffing, poor working conditions, along with a transition to a non-profit LTC.

We call on the Ontario government to return to the drawing board with its flawed legislation and overall strategy for LTC. This is not a partisan issue, but an opportunity for the government to do the right thing and finally give our vulnerable the lives they truly deserve.

Birgit Umaigba RN, MEd ,, is an ER / ICU RN in Toronto, a course instructor at Durham College, and a director of clinical courses at York University School of Health and Centennial College. Follow her on Twitter @birgitomo

Dr. Amit Arya is a hospice physician who works in long-term care facilities in the GTA and has faculty appointments from the University of Toronto and McMaster University. He is a co-founder of Doctors for Justice at LTC. Follow him on @AmitAryaMD.

Dr. Gaibrie Stephen is an emergency room physician working in the Peel region. Follow him on @SGaibrie.

Dr. Naheed Dosani is a palliative care physician and health justice activist serving as a professor in the Department of Family and Community Medicine at the University of Toronto and an adjunct clinical professor in the Department of Family Medicine at McMaster University. Follow him @ NaheedD.i


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