Commission investigating COVID-19 in Ontario long-term care homes releases interim recommendations

The independent commission investigating COVID-19 in Ontario's long-term care system is calling for immediate changes to better deal with the second wave of the disease, including increased staffing, improved infection prevention and control measures and stronger relationships between homes and hospitals.

The commission, led by Superior court Justice Frank Marrocco, says it "felt compelled" to submit interim recommendations to the Ford government in light of the rising COVID-19 case numbers at long-term care homes.

Currently, 77 nursing homes have declared an outbreak, with a total of 1,913 resident deaths reported. 

Since it's launch in late July, the commission has spoken to more than 200 witnesses who detailed a lack of preparation in long-term care leading to the disease overwhelming several nursing homes and taking thousands of lives. 

"We have heard that long-term care homes were forgotten in the initial provincial plans to control the spread of COVID-19 until residents started dying, and pleas that this not be repeated when this crisis is over," the commission said in its report. 

While the final report will be delivered in the spring, the commission felt it had gathered enough information to issue interim recommendations on how to best protect seniors in the province's 626 long-term care homes.

Staffing

The commission highlighted chronic staffing issues, that plagued the long-term care sector well before the pandemic, as one of the key areas of focus for the government. 

"We have heard repeatedly and consistently about critical staffing shortages pre-COVID and the reasons for long-standing recruitment and retention challenges in long-term care homes. COVID-19 exposed these challenges in stark terms," the commission said. 

One of the key recommendations is a "minimum daily average of four hours of direct care per resident" which the commission said would require an increase in permanent funding to hire more full-time nurses and personal support workers. 

Earlier this week Merrilee Fullerton, Minister of Long-Term Care, acknowledged the government is still looking to hire 6,000 personal support workers for the second wave but said there has been a long standing difficultly in finding qualified staff. 

"We have to create a pipeline, so that people want to go into the sector, and then the sector can retain them," Fullerton said on Tuesday. "So you can't just snap your fingers ... and create PSWs."

Healthcare relationships

During the first wave, the commission heard that hospitals were instrumental in helping overwhelmed nursing homes stabilize their outbreaks and assist with infection prevention and control. 

"We have heard from numerous witnesses that early interventions and support, from public health units and hospitals, were successful in preventing outbreaks, and in homes where outbreaks have occurred, they succeeded in bringing them under control," the report states

The commission calls hospitals a "logical source" of support for long-term care homes and calls on an immediate "collaboration model" mandate between nursing homes, local hospitals and public health units. 

"There is no need to wait until an outbreak has occurred before a local hospital assists or is compelled to assist a LTC home," the commission recommends. 

Infection Prevention and Testing

The commission uncovered confusion in long-term care homes over who was responsible for implementing infection prevention and control measures and a lack of knowledge among staff. 

"We heard that in many cases, it was unclear who was accountable for compliance with IPAC measures, including having sufficient supply and adequate training for staff," the commission said. 

The commission is calling for a dedicated staff member in every long-term care home who would be responsible for infection prevention and control, ensuing compliance and to provide basic compliance for staff. 

The commission is also recommending that provincial inspectors should be sent into homes to conduct " timely, focused inspections to ensure homes are properly implementing proactive IPAC measures."

Commissioners also identified "system-wide challenges" with testing, surveillance and contact tracing and is calling on the government to prioritize long-term care homes for point of care tests. 

On Thursday, Health Minister Christine Elliott said thousands of Abbott Diagnostics rapid tests, which can deliver results in 15 minutes, would be deployed in long-term care homes to reduce the turnaround times for results and to increase the province's agility in fighting the virus.

The Ford government has also committed $540 million specifically for the long-term care sector to handle the second wave including: $405 million to health with operating pressures due to infection prevention and staffing; $40 million to help ensure maintain fewer residents per room; and has pledged a $3/hour pay raise for thousands of personal support workers.  

Minister Fullerton thanked the commission for its insights and said she is in the process of reviewing the recommendations.

"It is vital that we do whatever we can to protect our seniors, and staff, against this deadly virus, and to act quickly as we recognize the urgency of this situation,” she said in a statement published on Friday.

“As we continue this important work, we also look forward to receiving the commission’s final recommendations.”