Front Burner - How Ontario could have avoided the long-term care crisis

Episode Date: January 6, 2021

Last spring, Ontario Premier Doug Ford promised to move "heaven and earth" to prevent more long-term care residents from dying of COVID-19. But today, more than one-third of the province's long-term care homes are in an outbreak. More than 960 residents have died since the start of October. And experts say it didn't have to be this way. Today, we're speaking to Dr. Samir Sinha — the director of geriatrics at the Sinai Health System and the University Health Network, and the director of health policy research at the National Institute on Ageing — about what Ontario could have done, but didn't.

In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. This is a CBC Podcast. Hello, I'm Jamie Poisson. Last May, Ontario Premier Doug Ford promised to move heaven and earth to make sure that long-term care residents stop dying from COVID-19. You know, I think it's appalling.

I think it's disgusting what has happened. But we're going to fix this. I promise you. And I promise the people of Ontario. Today, one third of long-term care homes in the province are in an outbreak. More than 170 residents have died just in the last seven days. And experts say it did not have to be this way. Today, what Ontario could have done,

but didn't. This is Frontburner. I'm here today with Dr. Samir Sinha. He's the Director of Geriatrics at Sinai Health and the University Health Network in Toronto, and he's also the Director of Health Policy Research at Ryerson University's National Institute on Aging. Hi, Dr. Sinha. Thank you so much for making the time to speak with me today. Thanks for having me. So it's the start of January now, and as of this recording, there are almost 220 long-term care homes in Ontario with active COVID outbreaks. And since the start of October, just in the last three months, more than 960 residents have died from COVID-19. That's a third of the long-term care COVID deaths in the province since the pandemic began, something like nine months ago now.

since the pandemic began, something like nine months ago now. And Dr. Sinha, could the severity of this second wave in long-term care have been avoided? 100%. It's just an absolute travesty watching the death count rise every day and that we're just seeing, you know, the same tragedy unfold once again that we saw during the first wave. And it's almost as if we didn't really learn any of the lessons that we could have and implemented to make things better. Ontario Premier Doug Ford has talked repeatedly about building like an iron ring around long-term care. We will stop at nothing to protect those who cannot protect themselves. nothing to protect those who cannot protect themselves. We will fortify the iron ring of protection. We'll go further in our testing, screening, surveillance, targeting the homes facing outbreaks. And the province's minister of long-term care, Mayor Lee Fullerton,

recently said that every measure and every tool was used. Our government is dedicated to long-term care. I am dedicated to long-term care. And I'm bringing every ounce and every measure that I can to fight a deadly, deadly virus that has impacted our most vulnerable people. And we will continue. As someone in this, day in and day out, what do you think when you hear that from politicians? The sad part is, is that this iron

ring that we were promised has never really transpired. In fact, many of us are referring it really more as to an iron sieve. We really haven't pulled out the stops. And many of these measures have really been half measures. And we're seeing that in our performance as Ontario surges and having some of the worst second wave performance in our long-term care homes compared to many of the other provinces in Canada. So right now, you know, I'm really losing faith in the sense that we've actually done enough that we could extend the loss of life that by tomorrow will be at least a thousand people dead in our long-term care homes in Ontario. Wow, that is such a stunning number.

Today, I want to talk to you about some specific tools that could have been used in long-term care homes over the last nine months that have not been used? And, you know, as you mentioned before, tools that have been used in other provinces. And first, could we start with staffing? And let's use an example of this gut-wrenching situation at a home in Toronto right now in the Toronto area, the Tender Care Living Centre. One of the worst outbreaks in Ontario, more than 60 residents have died. More than 200 residents and staff have been infected with the virus. And family members have raised concerns claiming residents

weren't getting enough water or medication due to the lack of staff. Doctors who've been inside have even taken to Twitter to express their shock at what they've seen on the inside. And family members have been protesting outside the home trying to draw attention to conditions there. They place more than 40 candles on the ground outside the home each one representing a resident who has died from the virus including Wei-Lo Lin who passed away on December 19th. The way that the the virus spread within the home there's obviously some lack of training when it comes to like how to handle an outbreak. We've talked about how the way homes are staffed leads to the COVID deaths in these

homes many times on the show. But briefly, explain to me, as it relates to tender care, what's been happening there? Well, the sad part, first of all, is that this is Tender Care's third outbreak of this pandemic. And what was really devastating to hear was when the ministry finally sent in its own inspectors to kind of say, okay, what's going on here? The report that came out just showed that, number one, resident needs were not being met, people were starving, people were dehydrated. And worst of all, the staff really didn't actually know in certain circumstances how to use their PPE, their personal protective equipment, properly. And I think it's largely because we haven't really dealt with any of the root causes of the issues

that other more successful provinces had early on or subsequently when we figured out what went so terribly wrong during the first wave. It is one of the issues in Tender Care as well that there simply isn't enough staff too? Absolutely. I mean, prior to this pandemic, 80% of homes in Ontario were telling us they were having recruitment and retention problems. It was hard to get a full staffing complement in these homes. And when a home enters an outbreak, for example, when you actually have so many staff who are sick, all of a sudden, you actually can decimate the entire typical staff in a home. And then this home in particular, at one point was using up to 11 different staffing agencies. You know, they were just saying anybody who could possibly come, even when they actually

had doctors basically saying, if there's anybody with a spare day to spare today, come on in. We just need hands on so that people can actually get fed. People can actually get hydrated, let alone having their basic medical care needs actually met. What have other provinces done to address staffing issues that have existed across the country? And, you know, have they done better in this second wave? So early on, what we started seeing across the country was BC, for example, started creating SWAT teams, if you will, so that if a home entered in an outbreak, literally, as soon as the outbreak

was declared, you actually had a whole team that arrived on your doorstep, infection prevention and control folks, you know, folks from the local health authority saying, what can we do? What do you need? How do we help you? So that they could try and help them out. What they also did early on, as soon as they started having their very first outbreaks, is they realized that because the homes weren't properly staffed, that many of these staff were actually hired on a part-time basis, meaning that they also had inadequate benefits like sick days, for example. And that when we started realizing that we can't have staff who often

work part-time and then work in multiple homes to try and cobble together a full-time wage, they actually took all of their long-term care workforce, they offered them all full-time salaries at the highest unionized rate available in the system, and that also gave them access to full-time benefits. And by doing that in BC, they immediately stabilized the entire staffing situation. Because in BC, you know, you had the chief medical officer of health going to the province and saying, I need you to pony up $10 million a month to make this happen. And BC did. In contrast, we spent over a billion dollars a year to respond to the nursing home crisis in Ontario, that frankly, we could have stabilized if we did what BC did. And when you say that we spent over a billion dollars to respond to it, where has that money gone? Well, you know, you can either actually, you know, make an investment. I always say a good offense is a great defense. So what BC did, for example, by stabilizing their workforce early, was they didn't all of a sudden have massive staffing shortages that then what Tender Care, for example, is doing in Ontario in a classic situation, because when a home lose its regular staffing, then all of a sudden you turn to

agencies and agencies, you know, these are businesses, right? And of course, these agencies are charging premium rates. So instead of paying someone a living wage at, say, $26, $27 an hour, you're now going to an agency. And again, TenderCare was using 11 different agencies at one point where they're actually paying probably $40, $50 an hour. These agency workers even are only getting paid $15, $16 an hour, but I'm sure in a pandemic, they might be able to get a little bit more. But all of a sudden, these homes have all this money that's being thrown at them to try and fix the problem. But these are all band-aid solutions.

It's not dealing with the underlying issue. What Quebec actually did in the spring, Quebec had a horrible first wave, worse than any other province. And so what Quebec did was they realized we've got to fix the staffing problem if we're going to have a chance through the second wave. So they actually, in May, they actually announced they were hiring 10,000 new staff. They actually said, we recognize the barrier to coming to work in these jobs is that you have to pay for your own training. So what the Quebec premier announced was, if you sign up, we will pay for you to do your training and we will guarantee you a job at the end of this. So I'm asking all Quebecers from the bottom of my heart, if you're ready to mobilize your strength, your energy, your humanity, if you want to make a real difference in the life

of our elderly, please join us. We need you. And they organized it so that all of these new workers would be on site working as of beginning of September as soon as our second wave started to take off. And what did Ontario do? Ontario didn't make any of those moves. We just kept throwing money at the homes saying, use the money for agencies, use the money, just do anything you can to stabilize the situation. But I'll give you an example, because your question is, well, did these investments, the BC or Quebec actually make

a difference? Yeah, absolutely. In BC, only about one in three of their overall homes has ended up in outbreak. In Ontario, over 50% of our homes have ended up in outbreak. And currently today, if you think about Ontario versus Quebec, Ontario has over 220 homes in outbreak currently today. Quebec, from our counts yesterday through the National Institute on Aging, had only 63 homes in outbreak. In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization. Empowering Canada's entrepreneurs through angel investment and industry connections. Hi, it's Ramit Sethi here.

You may have seen my money show on Netflix. I've been talking about money for 20 years. and industry connections. That's not a typo. 50%. That's because money is confusing. In my new book and podcast, Money for Couples, I help you and your partner create a financial vision together. To listen to this podcast, just search for Money for Couples. I want to pick up on something you said about the use of these temp agencies. And correct me if I'm wrong here, but my understanding too is that Ontario did put a law in place that would ban personal support workers from working at multiple facilities, which is a way that the virus was being spread. But by using these temp agencies too, this is creating a bit of a loophole. Am I right about that? And we are seeing workers working at multiple locations as well. Absolutely. So what BC had done, for example, all the provinces actually put in

a mandate saying that if you work at one home, you can't work at another home. But you can get around that by working for a temp agency, for example. And by BC actually giving everybody full-time employment and stabilizing the workforce, it actually significantly reduced the need to actually use temp agencies to fill in gaps. But in Ontario, because we actually didn't deal with the underlying staffing issues, and they only became worse after the first wave, you know, temp agencies have absolutely taken off. And for these workers, because they're working in multiple different homes, they don't necessarily have the requirement that they need to get tested the way we've actually required the staff in the homes to get tested. you know, you have to get tested on a weekly basis. But then it only came out a few months ago that they don't even hold their own inspectors who go to multiple homes. They're not required to

get tested on a regular basis, and they're going home to home to home. So it just shows you that it's not just one loophole. It's that we have loophole after loophole after loophole. And all these things together that haven't actually addressed the underlying staffing issue are just seeing homes blowing up, homes that are on fire, and residents that are ultimately the ones who are paying the price. You mentioned in British Columbia, these SWAT teams going into long-term care homes and that they're rapidly deployed and they can deal with outbreaks just as they're beginning. And I know that you hear people talk about formal orders here. So going back to tender care, for a moment,

North York General Hospital has temporarily taken over the management of that home to get the outbreak under control. But I also know that critics say that this process has been broken. It's cumbersome. It's taken so long. And can you explain to me how? I think the challenges that we've had compared to BC is that we organize our whole healthcare system differently, much differently compared to BC. BC runs under what we call a health authority model. So it means that the hospitals, the long-term care homes, they're already all under the management of one group, for example. So everybody's already working together as a team. The challenge that we've had in Ontario is we've

never had these formal relationships. So even the home tender care, for example, was originally partnered during the first wave with the Scarborough Health Network. But the sad part was that the Scarborough Health Network was so overwhelmed that they just couldn't really actually put together the staffing and the resources to really help this home figure things out. And a lot of these partnerships that have happened, you know, again, it's not organized and streamlined in a similar way. It basically is a negotiation between the home and the hospital to figure out what do you need. And it sometimes takes days and weeks to kind of arrange and get things set up. And we don't have time to figure that out during a pandemic. Okay, so what I'm hearing from you is that on the staffing front,

while BC and Quebec have recruited staff, paid them better, gave them benefits, offered training, tried to essentially stabilize the staffing situation at its source, Ontario did not do this. And when it comes to responding to outbreaks, while BC has created these nimble SWAT teams that could be deployed right away when there's an outbreak. In contrast, Ontario's response protocol has been bureaucratic and cumbersome, and any emergency response is coming too late. And I imagine that this is very hard for a lot of people to hear,

especially people who have loved ones in these long-term care homes. Dr. Sinha, before we go today, I also want to address vaccines with you. Let's talk about getting vaccines into the people inside long-term care. Again, my understanding is BC has done this better, and I believe Quebec has as well. And why? What's happening in Ontario when it comes to administering the vaccine in long-term care homes? Well, that's a great question. Right now, as of this morning, we had twice as many doses that were still sitting in freezers than were actually in people's arms. But we've already had vaccines in the province for 21 days. And right now, the majority of our homes have not been vaccinated. I mean, the residents, the staff, the care workers, and this is a travesty. You know, people say, oh, well, this is logistically hard. You know, how are we going to

do this? It's actually not that hard. When we were actually worried about a twindemic, for example, and worried about flu, like a flu season on top of COVID, we made sure that these homes, all of our homes in Ontario had the first crack at getting the vaccines. We got them out there and the homes vaccinated all their residents and their staff literally within a week or two without even a whimper. You didn't even hear about it because nobody made a deal out of it. So the fact that it's been now been 21 days and we're still trying to figure out how we can get vaccines to homes, how we can actually vaccinate people. It absolutely boggles my mind.

You hear the government talk about sort of the inability to transport the Pfizer vaccine. Yeah, this is something that Ontario has said. That's why they were going to decide to vaccinate, for example, staff, you know, through vaccination centres and then wait till the Modna vaccine was ready to vaccinate out in the communities that was ontario's take quebec actually they figured it out most of the u.s has figured it out the uk has figured it out in bc as well and they actually have used the pfizer vaccine where you can actually take it into homes because actually yes you have to keep it at the minus 70 degrees but you can actually keep it stable in a fridge at a

fridge room temperature for at least five days after that. But in Ontario, they decided to, you know, just stick with this idea that we're going to have to keep the Pfizer vaccine, you know, giving it through these vaccination centers. And even when we have all these doses of Moderna that have come in, we still haven't gotten even that in the arms of the people in long-term care homes. It's just, it's a travesty. Dr. Sinha, I do feel like we've given BC and Quebec quite a bit of credit in this conversation. And I just wonder, are we overstating the benefits of what those provinces have done? Or do you genuinely feel like it's such a step up from what Ontario has done here? So right from the beginning of this pandemic, we realized that

nobody was even really keeping track at a national level of the deaths and the cases that were happening amongst residents and staff in our long-term care homes in Canada. So I have a team of dedicated volunteers and staff who've been actually recording all of this data, updating our NIA long-term care tracker right from day one. And we have the data, and we've actually been studying the different provincial and territorial responses, what's worked, what hasn't worked, and we've used that to issue guidance and policy statements and really help share this information in the interest of trying to save lives. And so, you know, did Quebec do well during the first wave? No, they did terribly.

They were absolutely the national outlier and the worst performing province. How's Quebec done during the second wave? Remarkably well, because they stepped up, they figured it out, and they've actually, you know, I'm going to give credit always where credit is due. BC hasn't gotten everything right. I mean, frankly, they've kept essential family caregivers largely shut out of these homes. And that's really been a travesty in terms of their visitor guidance. But everything else, I'm giving them high marks. And really, you know, when you actually look at the provincial data, you can see, you know, how Ontario has sadly continued to lead the country, especially

in the second wave, with the highest number of outbreaks and the highest number of deaths happening in its homes compared to any other province. And so now it's taken that crown away from Quebec. But this is a crown of thorns that I don't think any province wants to be wearing. And frankly, at the end of the day, you know, we need to be held account to say, why did we let this happen? And frankly, you know, we have the answers and we now know why. So one final question today, I know we've covered a lot of ground here, but I do, I don't want to lose sight of the people whose lives are on the line here. And how does it feel to you knowing that at the other end of all

of these decisions are these very vulnerable people who need us to do better? It sickens me. I mean, it is, it's, I'm on, honestly, there have been so many nights during this pandemic that I've just been moved to tears. When I hear from my patients who've died in these settings, when I've heard from their families, when I see the reports, when I see what's happening at tender care, no human being should ever be treated this way. And people have been calling this now a humanitarian crisis, and it really has turned into one. And if there's anything I can do to finally move people to act, it's remembering that one day this may be you. And how would you like to be on the receiving end of

just people who say, we've done everything we can, and we think we've done a better job when we haven't. Okay. Dr. Sinha, thank you so much for this conversation. I find myself repeatedly shocked that we keep having it. Thank you very much for your time. We're really, really appreciative. Thanks for having me. All right, so before we go today, to date, fewer than 1,000 long-term care residents have been vaccinated in Ontario despite the fact that the first shipment of vaccines were delivered on December 13th. 26,000 long-term care health workers have been vaccinated according to the province's Minister of Health. The Ontario government said Tuesday the goal is to vaccinate all long-term care resident staff and essential caregivers in the hard-hit regions by January 21st.

Those regions are Toronto, Peel Region, York Region and Windsor-Essex. Also on Tuesday, for the first time, Ontario's seven-day average exceeded 3,000 COVID cases. The number of patients with COVID-19 in Ontario hospitals, 1,347, and intensive care, 352, are also at record highs. And Ontario's first field hospital in Burlington has also started seeing patients to take some of the strain off the health care system. I'm Jamie Poisson. Thanks so much for listening to FrontBurner, and we'll talk to you tomorrow. For more CBC Podcasts, go to cbc.ca slash podcasts.