Background: The high proportion of COVID-19 deaths among elderly individuals living in Long-Term Care (LTC) homes has exposed long-standing challenges in the delivery of long-term care in Ontario. Ninety percent of workers in LTC homes are women, making the outbreak of COVID-19 in LTC homes a gender crisis (Estabrooks and Keefe, 2019). As of January 11, 2021, there were a total of 2,952 lives lost in LTC homes since the start of the pandemic (Government of Ontario, 2021). Ten (10) staff members in Ontario’s LTC homes have died due to the virus. Seventy-three point three (73,3%) percent of residents are women and Ontario reported that 64.5% of COVID-19 cases among LTC residents were women (Norris, 2020). Clearly the measures that have been taken are not adequate. Inadequate Personal Protective Equipment (PPE), improper co-horting and infection control practices, lack of accountability by home operators who are not ensuring adequate safety measures, and crisis-level staffing shortages are issues that require urgent action (Ontario Health Coalition, 2021) Lack of leadership and a lack of comprehensive infection control vision for implementation of procedures have made major contributions to the death of the elderly. These issues predate the COVID-19 pandemic, as documented in numerous reports prior to the start of the pandemic, the most recent being the Gillese Report of 2019 (Gillese, 2019)
Ontario’s Long-Term Care COVID-19 Commission has made comprehensive recommendations for improving the situation in their first and second interim letters and the final report (Marrocco 2020; Marrocco, 2021; Marrocco 2021). Non-compliance with standards of infection control have been particularly egregious, despite guidance available from Health Canada and Ontario experts. In July 2020, the latest report of many on the subject, the Ministry of Long-Term Care published recommendations on appropriate levels of staffing in LTC homes, to address one of the root causes of this crisis in LTC homes (Government of Ontario, 2020). The Armed Forces Report recommended various immediate operational measures that should be undertaken immediately.
It starts with leadership. There needs to a clear lead for the quality of care amongst the leadership team, which needs to be comprised of a dedicated Executive Director, Director of Nursing and Personal Care and Medical Director in each LTC home. The Director of Nursing and Personal Care must be on-site each day in a full-time position and be held accountable for resident quality of care. The Government of Ontario needs to provide the financial resources necessary to effectively support designated leads in the areas of infection control, quality of care, operations and care, and medicine in carrying out their roles and responsibilities.
Specific standards for infection control and management have also been recommended to be implemented to continue to ensure ongoing safety of residents (Marrocco, 2021). In the area of premises management, such as ventilation, attention to maintenance, limits to room occupancy and sharing of sanitary facilities, training to adhere to sanitary measures, and effective zones for staff movement to limit contagion are effective measures that need to be met (Marrocco, 2021).
Staffing should be the key focus of improvement to address recruitment, retention, and compensation as per the July 2020 report from the Ministry of Long-Term Care (Government of Ontario, 2020). A key standard, not currently met, is at least four (4) hours of care per resident per day. Other recommendations for improvement include dealing with the building and design of nursing homes, ensuring residents have access to a variety of healthcare professionals, adequate data collection, and penalties for homes that fail to provide proper care.
