The Washington PostDemocracy Dies in Darkness

Opinion The high covid death rates in Ontario long-term care facilities were avoidable

Ontario Premier Doug Ford speaking at a news conference in Toronto on Jan. 12. (Frank Gunn/AP)

On March 3, Ontario surpassed 7,000 covid-19 deaths. Yet, for a “we’re all in this together” pandemic, as the often-repeated refrain goes, a breakdown of the mortality figures reveals jarring inequities, especially for those living in the province’s long-term care facilities (LTCs).

Of the 7,014 deaths recorded, 3,745 came from LTCs. The extraordinary level of suffering and death in these care facilities was avoidable. Those who could have done better to mitigate or prevent the tragedy ought to be held to account. Ontario — indeed, Canada — ought to look ahead to structural elder-care reform, including new or converted public homes and ending for-profit care.

As the early March death statistics were shared, the Canadian Broadcasting Corp. reported that Ontario’s LTCs were still breaking the rules, with one major company, Extendicare, responsible for 22 percent of infractions. According to the CBC’s investigation, “for-profit long-term care homes received 70 percent of the violation citations despite accounting for 56 percent of the homes in the province. An additional eight percent of the violations were found in nonprofit homes managed by for-profit companies.” This is further evidence that while the LTC crisis in Ontario is widespread, the heart of the problem is found among for-profit homes.

The administration of Doug Ford in Ontario has been under scrutiny for its inaction on LTCs. The province launched an independent commission. As TVO journalist Sabrina Nanji wrote, the commission found serious shortcomings, including on PPE procurement, Ford ignoring advice on asymptomatic testing, delayed acceptance of asymptomatic spread and staffing issues.

Who’s to blame? That’s being sorted out. But we know where to start: Premier Doug Ford, Minister of Long-Term Care Merrilee Fullerton and Health Minister Christine Elliott are all implicated, as is the province’s Chief Medical Officer of Health David Williams. People in care deserve better. Ontario deserves better.

Researcher and long-term care advocate Vivian Stamatopoulos has been working to hold the government accountable for its failures on LTCs and push for reforms. Reviewing commission testimony, she said during an interview that the "most upsetting is that they did not have a plan in place to properly and expeditiously send test results to these homes to alert them of covid positive cases.” She notes that some results were sent by mail. She also laments, as have many, the accepted practice of having workers move from facility to facility, shuttling around and, in some instances, taking covid-19 with them. These are some of the many failures that have caused unnecessary suffering and death in the province’s LTCs. However, once again, not all homes are equal.

In January, the Lancet in its World Report cited numbers that found in Ontario there was a significant difference in death rates depending on the type of home, such that “in facilities with an outbreak, 6.5% of all residents in for-profit facilities died of covid-19, whereas 5.5% died in nonprofit facilities and 1.7% in municipal homes.” Predictably, for-profit homes also had higher outbreak rates. According to Pat Armstrong, a York University sociologist cited in the article, “there’s plenty of evidence of lower-quality care in the privately owned facilities.”

It’s almost as if we ought not to be treating the care of those who live in LTCs as a chance to make money. And if we accept such a revolutionary idea that it is wrong to trade the well-being and lives of those in care for profit, we should move toward public care, end for-profit care, and adopt objectives called for doctors and advocates, including “hiring more qualified staff” and “ensure 70 percent of staff at each LTC home are full-time.”

There must be political consequences for deadly failures in the province’s LTC’s, too. In a decent and just democracy, there would be resignations. Anyone who came anywhere near this mess should quit or be dismissed, starting with Minister Fullerton and, quite frankly, Ford himself.

The government has failed those in care in Ontario. That failure, which began pre-pandemic as LTCs descended into long-term crisis, was avoidable. It cost lives. The leadership that sat idly by and allowed it to happen should go. And new leadership should avoid future suffering and death by doing the obvious, correct thing: ending for-profit care and introducing new or converted public care facilities.

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