May 18, 2020
PUBLIC INQUIRY ON LONG TERM CARE IN ONTARIO
Dear Mr Ford:
We appreciate the focus of attention that you and Minister Fullerton are giving to the dire conditions in Long Term Care (LTC) homes across the province. Decades of underfunding, lack of supportive and poor oversight by the various parties in government have left these facilities as an easy target for the pandemic to spread and create the tragic death rate that is consuming attention and financial support. . Now your party has the opportunity to make a real and sustained difference for the care that Ontario seniors receive.
As we slowly learn how to deal with COVID-19 and recover from the pandemic, plans are needed to move to a new and sustainable care model for Long Term Care residents. We see this in two phases: a) an immediate Interim Plan (within three months) and 2) a Public Inquiry to ensure that the entire Long Term Care system and linkages to Health Care are working at an acceptable standard and embrace the new evidence based models of care. The non-partisan inquiry needs to be a transparent deep dive to explore all the weak and broken parts in order to create a seamless and safe environment.
To support the Interim Phase, there is a rich library of resources and reports that outline crucial steps to begin the creation of a safe environment for residents in all LTC homes. Two resources that provide an excellent and immediately actionable plan are:
1. The Public Inquiry into the Safety and Security of Residents in the Long-Term Care Homes System by Commissioner Eileen Gillese,(July 2019) in which she clearly outlines 91 recommendations that need to be implemented immediately.
2. Professor Pat Armstrong and colleagues recently released a publication outlining the barriers to the rights of care and a blueprint for short term and long term actions. (Re-imagining Long-term Residential Care in the Covid-19 Crisis Pat Armstrong, Hugh Armstrong, Jacqueline Choiniere, Ruth Lowndes, and James Struthers Toronto, April 2020 )
Support for both of these phases also requires reformation of the oversight process that is educational, responsive, timely and consistent to standards. To support the Public Inquiry Phase, we would request that family member voices be invited to take part. . Organizations such as Family Council of Ontario would be an ideal source to share the lived experience and offer suggestions as the repair structure is put into place. Our team is also prepared to respond to inquiry sessions and serve on work groups rebuilding the standards and environment that our seniors deserve.
May 18, 2020
Thank you for listening
Chair of the Advocacy Committee of Family Councils Network 4
This network embraces 86 LTC homes and over 11,000 residents within Hamilton, Niagara, Haldimand, Brant, including the city of Burlington and most of Norfolk county
cc Hon. Merrilee Fullerton, MPP Kanata - Carleton, Minister of Long Term Care Andrea Horwath, MPP Hamilton Centre, Leader of NDP, Leader of Opposition Teresa Armstrong, MPP London/ Fanshawe, NDP LTC Critic Hon. Christine Elliot, MPP Newmarket-Aurora, Minister of Health Samantha Peck, Executive Director, Family Councils of Ontario
Staff increases needed to reduce violence in LTC homes: Advocacy Group
NEWS Feb 03, 2020 by Allan Benner The St. Catharines Standard
Network 4 Long-Term Care Advocacy Committee chair Carol Dueck, right, and Ontario Health Coalition board member Sue Hotte discuss concerns about a shortage of personal support workers. - Allan Benner , Torstar
As incidents of violence increase at long-term care homes, an advocacy group says having more, better trained personal support workers on hand is needed to protect residents and staff.
Network 4 Long Term Care Advocacy Committee chair Carol Dueck is teaming up with Ontario Health Coalition board member and Niagara chapter president Sue Hotte to appeal to Queen's Park to increase to at least four hours the level of care available per resident per dayat facilities across the province.
Dueck joined Hotte for a media conference at the downtown St. Catharines library last week to discuss a report called Caring in Crisis: Ontario's Long-Term Care PSW Shortage. It was developed through a series of roundtable meetings conducted last year in Hamilton, London, Chatham, Kitchener-Waterloo, Windsor, Sault Ste. Marie, Sudbury and Thunder Bay.
While increased staff levels and training might not prevent all incidents because of the "sudden acting out and the anger that happens" among many patients with dementia, Dueck said "you certainly would be able to reduce it by a whole bunch."
Considering that incident and many others that are occurring in long-term care homes, the advocacy committee and the Ontario Health Coalition are continuing to advocate for a minimum standard of four hours of hands-on care per day for residents.
If there were enough staff on hand, Dueck said, workers would be able to "de-escalate an incident before it gets really bad."
"Half the time you don't even see what's going on because you're down the hall with two other patients and there's just not enough hands on deck," she said.
PSWs, Dueck added, also need to be trained to handle situations when residents become aggressive and violent, and there are not enough lockdown places to put people who cannot be controlled.
"It would reduce the risk both for residents and other staff remarkably if there were enough hands on deck, if there was four hours of care for everybody," she said.
Hotte said the coalition has been investigating recent instances of violence in long-term care homes, and "had a series of recommendations in terms of what could be done to avoid that."
The Time to Care Act
In September, 2019, Carol Dueck, Chair of FCN4 Advocacy Committee met with with Teresa Armstrong MPP / NDP and Long Term Care critic.
She followed up with a second meeting with Ms. Armstrong's office staff in February, 2020.
Advocates wonder why long-term care COVID warnings were ignored
Deadly crisis 'foreseen' in patchwork system with known weaknesses
By Jonathon Gatehouse · CBC News · Posted: Apr 14, 2020 7:34 PM ET |
Last Updated: April 15
See the comments by Tom Carrothers, a member of the Family Council Network Work Advocacy Committee highlighted below.
A body is removed from a long-term care facility, the Centre d'hebergement de Sainte-Dorothee in Laval, Quebec, on Monday. Almost half of all COVID-19 deaths in Canada have occurred in homes for the aged. (Christine Muschi/Reuters). The surge in COVID-19 illnesses and deaths within Canada's long-term care facilities has left politicians scrambling to react and experts wondering why no one listened to their warnings. According to data collected by the federal government, close to half of all COVID-19 deaths — a toll that stood at more than 975 as of Wednesday — have occurred in nursing homes. "We recognize the terrible and tragic stories that have come out of seniors' residences and long-term care facilities across the country," Prime Minister Justin Trudeau told reporters in Ottawa on Tuesday afternoon. "We know we need to do more." In Ontario, where 114 long-term care facilities are now dealing with COVID-19 outbreaks, with three of the homes having reported more than 20 deaths each, Premier Doug Ford likened the situation to a "wildfire," promising to dispatch hospital-based teams to tackle the problem. "My top priority right now is getting the troops and resources needed at this front," he said during his daily media briefing Tuesday.
While in Quebec, where the province is calling the situation in 41 long-term care homes "critical," and 1,250 staff are off work due to illness or potential exposure to the virus, Premier François Legault issued a desperate plea to health care workers. "I'm asking everybody available to come forward and help us," he said. "I appeal to your sense of duty to help us protect the most vulnerable." But those calls to action are being greeted with skepticism by some experts and advocates who say that the country's seniors' residences were obvious COVID-19 danger zones and should have been better protected.
'We saw it coming'
"This wasn't just foreseeable, it was foreseen. We saw it coming in Italy. We saw it coming in Spain, let alone what was happening in Asia. And we knew that people in long-term facilities would be left without the care they need," says Laura Tamblyn Watts, the CEO of CanAge, a national seniors' advocacy organization.
"There is a failure of leadership at every level of government."atch
Trudeau faces questions on long term car
Dr. Nathan Stall, a Toronto geriatrician and fellow at Women's College Research Institute, says the current crisis is revealing all the weaknesses of a senior care system that has suffered from decades of neglect.
"This is not new," he told CBC News. "It's just taken a global pandemic to unearth the problems that affect almost every aspect of the sector." One such shortcoming, Stall said, is dated facility designs, where residents often share rooms or are packed into common areas, thereby increasing the probability of virus transmission. Another is the low pay and scant benefits offered to workers. "There are chronic under-staffing issues," he said. "Many of them work part-time and don't have paid sick leave. And that necessitates them to work at multiple facilities, which contributes to the spread."
Alicia Tamayo, 95, waves at her daughter Betty Fernandez and granddaughter Romina Varella from her window at the Eatonville Care Centre in Toronto, where several residents have died from COVID-19. (Carlos Osorio/Reuters). Governments in British Columbia and Newfoundland and Labrador have already told staff that they can only work at one facility during the crisis. On Tuesday, Ontario announced that it intends to enact a similar emergency rule. Over the long weekend, the federal government unveiled a slew of new guidelines for long-term care facilities, including enhanced cleaning, mandatory medical screening for staff and physical distancing at meal times. But even that is unlikely to halt the rapid spread of the novel coronavirus, says Dr. Samir Sinha, director of geriatrics at Toronto's Sinai Health and chief researcher at the National Institute on Ageing.
Sinha says the coronavirus outbreak seems to be exposing "unique systemic vulnerabilities" within Canada's long-term care system — an underfunded patchwork of public and private homes, all governed by rules and regulations that differ from province to province. Testing for the virus among residents and staff remains sporadic, while long-term care workers have limited access to personal protection equipment (PPE), and less training on how to properly use it, he notes. "There are a lot of people right now in the system who don't feel confident," says Sinha. "They don't want to be working in a home where there's an outbreak because they're not sure if they're going to be protected." More than 150,000 people live in dedicated care centres across Canada, according to the Canadian Association for Long-Term Care. Quebec alone has 40,000 residents in its 440 accredited homes, while Ontario has 628 such facilities. And the vast majority of the clients are both elderly and frail. A 2019 survey of Ontario care homes found that 76 per cent of residents had heart or circulation illnesses, while 64 per cent had been diagnosed with dementia, and 21 per cent had suffered a stroke.
Tom Carrothers, a longtime volunteer with the Family Council Network 4 Advocacy, an Ontario organization dedicated to fighting for the rights of long-term care patients, says families are terrified of what lies ahead. Prohibited from visiting their loved ones, they are also finding it hard to pry information out of the homes. "They're just worried that they're not getting the care they need right now and so many staff and residents are very sick," he says. Still, Carrothers is hopeful that something positive will ultimately come out of the COVID-19 tragedy, and that governments will finally take action to address the many weaknesses in the long-term care system. "I think there will be change out of it because it is hitting so many people right across the province as well as the country," he said. "I can guarantee you that groups like ours will be sure to keep it moving."
Tamblyn Watts rattles off a list of specific measures that Canadian governments need to immediately take to confront the current crisis and its underlying causes: a vast expansion of testing, more PPE and, above all, a co-ordinated and fully funded national strategy for long-term care. "The time was about a month ago, but every day matters," she said. "These are not numbers. These are people who are being neglected, people who are dying. They have names. They have families. And so everything that we do matters."
Family Council Network 4 Advocacy
Committed to Improving the lives of Ontario Residents in Long Term Care
September 4, 2020
Hon. Merrilee Fullerton ,
Minister of Long Term Care
Toronto, ON M7A 1A1
RE: Second Wave Planning for Long-Term Care
Dear Minister Fullerton:
Our Advocacy team speaks for 86 Long Term Care homes in the Hamilton, Brant, Haldimand, Niagara, Burlington and Simcoe area. We echo the concerns raised by the Champlain Region Family Council Network in letter dated September 2, 2020, as our families in this region have raised questions and concerns about the preparedness of LTC homes for a potential second wave of COVD-19.
Although most of the homes report the the current supply of protective equipment is available, the sustainable staffing issues have not been addressed. Staff stamina and resiliency are fragile and staff ratios are barely coping with the current workload. Students nurses who were in the role as PSW’s are returning to class and will leave a void in hands to care for residents.
The question of Ontario’s preparation for an uptick of infections of the seasonal flu, coupled with a second wave of COVID-19, with the recruitment, retention and education of the care giving staff is outstanding. We were impressed with the published report in August 2020 from the Government of Quebec with detailed planning and recruitment outlined to cope with the eventual second wave. We are asking for Ontario’s LTC team to share similar plans to date.
We are aware that individual long-term care homes have recently submitted “preparedness assessments”. Many of our Family Councils in our region report that they were not informed or consulted in the process. The announcements were happily received about the stepwise increase in visitation guidelines, but with more families assisting in the care and visitation, this will add to the burden of equipment needs and staffing to show and monitor families the correct infection control procedures. We wonder if this was part of the preparation planning and ongoing assessment.
Our Advocacy team wholeheartedly supports the recommendations put forward by the Champlain Family Council Regional Network.:
• Recognize family members as essential care partners who help with the psychosocial and physical care needs of residents (but are not be seen as free labour to replace paid staff).
• Establish clear guidelines and policies for essential care partners that can be applied consistently across all homes.
• Require homes to have regular and consistent communication to keep families apprised of the outbreak status in the homes and the well-being of their loved one.
• We support the recommendations of the Ministry Staffing Study but urge that many of the recommendations need to be implemented in advance of a second wave.
• Hire more nurse practitioners. We are aware that many doctors did not visit homes during the pandemic. On-site nurse practitioners would oversee consistent medical care and monitoring
• Immediately improve pay and benefits for staff and reduce part-time positions.
• Implement a minimum care standard to assure adequate staffing levels (Time to Care Act)
• Continue with policy of limiting front-line workers to one home
• Implement an accelerated hiring program so that homes are prepared for the second wave with a full complement of staff. The sector must attract and fast track the training of personal support workers or aides similar to what Quebec has done. Similar programs may be required for nursing, dietary aides and cleaning staff. Personal suitability for the work should be an essential requirement for admission to training.
• Require that all homes hire a full-time IPAC specialist, or for smaller homes, ensure that they have ready access to a specialist.
• Eliminate the use of staff who work in other high-risk settings such as educational aides.
• Identify and train volunteers to assist with resident care such as feeding, hydration and personal interaction.
Inspections and compliance
• Conduct unannounced inspections of all homes prior to the second wave to assess home preparedness for a second wave
• Ensure that inspectors have a regular presence in homes during a second wave to assess infection control practices and resident care and whether the home is coping
• Work with homes to ensure that they can meet the requirements for infection control and implement strict penalties if they fail to comply.
• Take over the management of homes that are not compliant and have demonstrated the inability to protect residents and staff.
PPE and Testing
• Ensure that all homes have sufficient PPE for staff and essential care partners and that everyone is trained in their proper use.
• Supplement funding for homes to account for the cost of PPE.
• Prioritize LTC staff, resident and family testing so that there are no delays in results that may put residents and other staff at risk
• Require homes to report when they are in crisis and need help from care partners such as hospitals
• As during the initial pandemic, ensure that local hospitals and other resources are prepared to provide assistance to overwhelmed homes.
• Ensure oversight of homes that have required outside assistance, and if necessary, take over the temporary management of the home.
We again offer our voice and experiences in the planning process and are available to discuss these recommendations via videoconferencing.
Chair, Advocacy Committee of Family Councils Network Four
carol,firstname.lastname@example.org. /. 289-696-6994
Hon. Doug Ford, Premiere
Christine Elliott, Minister of Health
Dr. David Williams, Chief Medical Officer
MPPs LHIN 4 Region
MPP Teresa Armstrong, NDP LTC Critic
Samantha Peck, CEO, Family Councils Ontario
Cathy Fooks, Patient Ombudsman
Bonnie Lysyk, Auditor General of Ontario
Paul Dubé, Ontario Ombudsman
Niagara advocacy groups say province’s long-term care plan falls short
By Allan BennerStandard Reporter
Wed., July 15, 2020
It’s been a long time coming, but Wednesday’s provincial government announcement of investments and enhancements to long-term care was welcome news to Niagara advocacy groups and political leaders.
Premier Doug Ford teamed with Long-Term Care Minister Merrilee Fullerton and deputy premier and Minister of Health Christine Elliott to reannounce a $1.75 billion, five-year investment in long-term care homes.
They also announced updated design standards; residents within the facilities were particularly hard hit by the COVID-10 pandemic. In Niagara, 44.1 per cent of the region’s 783 confirmed cases occurred during outbreaks, mostly in long-term care homes.
The province also announced new standards such as requiring air conditioning in new or renovated homes, including funding to help private, non-profit and publicly run facilities cover the cost of installing systems.
“Thank goodness they’re finally addressing this, especially the air conditioning piece,” said Carol Dueck, chair of the Network 4 Long Term Care Advocacy Committee. “A lot of the homes are just so old that the electrical systems can’t handle it.”
She said the lack of air conditioning is a problem that has gone on for decades.
“As soon as the winter comes they forget about it, and then the next June they start harping about it. At least they’re addressing it, which is good.”
In addition to rebuilding dozens of facilities, the announcement calls for an additional 8,000 new long-term care beds to be opened by 2022.
But Dueck said there’s “still a big gap to get through,” with a second wave of the coronavirus expected prior to then.
Betty Miller, president of long-term care advocacy group Guardian Angels Program, called the announcement disappointing, saying she’s concerned residents of older facilities with no air conditioning will continue to suffer.
Miller’s group has advocated for a substantial change in the way long-term care homes are designed, calling for smaller facilities where outbreaks can be more easily managed.
“We’d like to see it going to a new vision for long-term care, instead of warehouse facilities, that are more home-like,” she said. More funding also needs to be invested in homecare services so seniors can remain in their own homes longer. After what she said were too many promises under Liberal and Progressive Conservative governments, St. Catharines MPP Jennie Stevens wonders, “is it going to be acted on this time?”
The New Democrat is also concerned that for-profit long-term care homes would benefit from funding set aside for the installation of air conditioning.
“Profits don’t belong in long-term care,” she said. “These for-profit homes should be paying for air conditioning.”