new long-term care legislation aims to reform battered care system
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covid-19 outbreaks have devastated long-term care homes in ontario.
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by: elizabeth payne
ontario plans to scrap its 24-year-old long-term-care legislation and has introduced a bill that would double maximum fines in long-term care and make it easier for the province to take over homes that are failing residents among other things.
long-term care minister rod phillips says some of the proposed changes — including the ability of the province to quickly take over homes — “would have made a significant difference” in the course of the covid-19 pandemic in long-term care homes.
he introduced the bill in the ontario legislature thursday. earlier, the province announced it was extending pandemic pay increases to psws and nurses in long-term care until next spring, something unions have criticized, saying the pay hikes must be made permanent to stop a staff exodus out of long-term care.
phillips said the proposed legislation, along with more money for training, hiring staff and inspectors and adding thousands of beds, represents significant reform of the system and reflects lessons learned from the pandemic, which devastated many long-term care homes.
nearly 4,000 long-term care residents died during the covid-19 pandemic in ontario, leading to calls for major reforms to fix the system of care for the elderly and others based at more than 600 homes across the province.
a long-term care commission, appointed by the government to look at the spread of covid-19 in homes and the steps taken to contain it, delivered 85 recommendations last spring. phillips says the proposed new law and other reforms answer many of those recommendations.
provincial investments and reforms do not address calls to move the system away from for-profit operation of long-term care homes, though, something raised by the long-term care commission, the opposition ndp, and others. for-profit status of long-term care homes was associated with worse outcomes for residents during the pandemic. phillips said that approach would cost billions to expropriate assets. he said he is confident that tightened accountability, enforcement and transparency will respond to those concerns, adding: “we want to make sure that we are spending billions of dollars on building these new beds and care. that’s where the money should be spent, not paying off private shareholders.
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the proposed long-term care act and planned regulations would:
- enable the province to suspend a long-term care home’s licence and install a supervisor to take over the operations without having to revoke the license and close the home. the change would give the province control of the home until the suspension is lifted.
- embed the commitment to increase direct care of long-term care residents to an average minimum of four hours by march 31, 2025, with incremental increases beginning next march. the minister will be accountable for annually reporting on each target and, if it is not met, producing a public plan to explain why and how the next target will be met. increasing direct hours of care is seen as key to improving long-term care and requires increased staffing. it was among recommendations of the commission and other groups, some of whom say four hours does not go far enough, soon enough.
- mandate that palliative care becomes part of residents’ plan of care. palliative care has long been lacking in long-term care homes, more so during the pandemic.
- mandate that each home has a dedicated infection prevention and control lead whose primary responsibility is to be responsible for the home’s infection prevention and control program. the person in charge will be required to take training and inspectors will be required to audit infection prevention and control programs. only a small number of homes had a full-time staff member in charge of infection control during the pandemic, according to a survey by the registered nurses association of ontario.
- the proposed legislation would also double the maximum fines under the provincial offences act making it the highest of any jurisdiction in the country. individuals could face $400,000 fines for a second offence and corporations could face fines of up to $1 million. board members could also face fines under the act — which has never been used successfully against a long-term care home in the province. the legislation also prohibits anyone convicted of an offence from working for, volunteering for or sitting on the board of a licensee or long-term care home.
- inspectors will be given the power to issue compliance orders to long-term care homes — now something previously reserved for directors.
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“these send clear signals that we expect operators to work within the clear guidelines that we are laying out and make sure they understand their accountability,” said phillips.
the proposed act would also include quality indicators, annual resident and family surveys and quarterly public reporting about those quality indicators.
regulations that will follow the bill are expected to define the roles of caregivers and medical directors in delivering care to residents.
the province also says it will create a long-term care quality centre for training and research into best practices.
in recent weeks, the provincial government has announced $4.9 billion over four years for more staff and care, that it will double the number of long-term care inspectors and build more beds.
some critics have long complained that the existing legislation, which includes a residents’ bill of rights, contains all the language needed to ensure quality long-term care, if it is followed.
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