Chapter Four (3 of 3): The Pandemic Years ~ The Reports in Review
This is an excerpt from the book A Physician in the Political Arena: Ethics, Duty and the Pandemic. Broken into three parts, the Chapter “The Pandemic Years” is a detailed review of the what took place in Ontario’s long-term care sector during the COVID-19 pandemic in 2020 and 2021. Within the Chapter there is a detailed review of the independent and government reviews of what transpired. The full text of the chapter can be found online at MerrileeFullerton.com.
The reports
In summary, the reports delivered by the Commission, Auditor General, and the Ontario Ombudsman are important documents recording details and capturing testimony from this critical period in which COVID-19 was inflicting such hardship in long-term care homes. The reports were united in their critical comments about successive governments’ failure to provide the necessary investments required in long-term care in the province. This neglect resulted in systemic weaknesses for the long-term care sector. Given the magnitude of the challenges faced in 2020 and 2021, the newly established Ministry of Long-Term Care was unable to make up for lost time in the months before the pandemic hit.
When considered together, the reports have produced a valuable record of facts. The combined recommendations provide a good checklist for government to advance and improve elder care.
Reflecting on the new ministry’s accomplishments
On June 18, 2021, almost two years to the day that I was named the Minister of Long-Term Care, Premier Ford notified me that I was to move on from long-term care to assume the responsibilities of the Ministry of Children, Community and Social Services. For me it was a sad moment for there was much in the long-term care sector that I had wanted to see through to its completion.
Not only did the Ford government create a stand-alone ministry to oversee the province’s long-term care sector, it appropriately funded the ministry’s objectives. I was fully engaged in the priorities the government set for elders and long-term care – and it was disappointing to have to move on when ministry initiatives were being implemented and finally taking shape.
In the appendices there is a summary of Ministry of Long-Term Care activities through the first two years when I was Minister. There was much accomplished in a short period of time. In creating the new ministry, the Ford government demonstrated its commitment to improving elder care in Ontario. However, it is certain that nobody at Queen’s Park factored in just how much would need to be invested in long-term care. There is a terrible irony here in knowing that the COVID-19 pandemic crisis prompted attention and large investments into a long-term care sector that had been neglected for far too long.
In the Spring 2021 Ontario Budget our government provided additional funding that would signal historic investments totaling nearly $10 billion in long-term care. This was gratifying, albeit bitter given the tumultuous times experienced and lives lost in the long-term care sector through the past year. From my first months in 2019 when the Ministry of Long-Term Care was responding to the Justice Gillese Report, I worked to secure greater investments in staffing and infrastructure. In this budget there was the commitment to billions of dollars of investment.
Perhaps there was no more significant expenditure the government made than the investments to address the staffing supply shortages. With the pressures caused through the pandemic years, the government focused on the needed investments in PSWs and nursing staff. As laid out in the budget, we were spending $4.9 billion over four years to create more than 27,000 new positions for PSWs, registered nurses, and registered practical nurses in long-term care. The additional staff will enable the province to increase hours of daily direct care and provide an average of four hours per day of care for residents. This commitment placed Ontario as the leader in Canada for supporting long-term care staff.
The 2021 budget also provided for the accelerated training of 8,200 PSWs at Ontario’s publicly assisted colleges -- and this is in addition to over 8,600 new staff hired through pandemic pay. The government also provided for an expansion of nursing programs to 1,130 new practical nurses and 870 registered nurses -- an expansion that was long overdue for decades. This is all part of the ministry’s comprehensive staffing strategy and I was pleased to be finally directing the implementation of the recruitment and training program.
In two short years we had already gone a long way in keeping our campaign promise to increase long-term care beds in Ontario. The government was building new long-term care homes and redeveloping aging long-term care homes at a remarkable pace. With a budget of $2.6 billion in 2021, there were over 20,000 new and over 15,000 upgraded spaces in development.
In summarizing these investments, I am fully aware that all the gains made over the two years by the new Ministry of Long-Term Care are totally eclipsed by the fact that the province suffered through a global pandemic that resulted in such tragedy for so many elderly. The deadly virus greatly impacted Ontario long-term care homes, their residents and families, and staff. As the independent Long-Term Care Commission looking into the pandemic period concluded, long-standing issues neglected by successive governments contributed to the spread of COVID-19. The government did not apply the lessons learned from the SARS pandemic, nor did it respond as fast as it should have to the evolving science.
The pandemic losses will forever outweigh the new ministry’s gains -- as they should. In retrospect, there could be no realistic expectation that a new ministry, largely dependent on the Ministry of Health, would be able to make up for so much lost time during such an unexpected and urgent pandemic crisis. Again, it is a sad irony that the crisis shone the light onto Ontario’s neglected long-term care sector and prompted the government to make necessary investments in staffing and infrastructure.
Videos
The concepts of the Precautionary Principle, aerosol spread, and community and asymptomatic spread are explained in the following short videos. Here I explain why these concepts are critical to understanding what happened during the COVID-19 pandemic and how we can improve mitigating future health pandemics where we are managing a viral outbreak.