Ontario’s Long-Term Care sector is in a grave humanitarian crisis.
Ontario’s Long-Term Care sector is in a grave humanitarian crisis.

We are a group of physicians, researchers, and advocates who have come together to express our grave concern for the safety and well-being of Ontarians who reside and work in long-term care (LTC) homes. We call upon the Ontario government to immediately end the violations of peoples’ human rights and control the spread of COVID-19 in LTC. Action is needed today.

To date, the Ontario government’s approach to protect LTC residents has been reactionary at best. The lack of transparency and coordinated provincial oversight has resulted in piecemeal interventions that are too late, or sometimes, even non-existent. Proactive implementation of policies to prevent the spread of COVID-19 are desperately needed.

Lessons not learned in COVID-19’s first wave:
In the first wave, the Ontario government managed the pandemic in a way that put LTC residents and staff at increased risk for COVID-19, with devastating results. While many countries had challenges managing the rapid spread of COVID-19, Canada had the highest proportion of LTC deaths as compared to other OECD countries [1]. In Ontario, this resulted in almost 2000 deaths.

Failure to follow expert guidance:
From the Canadian military to an independent commission appointed by the government, many reports from the first wave recommend swift and decisive action to prevent outbreaks in LTC homes. The premier of Ontario, Doug Ford, promised to move “heaven and earth” to protect seniors in LTC [2]. Yet, the Ontario government has taken little immediate action in implementing these expert recommendations to improve staffing levels, increase training and improve infection control practices. The government has allowed the situation in our LTC homes to become a preventable and recurring crisis during the 2nd wave, with deaths across the entire province.

In the second wave, we’re still seeing:

-Poor infection control practices. For example, the Ontario government still allows health care workers to work at multiple LTC homes. This goes against infection control practices, many of which we learned from the SARS outbreak nearly 20 years ago.

-Delayed responses to outbreaks in homes. The Ontario government has not consistently or proactively tapped into hospital or community-based response teams despite their expertise in infection control and ability to improve medical care. This failure has resulted in more cases and deaths.

-Lack of transparency. Family members and the public often do not know about staffing levels and infection control standards in a LTC home until it is revealed by a whistleblowing family caregiver or anonymous frontline health worker, who provide facts that differ from the home administration and the provincial government.[3, 4].

-A worsening staffing shortage during the second wave. Reports show the province has 30 percent fewer personal support workers compared to the first wave.[5]. Sixty-five percent of front-line health workers in homes with COVID-19 outbreaks, reported not having enough staff to provide daily hands-on care to residents [6].

-Delays in improving staffing levels. Despite the COVID-19 crisis and the fact that residents have a median life expectancy in Ontario LTC homes of 18 months [7], the government has announced that they plan to improve staffing levels within 4-5 years with little details on funding to support this direction [8,9]. This timeline is unacceptable.

Continued abandonment and inhumane conditions for LTC residents:

As physicians, researchers, and advocates, we know the ongoing staffing shortages compromise resident care. Due to the Ontario government’s inaction in compelling improvements in private, for-profit settings and insufficient action broadly, LTC residents are at high risk of death from COVID-19. In many circumstances, residents are also left without basic care, hygiene, food and water. This is a human rights violation.

Despite all of this, the Ontario government passed legislation to make it harder for families to seek justice for the tragic loss of loved ones by raising the threshold for liability of wrongdoing for LTC operators, many which are private and for-profit [10,11]. We are concerned to learn from media reports that the Ontario government has delayed the Commission’s efforts by delaying release of documents to the commission and impeding their work [12].

The Ontario government is heading in the wrong direction. LTC residents are paying the price.

Urgent call to action

At a minimum, we demand the Ontario government take the following actions immediately:

1. End for-profit LTC. For-profit LTC homes have had far worse outcomes during the pandemic as compared to non-profit and municipal LTC homes [13]. Any home operator that does not comply with staffing ratios, infection control protocols, or commits any other major infraction which harms the residents should immediately face a harsh penalty. A strong consideration should be given to remove licenses permanently and incorporate the home into the public system.

2. Use all powers and resources available to hire qualified staff who are available now while building capacity through an urgent training and recruitment effort. Legislate a care standard immediately to ensure all LTC residents receive a minimum of four hours of direct hands-on care per day.

3. Set a minimum pay standard for front-line LTC staff consistent with the hospital sector. It is the decent thing to do to support frontline workers.

4. Ensure at least 70% of staff at each LTC home are full time. All staff should be permanent and receive paid sick leave and benefits. In the case of shortages, part-time staff should receive the first opportunity to receive full-time work. Eliminate the use of agency workers.

5. Ensure essential caregivers are allowed unrestricted entry into LTC homes with proper PPE to look after their loved ones and make sure appropriate care is being delivered. Legislate and enforce essential caregivers’ rights to enter LTC homes, whether they are in COVID-19 outbreak or not.

6. Ensure formal partnerships are established between hospitals, primary care teams and all LTC homes. This way, the right expertise can be available at the right time. This will improve infection prevention & control and will cut response times down in the event of an outbreak.

7. Keep hospital or community based medical teams on standby, and give them the authority to go into LTC homes, with or without permission from the home’s ownership, at the start of an outbreak to help with:
a. infection control practices
b. meeting the basic care needs of residents, including feeding and bathing
c. medical assessment and treatment of residents affected by COVID-19 or
otherwise

8. Where required, call upon the Military to immediately assist LTC homes struggling with large outbreaks where staffing has collapsed.

9. Accelerate the vaccination rollout to vaccinate LTC residents, front-line staff, and essential family caregivers as soon as possible.

Urgent action is needed now. This is a matter of life and death.

*For access to the official document and references, click here: https://docs.google.com/document/d/1IO8NP3Jj7dcWjqOikBbujY2Y2YYCVGr5CQDKntTMobc/edit?usp=sharing

Signed,

1. Amit Arya, MD, CCFP (PC), FCFP, Palliative Care Physician, Lecturer, Department of Community & Family Medicine, University of Toronto
2. Vivian Stamatopoulos, M.A., Ph.D, Associate Teaching Professor, Faculty of Social Sciences & Humanities, Ontario Tech University
3. Pat Armstrong, Ph.D., Distinguished Research Professor of Sociology, York University
4. Hugh Armstrong, Professor Emeritus of Social Work, Political Economy, and Sociology, Carleton University
5. Naheed Dosani, MSC, MD, CCFP (PC), Palliative Care Physician, Lecturer, Department of Family & Community Medicine, University of Toronto
6. Danyaal Raza, MD, MPH, CCFP, Family Physician, Board Chair, Canadian Doctors for Medicare
7. Sarah Newbery, MD, CCFP, FCFP, Family Physician, Assistant Professor, Division of Clinical Sciences, Northern Ontario School of Medicine
8. Andrew Boozary, MD, MPP, SM Family Physician, Assistant Professor, Institute of Health Policy, Management & Evaluation, University of Toronto
9. Semir Bulle, MD Candidate, University of Toronto
10. Jennifer Kwan, MD CCFP, Family Physician
11. Brian Goldman Emergency Physician, Sinai Health System, Toronto
12. Philip Berger O.C. O.Ont , MD University of Toronto
13. James Maskalyk MD University of Toronto
14. Ross Upshur, Professor, Department of Family and Community Medicine and Dalla Lana School of Public Health, University of Toronto
15. Ritika Goel, MD, MPH, CCFP, Family Physician, University of Toronto
16. Lynn Wilson, Family & Community Medicine, UofT
17. Sandy Buchman MD CCFP (PC) FCFP, Chair & Medical Director, Freeman Centre for the Advancement of Palliative Care, North York General Hospital, Toronto.
18. Najma Ahmed, MD, PhD, FRCSC, St. Michael's Hospital
19. Onye Nnorom, MD, CCFP, FRCPC, President Black Physicians’ Association of Ontario
20. Joel Lexchin MD, CCFP(EM), FCFP, Board member Canadian Doctors for Medicare, Emergency Physician University Health Network
21. Tara Kiran, MD, MSc, CCFP, FCFP, Family Physician and Associate Professor, University of Toronto
22. Suzanne Shoush, MD, Family Physician and Indigenous Health Faculty Lead, DFCM UofT
23. Lisa Richardson, MD MA FRCP, University of Toronto
24. Nili Kaplan-Myrth, MD, CCFP, PhD, Family Physician
25. Ashley Verduyn, MD, FCFP, LTC and Family Physician, Lecturer Department of Community & Family Medicine, University of Toronto
26. Abdu A Sharkawy MD FRCPC. Internal Medicine & Infectious Diseases, Assistant Professor of Medicine, University of Toronto
27. Yoni Freedhoff, Associate Professor, Dept. of Family Medicine, University of Ottawa
28. Ashleigh Tuite, PhD MPH, Assistant Professor, University of Toronto
29. Sharleen Stewart, President, SEIU Healthcare
30. Candace Rennick, Secretary-Treasurer of CUPE Ontario
31. Patty Coates, President, Ontario Federation of Labour
32. Katha Fortier, RPN, Assistant to the National President of Unifor
33. Tamara Daly, Professor of Health Policy and Equity and Director, York University Centre for Aging Research and Education, York University
34. Camilla Wong, MD FRCPC, Geriatrician
35. Jose Pereira. Professor, Division of Palliative Care, McMaster University
36. Nanky Rai, MPH MD CCFP, Family Physician, Parkdale Queen West Community Health Centre, University of Toronto
37. Seema Marwaha, MD, FRCPC, Editor-in-Chief of Healthy Debate, General Internist
38. John Neary MD FRCPC, Director, Division of General Internal Medicine, Department of Medicine, McMaster University
39. Michael Warner, MD, FRCPC, MBA; Medical Director of Critical Care, Michael Garron Hospital
40. Gary Bloch MD CCFP FCFP Family Physician and Associate Professor, University of Toronto
41. Javeed Sukhera, MD, PhD, DABPN, FRCPC, Psychiatrist and Associate Professor, Western University
42. Tara Moriarty, PhD, University of Toronto, COVID-19 Resources Canada
43. Michelle Cohen, MD, CCFP, Family Physician, Lakeview Family Health Team, Dept of Family Medicine, Queen's University
44. Shady Ashamalla, MSc, MD, FRCSC Head of Division of General Surgery, Sunnybrook Health Sciences Centre
45. Sharon Kaasalainen, PhD, Professor, School of Nursing, McMaster University
46. Kashif Pirzada, MD, CCFP(EM), Emergency physician, Co-founder, Masks4Canada
47. Jonathon Herriot, MD, CCFP, AAHIVS
48. Alan John Drummond, Emergency Physician, Perth, Clinical Assistant Professor, University of Ottawa and Queen's University
49. Abhishek Narayan, MD CCFP (COE), Clinical Assistant Professor (Adjunct) McMaster University, Clinical Lecturer-University of Toronto,
50. Samir Gupta, FRCPC, Clinician-Scientist
51. Andrew Baker MD, MHSc, FRCPC. Geriatrician. Medical Director for Seniors Health- Humber River Hospital. OMA Section Head: Geriatric Medicine.
52. Ayelet Kuper MD DPhil FRCPC, Associate Professor, Dept of Medicine, University of Toronto
53. Saadia Sediqzadah, MD, SM, FRCPC, Psychiatrist, University of Toronto
54. Sarah Giles, MD, CCFP(EM), FRRMS, DTMH, assistant professor, Northern Ontario School of Medicine, lecturer, University of Ottawa Faculty of Medicine
55. Saroo Sharda MBChB MMEd FRCPC Anesthesiologist Halton Healthcare
56. Amina Jabbar BSW, MSc, MD, FRCPC, Geriatrician
57. Nav Persaud MD CCFP, University of Toronto
58. Vanessa Redditt, MD, CCFP, Lecturer, Department of Family & Community Medicine, University of Toronto
59. Daniel Pepe, MD CCFP, Department of Family Medicine Schulich School of Medicine and Dentistry
60. Alykhan Abdulla MD FCFP DIPSPORTMED CTH CCPE MCPL ICD.D
61. Kiran Rabheru, MD, CCFP, FRCP. Geriatric Psychiatrist, The Ottawa Hospital & Professor of Psychiatry, University of Ottawa
62. Mamta Gautam, MD, MBA, FRCPC. Psychiatrist, University of Ottawa.
63. Samantha Green, MD CCFP, family physician
64. Shraddha Pai, PhD. Independent Investigator, Ontario Institute for Cancer Research
65. Kate Hayman MD, MPH, FRCPC, Emergency Physician, University of Toronto
66. Michaela Beder, MD FRCPC, Psychiatrist, Assistant Professor, University of Toronto
67. Brian Hutchison, MD, MSc, FCFP, Professor Emeritus, Departments of Family Medicine and Health Research Methods, Evidence and Impact, McMaster University, Board Director, Canadian Doctors for Medicare
68. Lucy Barker MD FRCPC, Psychiatrist
69. Kate Mulligan, DLSPH, University of Toronto
70. Ashley Heaslip, MD, CCFP, MPH, Family Physician
71. Edward Xie, MD MSc, Emergency Physician, University of Toronto
72. Andreea Manea, Student of Psychology at York University
73. Melanie Bechard, MD, FRCPC; Canadian Doctors for Medicare Board Director
74. Hasan Sheikh MD CCFP(EM) MPA; Board Member, Canadian Doctors for Medicare
75. Paul Gill, MSc MD CCFP FP-A, Lecturer, Department of Family and Community Medicine, UofT
76. Cathy Faulds, MD, CCFP, FCFP, CAC (PC) Family physician with focus practice in Palliative Care
77. Iacovos Michael, Ph.D., Sunnybrook Research Institute
78. Krishana Sankar, PhD, Biological Scientist; Science communication lead COVID-19 Resources Canada
79. Marie-Lee Yous, RN, MScN, PhD student, McMaster University
80. Jackie Brown, BASc, MES
81. Osman Raza MD; Board Member, Canadian Doctors for Medicare
82. Patricia Strachan, Associate Professor, School of Nursing, McMaster University
83. Lorraine Lee, MD, CCFP, Family Physician
84. Timothy Li, MSc, MD, CCFP, Family Physician
85. Eshrat Sayani MD CCFP FCFP MScCH
86. David Eisen, BA, LLB, MBA, MD, CCFP, FCFP, Family Physican
87. Tehmina Ahmad, MD FRCPC
88. Hershl Berman, MD FRCPC, Specialist in Internal Medicine and Palliative Care, Assistant Professor, Dept. of Medicine, University of Toronto
89. Tanya L. Zakrison, MD, MPH, FACS, FRCSC; Trauma Surgeon
90. Amanda Yvonne Li, MD, CCFP (PC), Family and Palliative Care Physician, Lecturer, Department of Family & Community Medicine, University of Toronto
91. Jeyla Chen, MD, CCFP, Family Physician
92. Yipeng Ge, MD, Public Health and Preventive Medicine Resident Physician, University of Ottawa
93. Peter Newman, MD, CCFP, FCFP, Family Physician
94. Seana Adams, MD Candidate, University of Toronto
95. Ripudaman Singh Minhas, MD MPH FRCPC, St. Michael's Hospital, Unity Health Toronto
96. Gillian Kolla, PhD, Postdoctoral Fellow, University of Victoria
97. Ed Jin, MD, CCFP(EM), Emergency Medicine Physician
98. Tanya Boozary MD, Resident Physician, McMaster Family Medicine
99. Hailey McInnis, MD, Family Physician
100. Abe Oudshoorn, RN, PhD, Assistant Professor, Western University
101. Amanpreet Brar, MD, General Surgery Resident, University of Toronto
102. Ali Damji, MD, MSc, CCFP Family Physician & Assistant Professor, Department of Family & Community Medicine, University of Toronto
103. Alissa Tedesco, MD CCFP(PC), Palliative Care Physician, Lecturer, Department of Family & Community Medicine, University of Toronto
104. Farah Marani, MD, CCFP, MPH, Family Physician
105. H.B. Ip, M.D. North York General Hospital
106. Samantha Young, MD, FRCPC, PhD Candidate, University of Toronto
107. Ikunna Nwosu, Medical Student (2022), Queen's University
108. Jonathan N. Stea, PhD, RPsych, Clinical Psychologist, Adjunct Assistant Professor, University of Calgary
109. Gaibrie Stephen MD CCFP(EM)
110. Javed Alloo, MD CCFP MPLc, Family Physician, Centre for Addiction and Mental Health
111. Karim Vellani MD CCFP, Lecturer @ University of Toronto, Family Physician @ Unity Health, Founder of MediCall
112. Arnav Agarwal, Internal Medicine Resident Physician, University of Toronto
113. Gray Moonen, MD, MSc
114. Tommy Tung MD, Family Physician and Attending Physician at Southlake Village and Chartwell Aurora
115. Sheila Boamah, RN, PhD, Assistant Professor, School of Nursing, McMaster University
116. Jennifer Tang, MD, FRCPC (Emergency Medicine)
117. John Aquino MD CCFP FCFP
118. Ahmednur Ali, PhD candidate, McMaster University
119. Robin Lennox, MD, CCFP, Family Physician
120. Nitin Mohan, MD, MPH - Assistant Professor, Schulich School of Medicine and Dentistry, Western University
121. Prashant Phalpher MD, CCFP-EM. Emergency Physician. Assistant Professor (adj), Department of Family Medicine, McMaster University
122. Claire Bodkin, MD, HAMSMaRT
123. Nagina Khan Ph.D., Mental health & Health Services Researcher, Touro University Nevada. Creative Communities UK Member
124. Meera Dalal, MD, FRCPC, ABIM, Palliative Care & General Internal Medicine, St. Michael’s Hospital
125. David Burns, MD, Resident Physician, Orthopedic Surgery, U of T
126. Allyn Walsh MD CCFP FCFP Professor Emeritus McMaster University
127. Samantha Buttemer, MD, MSc, CCFP
128. Yezarni Wynn, MD, MSc, Psychiatry Resident Physician, University of Toronto
129. Vanessa Zannella, MD, MSc, MSc(c), GIM Fellow
130. Kevin Lai, MD, CCFP, FCFP (Get Well Clinic)
131. Anna Holland, MD, CCFP
132. Beatrice Copps, MD, Dermatology Resident, University of Toronto
133. Andrew Lee, Medical Student, Queen's University
134. Victoria Reedman (Neurology Resident U of T)
135. Marcella Jones, MD, MPH, CCFP-EM, Emergency Physician
136. Jillian Macklin, MD/PhD candidate, University of Toronto
137. David Lawrence, MD, MPH, CCFP(SEM), Assistant Professor (Faculty of Medicine, University of Toronto)
138. Trevor Morey, MD, CCFP (PC), Palliative Care Physician
139. Stephen B Singh, MD CCFP(PC), Family Physician and Palliative Care Specialist
140. Katayun Treasurywala, MD CCFP EM, Lecturer, Department of Family and Community Medicine, University of Toronto
141. Sandy Tecimer, MD, Family Physician
142. Suzanne Sicchia, MHSc, MSc, PhD
143.Allan Kellehear, PhD, FAcSS Honorary Professor, Division of Palliative Care, McMaster University
144. Leigh Minuk, MD, Respirology Fellow, University of Toronto
145. Amanda Rosenblum, MD CCFP(PC), Palliative Care
146. Cait O'Donnell, Ph.D., MBHL
147. April Kam, MD MScPH FRCPC PEM, Assoc. Professor, McMaster University
148. Jeffrey Poon, MD, CCFP, Family Physician
149. Danielle Kain, MA, MD, CCFP (PC) Assistant Professor of Palliative Medicine, Queen’s University
150. Jacqueline Carverhill, MD, Family Medicine Resident, McMaster University
151. Fahima Dossa, MD, Division of General Surgery, University of Toronto
152. Daniel Buchman PhD RSW, Bioethicist and Assistant Professor, University of Toronto
153. Lian Peter, MD, MPH, CCFP
154. Leah Ugulini, RDH
155. Cheryl White, P.Eng
156. Meb Rashid MD Assistant Professor, Department of Family and Community Medicine, University of Toronto
157. Linda Wong, MD CCFP
158. Anjali Menezes, MBBS, Family Medicine Resident
159. Nisha Kansal, MD, Family Medicine Resident Physician
160. Latif Murji, MD, CCFP, Lecturer, University of Toronto
161. Britt Harrison, MD CCFP, Family Physician
162. Donna Mahoney MSc, MD, CCFP, Family Physician
163. Jonel Miklea MD, MEd, CCFP, FCFP , Associate Professor,Department of Family Medicine McMaster University
164. Donna Spaner MD,CCFP(PC),MScCH Department of Family and Community Medicine, University of Toronto
165. Kris Cheng, MD, CCFP
166. SC Grover, MD, Gastroenterology
167. Ilan Shahin, MD-CM, MBA, CCFP
168. Karen Born, PhD Assistant professor, Institute of Health Policy, Management & Evaluation, Faculty of Medicine, University of Toronto
169. Akshay Rajaram, MMI, MD, Family Medicine resident
170. Inna Berditchevskaia, MD, MSc, Internal Medicine Resident, McMaster University
171. Sheniz Eryuzlu, MD, Family Medicine Resident Physician, University of Toronto
172. Justin Huang, MD, McMaster University
173. Sheila Wijayasinghe MD CCFP, Family Physician
174. Rosalinda Chen - PGY1 Resident, Family Medicine, McMaster University
175. Tim O'Shea MD, McMaster University
176. Roddy Davey MD CCFP(PC)
177. Chetan Mehta, MA, MD, CCFP, Family and Addictions Medicine, Toronto
178. Mitali Vatsraj, MD, FRCPC, Internal Medicine/Palliative Medicine
179. Sue Gowans, PhD, retired Research Associate, UHN
180. Arianne Cohen MD, Family Medicine Resident
181. Sarah Griffiths MD CCFP (AM) Lecturer, Department of Family and Community Medicine, University of Toronto
182. Madeleine Verhovsek, MD, FRCPC, McMaster University
183. Jill Wiwcharuk, MD, CCFP (EM)
184. Antoinette Mihaylova, MD CCFP (PC) Palliative Care
185. Aveksha Ellaurie MD CCFP(PC)
186. Humaira Saeed, MD, CCFP- University of Toronto and McMaster University
187. Shazmah Hussein, Nurse Practitioner Primary Care
188. Sinthuha Sivananth, MD, Psychiatry Resident Physician, University of Toronto
189. Edith Hui, MD, CCFP, Family Physician
190. Christine Seidler, MD, MBA Health Services Management, CCFP, Assistant Professor NOSM
191. Kim Alexander, MD FRCSC, Gynecology
192. Jenn Brasch, MD FRCPC FCPA, Associate Professor, Dept of Psychiatry & Behav Neuro, McMaster University
193. Aisha Lofters, MD, PhD, Family Medicine
194. Roy Wyman, MD, CCFP, FCFP
195. Farah N. Mawani, MSc, PhD, Social Epidemiologist, CIHR Health System Impact Fellow
196. Shayna Henry, MBBS, Family Medicine Resident Physician
197. Nick Kates MBBS FRCPC MCFP(hon) McMaster University
198. Martin Shack, MD, CCFP, NYGH
199. Giovanna Sirianni, MD, CCFP (PC), FCFP, MScCH, Family Physician (Focused Practice Palliative Care), Sunnybrook Health Sciences Centre, University of Toronto
200. Denise Marshall, MD, CCFP (PC) Professor, Division of Palliative Care, McMaster University
201. Ayah Nayfeh, MSc, PhD(c), Institute of Health Policy, Management and Evaluation, University of Toronto
202. Daphna Grossman MD CCFP(PC) FCFP
203. Maggie Hulbert, MD PGY1, University of Toronto
204. Carol Kitai MD, FCFP, PhD University of Toronto
205. Thuy-Nga Pham, MD, CCFP, FCFP, MSc, University of Toronto
206. Mary Thomas, Family Physician South East Toronto FHT
207. Blaise Clarkson, MD, CCFP
208. Donna Alexander, MSW, RSW
209. Hissan Butt, MD, Family Medicine Resident
210. Tarin Arenson, MD CCFP, Family Physician
211. Sonika Kainth, MD CCFP
212. Pauline Pariser, MD MASC CCFP FCFP LM Associate Professor, Department of Family and Community Medicine, University of Toronto
213. Katie Marchington, MD CCFP(PC), Assistant Professor, Division of Palliative Care, Dept of Family and Community Medicine, University of Toronto
214. Alim Pardhan, MD, FRCPC
215. Paz Gajardo, MD, CCFP, Family Physician
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