With more damning findings about Ontario’s nursing homes, the auditor general issues more calls to action. But are they the right ones?

The Auditor General’s 104-page report detailing Ontario’s failure to protect long-term-care residents from COVID-19 arrived with a blunt disclaimer.
“There should be no surprises about what is noted and recommended in this report,” Bonnie Lysyk wrote.
That was an understatement.
For decades, reports calling for improvements to Ontario nursing homes have been published by nurses’ associations, industry groups, activists, task forces spurred to action by newspaper investigations, and perhaps most relevant to this global pandemic, the SARS Commission on protections against infectious disease.
And yet, as the Auditor General’s report found, the Ministry of Long-Term Care and nursing homes were unprepared for the arrival of COVID. Front-line staff needed better training. Infection prevention and control were inconsistent. And, nursing homes were disconnected from the rest of the health care sector.
The new report and its recommendations arrived Wednesday, two days prior to the expected release of the report written by Ontario’s Long-Term Care COVID-19 Commission.
Successive governments and most long-term-care operators have ignored more than 20 years of reports. This time, compelled by coronavirus, another 16 recommendations will be added, many of them repeats of past calls to action.
Most of those earlier recommendations went nowhere.
Sometimes there was incremental change. After a 2003 Star investigation into nursing home abuse, then-Liberal Health Minister George Smitherman responded with new legislation and a 2010 inspection system that promised rigorous annual inspections, although they are now a rare occurrence.
He was moved to tears by the Star’s story of Natalie Babineau, who suffered a massive pressure ulcer in her Hamilton-area nursing home. He promised a revolution in long-term care. Over the ensuing years, Star stories exposed untreated broken bones, asphyxiation, rape and emotional neglect.
As Babineau’s granddaughter, Lisa Neufeld, said a few months ago, “Nearly 20 years later and not a damn thing has changed.”
If this time the government acted fully and quickly on this latest list of recommendations, some would help the sector deal with mounting pressures. As residents increasingly enter homes with cognitive decline and a host of long-standing medical issues, homes would benefit immensely from the auditor’s recommendations that call for more staff, improved training, essential visitors, medical supports, and designs that eliminate four-person wards, a leading cause of infection spread.
Other recommendations, if implemented and taken too far, could harm.
The report’s sixth recommendation calls for “formal partnership agreements between long-term-care homes, local hospitals and public health units.” (In its response to the audit, the Ministry of Long-Term Care said it plans to “explore opportunities to formalize partnerships between LTC homes and hospitals or other organizations.”)
This alarms some seniors advocates and geriatric experts.
“We do not want long-term care turned into hospital care,” said Laura Tamblyn Watts, CEO of CanAge, a seniors’ advocacy organization.
Tamblyn Watts is not alone in this sentiment. She and other advocates have worried throughout the pandemic that the government may over-correct.
The long-standing problems highlighted in the report must be addressed, said Dr. Samir Sinha, director of geriatrics at the Sinai Health System.
But he also said change must “ensure we don’t do it in a way that over-medicalizes or regulates a sector that needs to be supported to deliver better resident and family-centred care with well trained and supported staff.”
No one is arguing against better medical care for nursing home residents. It is long overdue. While nursing homes can send ailing seniors to hospitals for necessary care, they may be reluctant to do so. The government keeps data on how often homes do this as a way to measure their impact on the health-care system. Homes may feel stigma if their transfer rates are high.
But long-term care is supposed to serve as a home. Hospitals are institutions.
Instead of turning long-term care into warmer, smaller households focused on relationships and the individual interests of residents, the medicalization of nursing homes risks doing the opposite.
Yet, the improvements created by these innovative homes, for residents and staff, are there to see and hailed by experts.
A 2018 Star investigation revealed the impact of emotion-focused care during a Peel Region pilot project of the Butterfly program. Over a year, residents embraced life through music, conversation and dancing.
Since then, other Ontario homes such as those operated by Primacare Living have adopted the program, saying it has resulted in less anxiety and aggression, a significant drop in antipsychotic medication use and greater satisfaction among staff and families.
But as Tamblyn Watts noted, “The report doesn’t talk about the need for emotion-focused care, smaller households and more flexible regulations to support the needs of older people.”
Donna Duncan, CEO of the Ontario Long Term Care Association, applauded the report’s call for better medical connections — with a caveat.
“Hospitals were an essential partner to protect residents through this unprecedented global pandemic, and as the system stabilizes, we must continue to foster and deepen these relationships,” Duncan said.
“We must also be cognizant that long-term care homes are our residents’ homes, and as we reimagine models of care, we must consider how and where we care for seniors to meet their changing needs.”
The Auditor General is right that the devastation in long-term care during the pandemic — and the public outrage that followed — has not pushed the government to make lasting change. She’s right that homes need better infection control, staffing and medical connections.
But she fails to see that to truly fix the system we need to create smaller, welcoming households within nursing homes that offer residents a shot at life with zest. Let’s hope the independent commission gets that right.