The Registered Nurses’ Association of Ontario (RNAO) welcomes the Tuesday, May 19 announcement by Dr. Merrilee Fullerton, Minister of Long-Term Care, of an independent commission into Ontario's long-term care (LTC) system.
RNAO expects the fully independent commission – set to begin in September – will be provided with broad and comprehensive terms of reference to examine both the government and the health-system response to COVID-19, as well as the long-standing systemic shortfalls within the sector. The members selected to participate in the commission should be widely respected experts on the topic.
The work of the commission should be part of a reconsideration of the importance of community care within a health system that continues to be hospital-centric, as examined by RNAO in its report on Enhancing Community Care for Ontarians (ECCO), issued on May 12. ECCO 3.0 calls on government and health system partners to strengthen community care and anchor the health system in primary care to better meet the health needs of all Ontarians. First released in 2012 and next in 2014, ECCO 3.0 aligns with much-needed health-system transformation that responds to the COVID-19 pandemic. ECCO 3.0 recommendation number six calls to re-imagine LTC as 'home' to residents, and integrate nursing and retirement homes into enhanced community care plans and funding.
The terms of reference for the commission should address a number of factors RNAO believes are at the core of the shortfalls that let down LTC residents during the pandemic:
- Issues of systemic response, such as low prioritization of the LTC sector, and the deadly delays in making personal protective equipment (PPE) and surveillance testing available
- Critical examination and a complete overhaul of the archaic funding model that has existed for Ontario nursing homes for decades, which includes: (a) insufficient overall funding levels for the sector, (b) a funding scheme that only rewards nursing homes for the level of complexity and acuity of its residents, while financially penalizing nursing homes that deliver better health and quality-of-life outcome, and (c) a lack of access to an inter-professional team – including occupational therapist, social worker, speech therapist and respiratory therapist – to provide expert care
- Key staffing issues, such as: (a) adequate number of staff, and (b) the proper skill mix and staffing ratios of regulated and unregulated staff – including larger utilization of NPs, RNs and RPNs
- Changes to the employment approach, including: (a) staff not working in more than one facility with benefits, (b) salaries that are commensurate with those paid to the same health workers in other sectors, such as hospitals, and (c) offering full-time employment to staff who request it to enable continuity of care for residents and staff retention
- Examination of management practices and organizational structure in the sector, such as health-care expertise required for home administrators, as well as levels of preparation and compliance with regulation
- Regulatory matters, such as a revision of the Long-Term Care Homes Act, 2007 and its regulation – which is out of date, unclear and does not represent best practices – with the purpose of providing for a robust LTC system that is person- and family-centred
- Proper facility standards, such as: (a) ensuring all residents have separate rooms unless they wish to share with a partner, (b) limiting the number of residents per room to no more than two, and (c) create facilities adequate for isolation of residents when required
“RNAO appreciates Premier Doug Ford saying on various occasions that the long-term care system in Ontario is broken, a phrase Minister Fullerton repeated on May 19,” RNAO President Dr. Angela Cooper Brathwaite says. “For the past decade, we have been urging the government to institute robust funding and staffing reform, but this must be done as part of a broader conceptualization of community care as central to health care, as we detailed in our ECCO 3.0 report.”
The issues and the proposed solutions are not new. In fact, RNAO raised many of them during the SARS outbreak in 2003, when the association called for a public inquiry, which was later announced and led by the late Justice Archie Campbell, who tabled the SARS Commission report in January 2007. RNAO also advocated for a public inquiry into safety and security in LTC, which launched in 2017 and was led by Justice Eileen Gillese, and resulted in a final report and recommendations released in July 2019.
RNAO will be watching to ensure the commission that has just been announced does not delay change and it leads to the drastic action that is sorely needed. The government must demonstrate its willingness to engage in real systemic reform and not tokenism.
“While RNAO fully supports and will eagerly participate in the commission’s work, we want to be clear this work must not deter from required immediate action, nor delay the report on the adequacy of regulated staff in long-term care, expected to be tabled by Minister Fullerton on July 31,” RNAO CEO Doris Grinspun says. “Close to 1,500 lives have been tragically lost in long-term care during the pandemic, including residents and staff. We need to ensure those lives are honoured and respected. And the best way to do that is to ensure nursing homes in Ontario are adequately funded and the staff supported to fully protect the health and safety of everyone. As COVID-19 has shown this is not the case today and the results are devastating for residents, their loved ones, and the staff who heroically care for them under the most trying circumstances,” Grinspun alerts.
The Registered Nurses’ Association of Ontario (RNAO) is the professional association representing registered nurses, nurse practitioners, and nursing students in Ontario. Since 1925, RNAO has advocated for healthy public policy, promoted excellence in nursing practice, increased nurses’ contribution to shaping the health system, and influenced decisions that affect nurses and the public they serve. For more information about RNAO, visit our website at RNAO.ca or follow us on Facebook and Twitter.