Ontario looks to increase accountability in long-term care sector with harsher fines

Ontario plans to double maximum fines for nursing homes that break the rules and prohibit individual offenders from working in long-term care in an effort to ramp up accountability in the sector devastated by the pandemic. 

Under legislation introduced Thursday, corporations could be fined up to $1 million for second offences and individuals and board members at for-profit homes could be fined up to $400,000.

“It's a very clear message to organizations that are running these homes, that we have an expectation that they're going to live within the rules,” Long-Term Care Minister Rod Phillips said in an interview before introducing the bill. 

“You must operate within the rules or there will be consequences.”

While the legislation was welcomed by home operators, critics said it didn't go far enough to improve the system. 

The long-term care sector was hit hard by COVID-19, logging more than 15,000 infections among residents and more than 4,000 deaths. 

Anyone convicted of an offence under the new legislation, or under existing rules, would be barred from working, volunteering or sitting on the board of a long-term care home.

The legislation also would give the minister power to suspend a home's license and install a supervisor without having to close the home and disrupt care for residents. 

The legislation would further mandate that homes have an assigned, trained leader for infection prevention and control programs, which are to be audited by inspectors. 

The government announced plans earlier this week to double the inspector workforce by next fall. The new legislation would allow inspectors to lay immediate charges at homes. 

Another section of the legislation would mandate quarterly reporting about quality indicators in homes and standardized yearly surveys of residents and families. 

Other efforts to improve transparency include regulations to come at a later date defining the roles of caregivers and medical directors and creating a quality centre that will focus on researching best practices.

The legislation comes after a commission into COVID-19 in Ontario long-term care homes found that lack of preparedness and decades of neglect contributed to the devastation in the sector during the pandemic. That commission's final report called for reforms to protect residents in the future.

The Ontario Long-Term Care Association welcomed the legislation that CEO Donna Duncan said “lays the foundation for a modernized long-term care system focused on residents, their needs, and their quality of life.”

The CEO of AdvantAge Ontario, which represents non-profit, municipal and charitable long-term care homes, said the legislation has “potential for meaningful transformation” and repeated calls to “strike the right balance” between enforcement, training and staffing.

But opposition politicians said the government had squandered a chance to better the sector by moving away from for-profit operators, which saw worse outcomes from COVID-19. 

“Today's announcement was a missed opportunity to transform a system in crisis,” NDP Deputy Leader Sara Singh told reporters. She repeated her party's calls to not renew licenses for homes found to be negligent. 

Liberal Leader Steven Del Duca said he was disappointed in the legislation.

“(Premier) Doug Ford announced he is doing nothing to support the expansion of not-for-profit care and isn't acting on many of the Long-Term Care Commission’s recommendations,” Del Duca said. 

Green party Leader Mike Schreiner called the legislation a band-aid solution.

Phillips defended the development of more for-profit homes by saying it would be costly to pay out existing owners and that the government would rather spend money on building new beds.

“We believe that when the rules are clear, and accountabilities and clear, and the enforcement is there, that we can have a range of operators delivering on long-term care,” he said.

Thursday's legislation would also require the minister of long-term care to report annually on the Progressive Conservative government’s targets to reach an average of four hours of direct daily care per resident by 2025.

To achieve that goal, the government plans to spend billions of dollars to hire more staff, including through recently announced programs aimed at attracting nurses and personal support workers. 

The Canadian Union of Public Employees Ontario said the legislation missed the chance to stabilize precarious working conditions for staff and expressed doubt that the government could meet its direct care targets.

“This new act is a serious disappointment that falls way short of where Ontario should be in improving care and staffing levels in long-term care,” said secretary treasurer Candace Rennick said. 

Unions have pointed to low wages as one key factor behind chronically low staffing levels in long-term care. The government announced Thursday it would extend a temporary $3 wage increase for personal support workers until the end of March.

Premier Doug Ford has said he will make the wage increase permanent but hasn't said how or when that will happen. Phillips said Thursday that he thinks the government's hiring targets are achievable despite the wage increase still being temporary.

A union representing frontline workers slammed the government for only temporarily extending the wage increase.

“It's just cruel to string PSWs along a few months at a time instead of providing them with the certainty of a secure job,” SEIU Healthcare president Sharleen Stewart said. 

Holly McKenzie-Sutter, The Canadian Press