Toronto·CBC Investigates

Ontario largely ignored long-term care as COVID-19 crisis began, internal documents reveal

Even after the March 11 declaration of a global pandemic, various measures to reduce the spread of COVID-19 in long-term care homes were either not put on the table as options or not actually put into practice for weeks, according to the documents. 

New reports from auditor general and long-term care commission expected to critique government's actions

Across Ontario, 3,756 residents of long-term care have died while infected with COVID-19, along with 11 staff of nursing homes. These crosses represent deceased residents of Camilla Care Community in Mississauga, Ont. (Evan Mitsui/CBC)

Internal government documents obtained by CBC News show few signs that Ontario prepared the long-term care sector for the risks from COVID-19 before the virus began its deadly spread through the province's nursing homes. 

CBC News asked the Ministry of Health and Ministry of Long-Term Care for all reports, memos and briefing notes concerning the novel coronavirus/COVID-19 and long-term care homes in February, March and April of 2020. 

Only a handful of documents from the ministries mention protecting long-term care residents in February, even as cases were steadily arriving in Ontario and the devastation from the infections in Italy became apparent. 

Taken as a whole, the documents add to the evidence suggesting the provincial government devoted far less attention to readying the long-term care sector for the impact of the coronavirus than hospitals. 

Even after the March 11 declaration of a global pandemic, various measures to reduce the spread of COVID-19 in long-term care homes were either not put on the table as options or not actually put into practice for weeks, according to the documents. 

WATCH | Minister's testimony on Ontario's response to COVID-19 reveals lack of planning:

Minister’s testimony reveals Ontario’s lack of pandemic plan for long-term care

The National

2 months ago
1:54
Ontario Minister of Long-Term Care Merrilee Fullerton’s testimony at a provincial commission about the COVID-19 crisis revealed a lack of planning and delayed responses, but Fullerton put the blame on community transmission. 1:54

"Develop clearer public health guidance to protect individuals in long-term care facilities as well as staff," is listed as an outstanding action in a March 29 document from Ontario's COVID-19 Command Table titled "Priority Issues."

By that date, 16 homes had already reported confirmed cases of COVID-19. That number quadrupled within a week.

The next day, Premier Doug Ford promised an "iron ring" around Ontario's vulnerable seniors. Nearly all of the 3,756 deaths of long-term care residents with COVID-19 happened after that date. 

The documents — obtained by CBC News through the province's freedom of information laws — provide further evidence that Ontario's long-term care homes were ill-prepared for the pandemic, according to experts in the sector. 

Long-term care homes "were left totally unprotected," said Dr Nathan Stall, a geriatrician at Toronto's Mount Sinai Hospital. 

"They were last in line to get personal protective equipment, they had insufficient infection prevention and control procedures, and they were largely excluded from provincial planning," he said in an interview Tuesday.  "Everything was focused on acute care and critical care, often to the exclusion of long-term care."

On Wednesday, Ontario's auditor general is due to release a special report into pandemic readiness in long-term care. Then Friday is the deadline for an independent commission to submit its final report to the provincial government on COVID-19 in long-term care. (Evan Mitsui/CBC)

Ontario's Ministry of Long-Term Care had not developed an emergency plan to prepare for a pandemic, said Vivian Stamatopoulos, an advocate for long-term care residents and their families. 

 "This government failed to exercise the precautionary principle to keep these residents safe. I don't think there is any question of it at this point," Stamatopoulos, an associate professor at Ontario Tech University, said in an interview Tuesday. "This sector was completely left on its own and entirely unprotected." 

The earliest dated documents provided by the Ministry of Long-Term Care in response to CBC's freedom of information request are from March 17, 2020. They're letters to the province's long-term care homes announcing $50 million in emergency funding for extraordinary costs related to containing the spread of COVID-19. 

The World Health Organization declared the novel coronavirus outbreak to be a public health emergency of international concern on Jan. 30, 2020.

New reports from commission, auditor

Ontarians will learn much more over the next few days about the behind-the-scenes details of the government's handling of COVID-19 in long-term care homes.

The province's auditor general is on Wednesday releasing a special report into pandemic readiness and response in long-term care. 

Friday is also the deadline for the provincial commission on COVID-19 in long-term care to submit its final report to the government. The commission has interviewed more than 700 people and reviewed thousands of documents since it began work last summer.

WATCH | Long-term care staff weren't restricted to one home because of low pay, commission told:

Long-term care staff weren’t restricted to one home because of low pay, commission told

The National

2 months ago
2:00
Chief Medical Officer Dr. David Williams told Ontario’s Long-Term Care COVID-19 Commission that he was initially reluctant to restrict workers to a single home early in the pandemic because care home positions "didn't pay a large amount." 2:00

Merrilee Fullerton, the long-term care minister, told the commission that she raised concerns about several key issues well before the government actually moved on them. They included that the virus could being spread by people without symptoms, that long-term care homes should be locked down and that staff should wear personal protective equipment at all times.

It was not clear from the transcript of Fullerton's testimony why swifter action was not taken as a result of her concerns.

Long-term care residents account for almost half of the nearly 8,000 Ontarians who have died while infected with COVID-19. 

CBC News initially requested the government records last May. The Ministry of Health provided its documents in January, while the Ministry of Long-Term Care took until earlier this month.

The Ministry of Long-Term Care withheld 11 documents on the basis that they constitute advice to government or a cabinet record and are therefore exempt from disclosure. Of the 14 documents disclosed by the ministry, six are letters to long-term care operators about pandemic-related government funding.

Merrilee Fullerton, Ontario's long-term care minister, answers questions about a disturbing report from the Canadian military regarding the impact of COVID-19 on five Ontario long-term-care homes. (Nathan Denette/The Canadian Press)

Other information revealed by the documents: 

  • Transferring patients out of hospitals into long-term care homes remained a component of the government's strategy for reducing hospital occupancy throughout March 2020, and was only paused in April. By that time, long-term care homes were already seeing what a government document describes as "significant increases in outbreaks and deaths."
  • A three-page Ministry of Health document entitled "COVID-19 Status & Action Items" from March 31, 2020, lists only two "outstanding actions" related to long-term care. One said the Ministry of Long-Term Care was "to co-ordinate with public health counterparts to leverage their expertise with infection control practices."  
  • In mid-April, the province provided guidance to long-term care homes on "end of life" sedation therapy for patients dying of COVID-19.  

More than half of the COVID-related deaths in long-term care happened last fall and winter, during Ontario's second wave of the pandemic.

However, as a result of vaccinations, COVID-19 deaths in long-term care have been rare during Ontario's third wave. Only nine residents with the virus died in March, and just three in April. 

ABOUT THE AUTHOR

Mike Crawley

Provincial Affairs Reporter

Mike Crawley is provincial affairs reporter in Ontario for CBC News. He has won awards for his reporting on the eHealth spending scandal and flaws in Ontario's welfare-payment computer system. Before joining the CBC in 2005, Mike filed stories from 19 countries in Africa as a freelance journalist and worked as a newspaper reporter in B.C.

with files from Nicole Brockbank

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