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

TORONTO — Ontario nursing homes that break the rules would face tougher penalties and individual offenders would be prohibited from working in long-term care, under proposed legislation aimed at strengthening accountability in a sector devastated by the pandemic. 

Corporations could face fines of up to $1 million for second offences, while individuals and board members at for-profit homes could be fined up to $400,000.

“You must operate within the rules or there will be consequences,” Long-Term Care Minister Rod Phillips said in an interview before introducing the bill on Thursday.

While the proposed legislation was welcomed by home operators, critics said it didn’t go far enough to improve the long-term care system, which saw more 15,000 infections among residents and over 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 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. It would also mandate that homes have an assigned, trained leader for infection prevention and control programs, which are to be audited by inspectors. 

Earlier this week, the government announced plans 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.

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,” he 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 increasing capacity. 

“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.

Vivian Stamatopoulos, an associate professor at Ontario Tech University who studies family caregiving, said stricter penalties are good but issuing them will require political will.

“Sure, you can hire more inspectors, you can have higher financial penalties, but are they actually going to be utilized is the question,” she said, also pointing to legislation introduced last year that critics said would make lawsuits against long-term care providers more difficult by raising the legal standard of “gross negligence.”

A spokesman for the ministry confirmed that no fines were issued over long-term care violations during the pandemic. 

The proposed 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 proposed 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. 

“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,” said Sharleen Stewart, president of SEIU Healthcare – a union representing front-line workers.

This report by The Canadian Press was first published Oct. 28, 2021.

Holly McKenzie-Sutter, The Canadian Press