Ontario nursing homes badly prepared for COVID-19 pandemic, auditor general says

TORONTO — The province’s decision to delay implementing mandatory measures to control the spread of COVID-19 in long-term care homes may have contributed to the devastating toll that the virus inflicted on residents and staff during the first wave of the pandemic, according to a long-awaited report from Auditor General Bonnie Lysyk.

The province began providing initial infection prevention and control direction to long-term care homes in February, 2020 but in her report Lysyk said that it was mostly “framed as guidance” at the time and that it was “was ultimately up to home operators to decide what actions to take to protect their elderly, frail and ailing residents.”

She said that by the time Chief Medical Officer of Health Dr. David Williams issued an emergency order on April 8 requiring that all staff and essential visitors wear masks there had already been 498 confirmed cases among residents, 347 confirmed cases among staff and 86 resident deaths.

Lysk said that Williams then waited another two weeks to issue another emergency order restricting staff from working in more than one home.

That order came nearly a month after officials in British Columbia took similar action.

“In light of how quickly COVID-19 spread in long-term-care homes, every day that implementing mandatory requirements was delayed made a difference in the effort to control its spread,” Lysyk said in her report.

Some measures to free up hospital capacity had ‘unintended consequences’

A total of 1,937 long-term care residents died during wave one of the pandemic, accounting for nearly half of all fatalities in Ontario.

Lysyk said in her report that the province was aware as early as March that 98 per cent of the COVID-19 deaths in Italy had involved elderly people with pre-existing conditions and should have recognized the risk the virus posed to long-term care homes.

But she said that the province “delayed mandating, as opposed to recommending certain measures, did not provide clear directions to homes, and did not inspect to ensure that homes were complying with containment measures.”

She said that some other measures taken early in the pandemic to protect hospital capacity, including the transfer of hundreds of alternate level of care (ALC) patients to nursing homes, may have even had “unintended consequences” by “further contributing to crowding and staffing shortages.”

“Given that homes were, on average, at 98% capacity prior to the pandemic according to the Ministry’s occupancy data, these transfers of patients designated as ALC added pressure to the homes, some of which were already struggling to contain the spread of COVID-19,” Lysyk wrote in the report.

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