Item - 2020.EX14.16

The Executive Committee recommends that:

1.  City Council request the Province of Ontario to immediately provide additional supports for staff and residents now to stem the COVID – 19 pandemic. This includes, but is not limited to:

a.  greater access to personal protective equipment;

b.  improved screening and increased testing;

c.  other improvements made to supply, capacity and infection control measures;

d.  following Alberta's lead, in homes that have recorded zero outbreaks, each resident should be granted an essential visitor when it is deemed safe, which would contribute to and improve residents' quality of life; and

e.  for homes that are experiencing an outbreak, greater access to technology is needed, so residents can connect with their loved ones more often.

2.  City Council request the Province of Ontario to conduct an independent, objective and impartial Inquiry that is not partisan, nor punitive, but rather focuses on uncovering the systemic issues and gaps in Ontario's long term care homes; and City Council indicate to the Province that the City of Toronto will contribute to the success of the Province’s review, regardless of whether it is an inquiry or commission.

3.  City Council direct the General Manager, Seniors Services and Long Term Care to actively engage in the province’s investigative process- whether by Inquiry, Commission, or other means - into the COVID-19 pandemic in Ontario's Long Term Care Homes in order to be transparent, accountable, learn and share best practices.

4.  City Council request the Province of Ontario, while focusing on safety, improve quality of care by incorporating "emotion-centered" approaches to care, with commensurate staffing ratio increases, into Ontario’s Long-Term Care Homes Act, 2007 and Ontario Regulation 79/10.

That:

5. City Council request the Federal government to immediately provide additional supports for staff and residents now to stem the COVID – 19 pandemic. This includes, but is not limited to:

a. a serious bolstering of public-health budgets, including federal health transfers ear-marked specifically for public health;

b. careful tracking and maintenance of infectious-disease laboratories in order to keep up with the surge demand during a pandemic;

c. better integration and preservation of the National Emergency Stockpile System;

d. an overhaul of long-term care homes to include space for quarantine infected residents; and

e. systematic funding and regulatory changes such that personal support workers don't need to work in multiple homes to earn a living.

6. City Council request the Federal government to create a National Long Term Care Strategy to fund modern pandemic ready infrastructure, and provide care-giver training and salaries commensurate with the job.

I am writing to request that the Committee consider the accompanying recommendations to support bringing about transformational change in long term care homes in Toronto, and across our province, to address the tragedies we continue to witness as a result of the COVID-19 pandemic.

I understand that you have asked City Staff for a review of our City of Toronto operated homes to ensure that all necessary steps are being taken. However, to better care for and protect long term care staff and residents now, and help ensure that outbreaks of this magnitude never happens again, please consider the following three requests to the provincial government:

1. Immediate changes made to the level and quality of care in long term care homes, with respect to pandemic relief:

Additional supports for staff and residents are needed now to stem the COVID-19 pandemic. This includes, but is not limited to:

- greater access to personal protective equipment;

- improved screening and increased testing;

- other improvements made to supply, capacity and infection control measures;

- following Alberta's lead, in homes that have zero recorded outbreaks, each resident should be granted an essential visitor when it is deemed safe, which would contribute to and improve residents' quality of life; and

- for homes that are unfortunately experiencing an outbreak, greater access to technology is needed, so residents can connect with their loved ones more often, given that loneliness and isolation can directly impact one’s health and longevity.

2.  Initiate an independent, objective and impartial Inquiry into Ontario's long-term care homes, including those operated by the City of Toronto:

In July 2019, a long-term care homes public inquiry on the safety and security of residents (https://longtermcareinquiry.ca/en/) was established to inquire into the events which led to, and allowed, offences committed by a registered nurse working in a long-term care home. While the recommendations tabled in the report are paramount to improving safety and security of residents in our homes, they do not consider lessons from a pandemic that had yet to occur.

That's why, an independent, objective and impartial Inquiry is necessary to address the growing number of outbreaks and deaths recorded in homes across our Province. This Inquiry should not be partisan nor punitive. Rather, the focus should be uncovering systemic issues and gaps that led to the issues we are currently facing.

An Inquiry, as opposed to a Commission, offers additional investigative tools, resources and a transparent process. The tragedies suffered by long term care residents, and their families, merits nothing less.

However, if the Province moves forward with a commission, the City of Toronto should play a supportive and constructive role towards one that is transparent, effective and successfully leads to improvements of all Ontario Long Term Care homes.

As the operator of 10 publicly funded long term care homes, the City of Toronto should be an active participant in this review. We should be open, accountable and meaningfully contribute to ensuring that lessons are learned and best practices are shared. As a public operator, it will be beneficial to compare and contrast our experience and outcomes with that of private and non-profit long term care providers.

3.  Culture Change: Adopt emotion-centered approaches to care into Ontario’s Long-Term Care Homes Act, 2007 and Ontario Regulation 79/10

In the midst of this pandemic, we cannot lose sight of the importance of planning for our future. In Toronto, we have led with an initiative (Item CC21.20 headed "Seniors Services and Long-Term Care Implementation Plan and Update" available at http://app.toronto.ca/tmmis/viewAgendaItemHistory.do?item=2019.EC10.8) to create emotion-centered approaches to care in our City's 10 long-term care homes. This approach should be adopted in homes across our Province with an update to the care standards as outlined in Ontario’s Long-Term Care Homes Act, 2007 (https://www.ontario.ca/laws/statute/07l08#top)and Ontario Regulation 79/10 (https://www.ontario.ca/laws/regulation/100079). Emotion-centred approaches to care have proven to benefit residents through reductions in unintended weight loss, falls, negative responsive behaviors, the use of anti-psychotics and cost-savings to our healthcare system.

In order to successfully incorporate this new approach within our homes, staffing ratios must be increased. This request, which was listed as a recommendation in the 2019 public inquiry, http://longtermcareinquiry.ca/wp-content/uploads/LTCI_Final_Report_Volume1_e.pdf and to be tabled in the legislature this summer, is crucial, as staff shift the focus of their care from a task-based, to an emotion-centred approach. With the increases made to staffing ratios, consideration should also be made to ensure their jobs become less precarious and transient through the forms of better compensation, benefits and ability to work in one home.

We owe it to our long term care homes staff and residents, along with their families and friends, to take the necessary steps to ensure that their provided the highest standards of safety and care. Those who we've lost to COVID-19 deserve nothing less than transformational change. Let this be their legacy.

Thank you for your consideration.