Editor’s Note: The following article contains graphic descriptions of conditions inside long-term care facilities.
Rooms infested with cockroaches and contaminated with feces.
Patients force-fed to the point of choking.
Staff afraid to use vital supplies and personal protective equipment “because they cost money.”
People with COVID-19 allowed to wander from room to room.
Residents bullied, sedated and left alone for hours as they cried for help.
When Canadian Armed Forces personnel entered five Ontario long-term care homes that had been struck by COVID-19 earlier this month, they found a litany of horrors and abuses, a disturbing military report made public Tuesday alleges.
“I think it’s appalling. I think it’s disgusting, what has happened,” Premier Doug Ford said, looking visibly emotional.
“Reading this report was the hardest thing I’ve done as premier.”
Prime Minister Justin Trudeau called for national action to fix troubled long-term care systems.
A report released publicly Tuesday details a long list of horrors found at five COVID-stricken long-term care homes. Premier Doug Ford says criminal charges are possible, while the critics are calling for officials responsible to resign. #onpoli
“I was sad. I was shocked. I was disappointed. I was angry,” Trudeau said.
“I believe we are talking about a situation that clearly is a reality associated with COVID-19, but has also existed for quite some time.”
On Tuesday, Ontario NDP Leader Andrea Horwath called for the resignation of Long-Term Care Minister Merrilee Fullerton, while health-care advocates criticized Ford’s government for allowing the situation to happen.
Ford said the province has launched an investigation into the situation at the homes, and criminal charges could be laid. Fourteen military members working at homes in Ontario have tested positive with COVID-19.
Here’s what you need to know about the report’s findings and what will happen next.
A 'crisis situation' inside nursing homes
The report details abuses inside five long-term care homes that have been among the hardest-hit by the novel coronavirus: Orchard Villa in Pickering (77 deaths), Altamont in the Scarborough area of Toronto (52 deaths), Eatonville in the Etobicoke area of Toronto (42 deaths), Hawthorne in Toronto’s North York (43 deaths) and Holland Christian in Brampton (11 deaths).
Ford, who said the findings described a “crisis situation,” called for military assistance in the five homes on April 22. Roughly 250 Canadian Armed Forces members — including nurses, medics and general personnel — were deployed in early May.
The report is based on what personnel saw during their first two weeks. National Observer has not independently confirmed the allegations in the report, and none of the five long-term care homes responded to requests for comment, save Altamont.
In an emailed statement, Altamont's operator, Sienna Senior Living, said it has already increased staffing levels and slowed the rate of new infections in its facility.
"To deliver the level of care that our seniors deserve, the staffing challenges we face in the long-term care sector must be addressed," the statement said. "We are committed to working with the government, and our health system partners, to solve this urgent issue."
Though the Armed Forces were not originally tasked with writing a report, military brass decided it was necessary, Ontario officials said Tuesday. Dated May 14, the report was sent to the Ontario government Sunday.
All five homes faced staffing shortages and failed to meet basic standards of care for their patients. In some cases, military personnel reported they were concerned that the homes would not be able to care for patients if they left (Ford has requested an extension on the military help).
Ford also said he believes that similar problems likely exist at other long-term care homes in the province. In a background briefing for reporters, government officials said the situation at the homes was stabilizing, though four of them had been asked to produce plans for how they would move forward.
Here’s a list of some of what the report found:
Eatonville Care Centre in Etobicoke
- Patients with COVID-19 allowed to wander around the facility, potentially spreading the virus
- Faulty practices for using personal protective equipment (PPE)
- Re-used a catheter that had been pulled out and left on the ground
- “Nearly a dozen incidents of bleeding fungal infections” due to improper care of patients with catheters
- A “general culture of fear to use supplies because they cost money”
- Medication that had been expired for months, with residents likely “getting expired medication for quite some time”
- Personal support workers (PSWs) “afraid for their jobs” if they were to give residents who soil their beds an extra towel or pad to soak up the material
- COVID-19-positive patients living in the same room as ones who have tested negative
- Internal communication problems and lack of information
- No training for new staff
- Some staff had not seen their families in weeks
- Patients who felt sad or scared, but were not violent or agitated, were sedated with narcotics
- “Aggressive behaviour” that military personnel deemed “abusive,” including “degrading an inappropriate comments” and refusing to stop or slow down when patients complained of pain
- Staff recorded incorrect information about patients’ condition and changed reports after they’d been filed
- Staff told residents’ families false information about their loved ones’ condition
Hawthorne Place Care Centre in North York
- Fans blowing in the hallways, which can further spread infections
- “Significant deterioration” of cleaning standards, and equipment “seldom” seen being disinfected
- Protocols that allowed for a “near 100 per cent contamination rate” for equipment, patients and the overall facility
- “Significant gross fecal contamination” in several patients’ rooms
- Insect infestations, including cockroaches, ants and other unidentified bugs
- Patients were not changed quickly after soiling themselves, which led to “skin breakdown”
- Patients got bed sores from not being turned
- “Forceful feeding” that caused audible choking
- Patients crying for help for up to two hours before staff checked on them
- Residents had not been bathed for weeks
- Staff unsure of who had a ‘do not resuscitate’ order
- Lack of documentation
- A patient’s bottle for their feeding tube hadn’t been changed for so long that the contents were “foul” and “coagulated”
- A catheter left in for three weeks longer than when it was meant to be changed
- No crash cart in case of a heart attack
- Residents sleeping on beds with no sheets
- Little to no orientation for new staff
- Staff “disappear” and leave their floor unattended
- Nurses were “pulled back” once military personnel arrived, which made the situation even more challenging
- “No shift handovers witnessed since arriving at site”
- Fears about misuse of narcotics
- Residents missing meals
Orchard Villa in Pickering
- Cockroaches and flies
- The smell of rotten food
- “Inappropriate PPE use” by staff, including layering scarves under masks
- Patients with soiled diapers left in their beds
- Staff not sitting patients up before feeding them or giving them water, which raises the risk of choking
- One patient who had been fed while lying on their back choked and died, as staff were unable to dislodge the food or revive them
- Unsafe medication errors
- A fractured hip that went unaddressed by staff
- Nurses documenting assessments that appear not to have actually happened
- Inadequate treatment of pain
- Oxygen equipment that was not functional
- Patients sleeping on bare mattresses
- No way for staff to report issues
- Lack of communication internally, including cases that led to patients being moved into rooms that hadn’t been cleaned
- Lack of training for new staff
- “No accountability” for staff who failed to uphold basic care needs
Altamont Care Community in Scarborough
- Most residents were not receiving three meals per day
- Extremely severe bed sores, including some that had worn through to the bone
- Residents not being moved or washed
- A non-verbal resident wrote a “disturbing” letter alleging neglect and abuse from a PSW (management handled it immediately, the report says)
- Improper care for wounds
- Dangerous medication errors
- Incorrect records of what medications had been given
- Lack of staff
- Regular public arguments between staff that included “derogatory language”
- Military personnel brought their own food to ensure residents were fed
Holland Christian Homes in Brampton
- Staff not changing PPE while moving between areas with COVID-19 patients and other patients
- No hand-washing between patients
- Staff attempting to sterilize gloves with hand sanitizer
- Failure to document medications
- Staff left food in a patient’s mouth overnight
- “Aggressive” repositioning of a patient
- Staff not helping residents eat meals
Whose fault is this?
On Tuesday, Ford said he took full responsibility for the neglect and abuses documented in the military report. He also repeatedly said he “inherited” a broken system, and vowed to “move heaven and earth” to fix it, no matter the cost.
Ontario’s long-term care system has been underfunded and has faced staffing shortages for decades. Systemic issues came to light in 2019, after an inquiry prompted by serial killer Elizabeth Wettlaufer, a long-term-care nurse who murdered eight elderly patients.
Advocates have been pushing for government action on the issues for years, even before the Wettlaufer inquiry. Now, COVID-19 has ravaged long-term care, spreading like wildfire to infect staff and vulnerable elderly patients who are especially susceptible to the virus.
On Tuesday, Fullerton said her ministry had been working to address issues raised in the Wettlaufer inquiry. And Ford said he believed the Progressive Conservative government had done well to act when it did.
“I don’t feel our government failed seniors,” he said. “Matter of fact, we saved a lot of lives by doing what we did.”
But critics said the Ford government worsened conditions in long-term care and contributed to the crisis.
Last month, CBC News revealed the Ford government largely stopped doing unannounced inspections of long-term-care homes. The province continued conducting investigations done after complaints, but in those cases, the facility knows an inspector is coming.
Issues and complaints had been reported at several of the five homes in the military report, government officials told reporters in a background briefing.
The government also cut $34 million from its long-term care budget last year, and the Ontario NDP and health care groups have said the government did not act quickly enough to stop long-term care staff from working at multiple facilities and potentially spreading the virus.
The Ontario Health Coalition, which has raised issues with long-term care for years, said Tuesday that it was “frustrated.”
“Shortages of PPE and incompetent and negligent management are compounded by the leadership failure in our provincial government,” said executive director Natalie Mehra in a statement.
“Thousands of staff and residents alike have been infected with COVID-19, almost 1,500 residents and staff have died, yet we are still waiting for a coherent, coordinated plan from Ontario’s government to intervene actively in long-term care homes with outbreaks.”
The Ontario government also failed to take advantage of a pool of nurses available to work in long-term care before calling in the military, National Observer previously reported. The Registered Nurses' Association of Ontario had assembled lists of qualified staff that were ready to go into long-term care, and may have better suited to it than military personnel without nursing home experience.
Doris Grinspun, CEO of the RNAO, said in an interview Tuesday that she was aware of issues at one of the homes, Orchard Villa, more than a week before the military was called in. No one was answering the phone when she called to ask about giving them nursing resources, she said. (Orchard Villa did not respond to a request for a response.)
“This could have been fixed before the military if the government would have listened to the RNAO,” she said.
Grinspun also said the government should have acted weeks before it did to bring extra help into long-term care.
“It’s horrifying that it came to this and it’s horrifying that it took this long,” she said. “There needs to be accountability.”
Others have pointed to issues with privately owned long-term care homes, where residents are far more likely to die of COVID-19 than they are at not-for-profit homes, the Toronto Star found. Three of the largest operators in Ontario have paid out $1.5 billion in dividends to shareholders over the last decade, the Star reported. And three for-profit long-term care companies in Ontario have hired lobbyists with Conservative ties.
Four of the five homes examined in the military report were privately owned, but it’s not clear whether that played a role in what happened, Ontario officials said Tuesday.
What happens next?
Ontario’s chief coroner is investigating one death at Orchard Villa. And on Tuesday, Ford said the province had opened an investigation into the situation at the homes.
“The results of these investigations will be shared with police to look into any criminal charges,” he said.
A week ago, Ford announced the province would hold an independent public commission in September to examine how COVID-19 had struck long-term care. On Tuesday, critics renewed calls for that to be expanded to a public inquiry, which would give the government less control and influence over the process — and Ford said that idea is now on the table.
Grinspun said the government needs to make immediate changes to fix the problems at long-term care homes, and it cannot wait for the results of a commission or inquiry.
Fullerton said Tuesday that inspectors from the Ministry of Long-Term Care will immediately begin investigating all the incidents detailed in the reports.
When a reporter asked Ford Tuesday whether anyone in his government will have to resign as a result of the report’s findings, Ford did not directly answer the question.
At the outbreak’s peak, 190 long-term care homes in Ontario reported outbreaks of COVID-19. That number has since dropped to 150.
Editor's Note: This story was updated at 7:59 p.m. Eastern to include comments from Sienna Senior Living.