Revera Inc., the long-term care home company owned by the Canadian Public Sector Pension (PSP) Investment Board that has seen hundreds of resident deaths during the pandemic, appears to shift taxable profits out of the United Kingdom into subsidiaries ...
Raw hot dogs served with undercooked fries.
Cold soup residents beg to have warmed up.
Fish so overcooked it feels like jerky.
These are some of the meals served to residents of a Chartwell long-term care home in the Greater Toronto Area, according to a family member.
“Even before the pandemic, the food was awful,” Sean Chiasson told HuffPost Canada.
Chiasson visited his 97-year-old grandmother at the home every day at lunchtime before the pandemic hit last March.
“ … As a human being, they should have dignity, and, you know, proper health and nutrition.Sean Chiasson
During those visits, he’d heat up residents’ soup, served at the beginning of every lunch for those who arrive in time for it. He couldn’t get to everyone in the dining room, but said he tried to at least help the residents at his grandmother’s table and those surrounding it.
In the spring, Chiasson’s grandmother was suddenly put on a pureed diet — without consultation or approval from her family, he alleged. Although he eventually got the home to reverse the change, for the days she was on it, she refused to eat the “mush” she was served.
The 97-year-old has lost more than 40 pounds since the start of the pandemic.
“ … As a human being, they should have dignity, and, you know, proper health and nutrition,” Chiasson said.
A spokesperson for Chartwell did not respond by deadline.
Ontario’s Long-Term Care Home Act states homes must have alternative choices available at meals.
“If the home’s menu cycle does not meet a resident’s nutrition needs, the home must develop an individualized menu for the resident,” it states.
Tanya Blazina, a spokesperson for the Ontario Ministry of Long-Term Care, said the ministry takes compliance with the act seriously, and encourages residents and families to contact the family support and action line if they have concerns.
Military report detailed force feeding
Most long-term care residents are at risk of malnutrition and dehydration, which can lead to an increased chance of falls, infections, hospital admissions and overall mortality, according to Dietitians of Canada.
Experts say because of the importance of residents eating nutritious food, more attention needs to be given to their diets. That includes more provincial funding so homes can meet residents’ dietary needs and cook food on site instead of contracting it out.
Families told HuffPost even before the pandemic their loved ones struggled with a lack of culturally appropriate food, were confused over why they were fed pureed food, and wouldn’t eat the food provided to them. They also said at short-staffed homes there aren’t enough workers to help residents eat — before the pandemic was further affecting staffing levels.
Blazina said homes are still required to provide adequate assistance and eating aids or assistive devices to residents eating in their rooms. She added the most recent visitor policy allows for essential caregivers, who can provide extra support to residents eating in their rooms.
Meal time is often the highlight of residents’ days, and an important time for socializing and maintaining independence, a 2015 report from York University researchers states. But during the COVID-19 pandemic — which has so far claimed the lives of more than 3,000 long-term care residents in Ontario — many are served alone in their rooms, without the prolonged assistance from family or staff they may require.
The Canadian Armed Forces, which was deployed to several Ontario long-term care homes in the spring, reported residents were force fed and forced to drink water, which caused “audible choking.”
There were 660 incidents of food and nutrition issues — from missed meals to residents choking and gastroenteritis outbreaks — reported by Ontario long-term care homes between January 2018 and May 2019, according to a 2019 auditor general (AG) report.
That included 27 cases of unexpected resident deaths because of choking and aspiration, and 100 cases of abuse or neglect of a resident by staff related to food that caused harm or risk of harm.
In 2018, six per cent of the ministry’s inspections related to aspects of food or nutrition, per the auditor general report. That number, according to the report, was 13 per cent in 2015, the last time the AG audited the long-term care inspection program. (At the time, the ministry was called the Ministry of Health and Long-Term Care; the two were made separate ministries in 2019.)
Food ‘for the pigs’
“S**t on a plate” is how June Morrison’s father, a resident at Orchard Villa long-term care home in Pickering, Ont., used to describe his pureed meals there.
George William Morrison died during the COVID-19 pandemic. Orchard Villa was Ontario’s hardest-hit home in the first wave.
She recounts one day when she visited and her father’s hamburger looked like “a mound of this brown stuff.”
“And I put a fork into it, took a mouthful, and I go, ‘OK, I now understand why nobody wants to eat this,’” she told HuffPost.
Morrison’s father, who used to live on a farm, would tell her the food on his plate appeared to be “for the pigs.”
Staff at the home, Morrison said, refused to give him non-pureed food, even when she offered to cut it. So he wouldn’t eat.
He also didn’t want to eat the food he found unfamiliar. Having grown up in Scotland, he was introduced to foods like spaghetti and rice later in life. Once his dementia took hold, he didn’t recognize those foods anymore and refused to eat them.
Candace Chartier, Chief Seniors’ Advocate and Strategic Partnerships Officer at Southbridge Care Homes, which operates Orchard Villa, said in a statement personal support workers record nutritional assessments, which are then reviewed by registered nurses, daily.
“In the event where a resident may refuse food or fluids, staff members will re-engage with the resident at a later time,” she said, adding these interactions are documented to identify patterns to discuss with a resident’s designated contact.
“Menus are established in advance, and residents are offered a selection of two options at each meal,” Chartier said. “Any resident with specific dietary needs or requirements are accommodated, in consultation with our dietician and family partners.”
As much as what’s on the plate, the simple social experience of eating in the dining room is also important for residents.
When George first moved to Orchard Villa, he was paired with another resident to eat together. He really enjoyed the man’s company and the two would have conversations together while they ate. But, Morrison said, the home later separated them without giving a reason. When the man died, George was “brokenhearted.”
“They need to pair people up with people that converse with them. Because if you lose that ability to talk to somebody, then you just grow into yourself…. You’ve got no mental stimulation at all,” Morrison said.
Chartier said the home encourages “positive resident-to-resident interactions” but “resident care appointments” may result in changes to a resident’s routine.
‘Huge gap’ in food inspections
Shauna Prouten, a registered dietitian in B.C. who has worked in long-term care, told HuffPost a home should take residents’ preferences — and right to self-determination — into account when planning their meals.
She said downgrading a residents’ diet should only happen on a temporary basis until they can be assessed by an expert, like a dietitian who works in the home, a speech language pathologist or occupational therapist. There are lots of variations a home could employ before going right to pureed food, Prouten said, such as bite-sized or minced diets.
“I think too often, facilities just have a very limited repertoire, and there’s nothing in between the regular or the cut up [food] and the pureed,” she said.
It’s easy for homes to provide menus that aren’t meeting residents’ needs, if their menus are not being observed or inspected, Prouten added.
She pointed to the 2019 AG report’s finding that in five homes assessed, registered dietitians and nutrition managers said in the last three years they’d never been asked by ministry inspectors for the nutrient analysis of their home’s menu.
The AG report also said the ministry doesn’t require homes to report on food and nutrition performance indicators.
“And so very rarely do you see audits done, full audits done, on the nutrition services in long-term care,” she said. “That is a huge gap.”
“I think they need to have inspectors go in there at mealtimes, and actually take a look at the nutritional plan for the day that covers the masses, plus look at the records of those that are diabetic or look at the fact that people are refusing food,” she said, adding inspectors need to see if residents can explain why they’re refusing food and if it’s because, as her dad experienced, it doesn’t look right.
Blazina, from the Ministry of Long-Term Care, said inspectors found non-compliance related to food and nutrition in 127 inspections in 2019, and 80 inspections in 2020. The ministry has assigned inspectors to monitor long-term care homes during the pandemic, she said.
“Proactive inspections assess food and nutrition, and concerns related to food and nutrition are also inspected as a result of complaints and as risks are identified during the course of other types of inspections,” she said.
Under the province’s Long-Term Care Act, a registered dietitian is required to complete a nutritional assessment for all residents in the home, and again in the event a residents’ health changes significantly.
Better menu planning needed
There are a number of factors that limit residents’ food intake, including individual eating challenges, the dining room environment and how staff interact with residents in the dining room, Heather Keller, the Schlegel Research Chair in nutrition and aging at the University of Waterloo, told HuffPost.
In her research analyzing long-term care home menus, she’s found a need for across-the-board improvements in several provinces, regardless of whether a home was for-profit or not.
An analysis of menus in four provinces found meals given to residents are lacking in a number of nutrients, including vitamin D and calcium.
The lack of nutritious food for residents points to a need for better menu planning in long-term care, Keller said.
“It’s certainly a money factor, but it’s also a policy factor about how we plan menus and making sure that the people that are in homes have the time and the skill to do that well.”
She found some homes planned their menus for up to 18 months in advance, which she called “inappropriate.” Homes should have a shorter menu cycle of around three weeks, Keller said, to reduce repetition and take advantage of seasonal ingredients. Staff should also review menus at least twice a year to address changes in a home’s population, changes in food supply and cost of food, as well as be using local food.
We need to have policy [makers] realize, ‘Hey, to feed people well, it takes money’ ...Heather Keller
Keller recommended homes use the Dietary Reference Intakes (DRI) — guidelines based on nutrition, not food groups — to plan menus, instead of Canada’s food guide.
That would cost $12 per resident per day, she said — up from the current ministry funding of $9.54 per each resident’s raw ingredients per day. (While families or residents pay for part or all of their room — this is sometimes subsidized by the government — homes receive ministry funding for personal care, programs, raw food and other accommodations, according to the AG report.)
But it’s also important to consider the cost of supplemental pills or drinks if residents aren’t currently getting the nutrients they need, she said.
“We need to have policy [makers] realize, ‘Hey, to feed people well, it takes money’ — not just food money but also staff money.”
The ministry spokesperson said licensees are responsible for ensuring menus provide adequate nutrients based on both the DRIs established in reports from the United States National Academies, and include a variety of foods in line with Canada’s food guide.
Despite her research showing the need for change, Keller said there are people currently working to improve the food in long-term care.
Dietitians of Canada, along with several other organizations, put out a paper in the summer about menu planning in long-term care. Their report recommends using the DRIs as standards for meal planning and states menus should be “based on in-depth knowledge” of the needs and preferences of residents.
Ontario should boost food funding: expert
In March 2020, Pat Armstrong, a sociology professor at York University and long-term care researcher, wrapped up a decade-long examination of food at 27 long-term care homes in six countries.
One of the most important findings, she told HuffPost, was the value of food being cooked on the premises of a home instead of being contracted out, as is the case in some Ontario homes.
She said it’s important for residents to be served by staff who know them and their preferences.
In one home that contracted out food, Armstrong’s team observed a sign that prohibited the contract workers from talking to residents.
Contracting out has several other negatives for residents: food being prepared offsite means they can’t smell the aromas, which can make residents less likely to want to eat. When food is contracted out, courses are often served all on one plate, which research shows can lead to residents eating less. It also makes it more difficult to adhere to cultural or dietary needs if food is being mass-produced offsite by people unfamiliar with residents’ care plans.
WATCH: Ontario promises new standard in long-term care. Story continues below.
But a trend toward privatization in long-term care as a way of reducing costs has led to homes contracting out food services, Armstrong said.
“We give such a piddly amount for raw food, and in terms of homes … it’s really hard for them to produce good food on site,” she said.
She said she wants to see the province increase its funding for food, and ban contracting out of food services — a move she said would be a “major step forward.”
The ministry spokesperson said it increases its allocations to the raw food funding each year, as well as its contributions to a category of funding called “other accommodations,” which homes can use for raw food if they choose to.
Prouten, the B.C. dietitian, noted food is an important part of residents’ quality of life — from the way it looks, to its flavours and presentations, to it being served in a way that they can chew and swallow as an enjoyable experience.
“You have these people that their island of operation opportunity is shrinking and their island of choice is shrinking, so they have very few opportunities in their life to make choices,” she said. “Food is one of those things where they can choose, and they can choose right up to the last breath, often.”
Residents in Ontario’s long-term care homes say they are depressed, suffering in isolation without social activities or family visits and watching their friends’ health decline.
In a January interview with the province’s long-term care commission, they called for facilities’ management and other decision makers to “walk a mile in our shoes.”
“They get to go home at the end of their so-called eight hours a day. We stay here all the time. They don’t know what we go through,” one resident, Sandy M, told the commission.
Residents’ last names were not listed in the commission transcript.
Another resident, Robert K, said because he’s not able to read or write anymore, he used to enjoy playing chess with volunteers. But now, he has to play on a computer, where it’s hard to see the images because he is almost blind.
“So I am feeling isolated mentally and physically,” he said. “I feel like my brain is in a straight jacket.”
More than 3,000 residents have died of COVID-19 in Ontario’s long-term care homes since the beginning of the pandemic. Workers and families have spoken out about a lack of personal protective equipment and short staffing, and there are new calls for military intervention and other measures to control the spread of the virus.
Meanwhile, public health officials confirmed Wednesday some of the cases at one Barrie, Ont., long-term care home are potentially a more transmissible variant of COVID-19. The region’s medical officer of health called the development “extremely concerning.” More than half of the 140 residents at Roberta Place have tested positive for the virus, according to provincial data.
‘We are not being treated like human beings’
A resident named Ann D told the commission the way residents have been treated during the pandemic is “inhumane.”
“We are not being treated like human beings,” she said, adding residents like herself, who are cognitive and able to take care of themselves are lumped in with others who need more support.
“So I think it is a disgrace the way they’ve handled it,” she said. “I think that they have taken abuse of their power by saying that we are just going to lock down the home.”
Ann said she’s noticed residents’ health and wellbeing declining.
“You can see the life is just draining out of their faces.”
Robert told the commision he has lost 20 pounds and has completely lost his appetite to the point where he can’t even look at the food served.
“I think it is a mental reaction to being locked up like an animal and unable to have a conversation because the staff is busy, and most people that I meet out in the hall, they have different interests, and it does not help.”
Sandy said she wishes residents were given a questionnaire to give their input on what’s happening, instead of finding out about new policies days before they come into effect.
Krystle Caputo, the press secretary for Ontario Minister of Long-Term Care Merrilee Fullerton, said in a statement the ministry thanks the commissioners for their hard work. She said resident support aides have started working in “many homes” to help with delivering meals, housekeeping and cleaning, as well as socializing with residents.
Caputo also pointed to the province’s new staffing plan, which she said will create more than 27,000 new positions. The province will invest up to $1.9 billion annually until 2024-25 to implement the staffing plan, and commit to having residents receive four hours of direct care per day by that year.
The province has given $1.38 billion in funding to the long-term care sector during the pandemic.
‘Everything is hush hush’
Another resident, Maria S, agreed that residents seem to be kept out of the loop on what’s happening.
“Things aren’t being communicated to residents,” she told commissioners. “A lot of us are cognitive, well aware of what is going on. I mean, it is like your ears are always out there because you want to know what is going on … everything is hush hush.”
“Like, excuse me, I’m a cognitive resident. I want to know what is going on. I would like to know ahead of time. Don’t leave me out in the cold.”
Asked what the residents want the commissioners to know, Joanne A said “That residents are getting depressed, majorly depressed.”
She said there needs to be more programming for residents in long-term care, and maybe more staff, or even volunteers, to help facilitate those activities. Without more help for staff, Joanne said she’s worried about burnout.
During the pandemic, general visitors to long-term care are not allowed. Only people designated as essential caregivers, who provide essential support to a resident, are allowed into homes while Ontario is on lockdown.
Maria said her home was so short-staffed at one point that residents went almost two weeks without a shower.
She also noted the isolation has been even more difficult for residents who have dementia.
“The only time they have any contact with anyone is with feeding and dressing. So it has been a long haul of loneliness and no interaction except with your staff and, again, that is limited interaction.”
Earlier on HuffPost:
This article has been updated with a statement from the Ministry of Long-Term Care.
“Once the pandemic is over.”
That’s the caveat when making plans with friends, family and pretty much anyone else these days. We have two vaccines approved in Canada, and worldwide there are dozens of others in various trial stages.
Where we go from here is complicated, experts say. There are still questions about how many people will take the vaccine, and how effective it will be at stopping the spread of the virus. All those future plans we want to make — from dinner parties with extended family to karaoke with friends — depend on these factors, though experts say it likely won’t be until the end of 2021 when life will feel more normal.
‘Back to normal’ may depend on health-care system capacity
For a disease to be eradicated, you need two things: a treatment and a vaccine that leads to herd immunity, Cynthia Carr, an epidemiologist based in Winnipeg, told HuffPost Canada. Herd immunity occurs when enough people contract an illness and become immune to it so it can no longer spread.
Based on those criteria, Carr said it’s “highly unlikely” COVID-19 will completely go away — it will likely continue to circulate, possibly seasonally, like other viruses.
“So I think in terms of quote ‘back to normal,’ it’s going to depend on how well these vaccines assist the health-care system,” she said.
If a vaccine can alleviate some of the immediate impact on the system, it could be safer to gather in larger groups — but that likely wouldn’t be until “well into” 2021, Carr warned.
It may fall to local areas to make decisions about reopening as community-based spread and the rates of serious health impacts decrease, she said.
Carr also cautioned that the COVID-19 vaccine may not prevent the longer-term health outcomes that some people, sometimes called “long haulers,” have experienced.
“That will again inform how much risk we can really afford to take,” she said.
Eventual reopenings will likewise depend on how many people take the vaccine, said Dr. Susy Hota, the medical director of infection prevention and control at University Health Network in Toronto.
A December Angus Reid poll indicated 48 per cent of Canadians want to be vaccinated as soon as possible, up from 40 per cent a month ago.
‘Life will feel better’ as vaccine rolls out
Even as some Canadians get vaccinated, others will need to continue to follow public health guidelines.
“It’s kind of an all or none,” Hota said. “It’s the whole picture of who actually gets the vaccine that will determine when we’ve reached a point where we can start thinking about opening things up.”
Hota noted some people won’t be able to get the vaccine. Pregnant women were not included in clinical trials, and Health Canada has warned people who are allergic to vaccine ingredients to not be inoculated.
That means some may still take safety precautions, like continuing to wear masks or businesses limiting the number of people inside, Hota said.
WATCH: How a COVID-19 vaccine gets from lab to your arm. Story continues below.
“We do have to be cautious in terms of letting the guard down, so I would say it’s more like towards the end of 2021 that we would start to see the gradual reopening,” Hota said.
She added she doesn’t want people to be discouraged by the wait.
“It seems like such a long way from now, but I do think that life will feel better, and it won’t be so much negative news before that even, as we’re successful in getting this vaccine out and people are willing to take it,” she said.
She said decisions around what to reopen first will depend on what governments decide to prioritize, based on what’s valued most in society, noting the need to consider the economic impact of businesses being closed.
But she is hopeful part of the gradual reopening will mean giving Canadians the chance to safely have more social contact with family and friends.
“As long as it’s done carefully and slowly, I think that would be extremely important to me, and probably to a lot of people,” she said. “You know, you can hold off on going to that hockey game if you can see your friends and family at least.”
Vaccine’s impact on asymptomatic carrying unknown
Although some regions may have such high COVID-19 case counts that natural herd immunity is possible, for the most part Canada is relying on a vaccine to bring that about, Dr. Michael Libman told HuffPost.
While we know Pfizer and Moderna’s vaccines prevent illnesses, it’s unclear if they prevent people from being contagious, said Libman, a professor in McGill University’s infectious diseases division.
“It’s possible you might still get infected with the virus, but have no symptoms … but you’re still contagious,” he said.
That could be the worst-case scenario, Libman said, because people who can’t take the vaccine — or whose bodies don’t respond to it — would be vulnerable to contracting COVID-19. But high levels of vaccination could make it harder for the virus to circulate, he added.
He pointed to current estimates that suggest having 70 per cent of a population either vaccinated or infected with COVID-19 would bring herd immunity.
There are a handful of documented cases where someone has had COVID-19 twice, Libman said, but as long as that number stays low we’re heading in the right direction.
“It’s no big deal if the immunity fades, as long as the vaccine works and we can keep people going with vaccine boosters, for example — that’s pretty common in the vaccine world, that we have to get the vaccine … periodically,” he said.
Carr, the Winnipeg epidemiologist, said the efficacy of the current vaccines is still a major public health benefit since data from clinical trials shows they stop disease severity. But, like Libman, she said that isn’t enough to impact herd immunity, unless part of stopping the severity means people who are vaccinated have a lower viral load and are less contagious.
Hota said she suspects the vaccines will have some impact on stopping transmission and said more clarity will come with further data.
‘None of us are safe until all of us are’
Raywat Deonandan, an epidemiologist and associate professor at the University of Ottawa, told HuffPost he predicts Canada will be able to start lifting restrictions around summer 2021 — assuming the vaccines prevent transmission, and enough people get inoculated.
He anticipates the pandemic will be officially declared over by 2022, but noted it will likely still exist in some countries. That means international travel won’t go “back to normal for several years,” he said, adding some airlines may require proof of vaccination.
But it also depends on what “normal” we’re talking about. We likely won’t ever go back to the way life was in 2019, Deonandan said, because some aspects, like Zoom meetings and distance learning, have become such accepted parts of day-to-day life during the pandemic.
So far, clinical trials have not validated the efficacy of vaccines in children, so there’s a chance schools could still offer distance learning in fall 2021. But it may be safer for children to socialize by then, Deonandan said, because older relatives would be less likely to get sick should they contract the virus if they’ve been vaccinated and are immune.
It looks like [you] will be able to, you know, hug your grandparents by the end of next year with impunity.Raywat Deonandan
Still, even as some populations start to get vaccinated, it’ll only be completely safe to resume more normal activities when COVID-19 is controlled at the population level.
“Just because you’ve got a shot in the arm, the ordeal isn’t over for you. None of us are safe until all of us are,” Deonandan said.
Despite the unknowns, though, he said there are reasons to be hopeful.
“It looks like [you] will be able to, you know, hug your grandparents by the end of next year with impunity,” he said.
What will change forever?
But other changes during this crisis may actually be positive ones, Carr said.
Now that Canadians have learned so much about how viruses spread, she predicted more people will stay home from work if they’re sick instead of feeling guilty and going in anyway.
Mask wearing may also become a “common tool in the toolkit,” especially during cold and flu season, she said, noting masks are already commonly worn in Asia.
Libman said there may also be more of an understanding of ways to keep people safe moving forward, like improving ventilation in restaurants.
Ultimately, he said, the goal right now isn’t to bring the risk of contracting COVID-19 to zero — it’s to make that risk “compatible with the risks we take in everyday life.”
“As part of life ... we all choose risks to accept,” he said. “If we bring coronavirus down to that level of risk, well, then that’s the risk of life.”
Ontario Minister of Finance Rod Phillips said he made a mistake in taking a personal trip to St. Barts at a time when Canadians are being told to avoid non-essential international travel.
Phillips and his wife left Canada on Dec. 13, days after the provincial legislature adjourned, and is still out of the country, Emily Hogeveen, a spokesperson for the minister, confirmed to HuffPost Canada.
“I deeply regret travelling over the holidays. It was a mistake and I apologize,” Phillips said in a statement Tuesday evening.
“I am making arrangements to return to Ontario immediately and will begin a 14-day quarantine as soon as I arrive.”
Phillips said in a previous statement he has continued to work daily in both his role as a minister and as MPP for Ajax, “including dozens of digital Ministry, constituency and cabinet committee calls and meetings.”
“Had I been aware then of the eventual December 26th provincewide shutdown, we would have canceled the trip,” the minister previously said.
Hogeveen also confirmed Phillips left the country in August for a personal trip and quarantined for 14 days upon arriving back in Canada.
Ford said in a statement he is “extremely disappointed” in the minister’s decision to travel abroad.
“I have let the minister know that his decision to travel is completely unacceptable and that it will not be tolerated again — by him or any member of our cabinet and caucus,” the premier said. “I have also told the minister I need him back in the country immediately.”
Tweets on Phillips’ account since his departure — which show him interacting with business owners, other politicians and community leaders — have all been posted by staff and include photos from before his trip, Hogeveen said.
One of those tweets, posted Dec. 24, is a message encouraging people to thank front-line workers for the sacrifices they’re making during the holidays.
After Newstalk1010 broke the news of the minister’s trip, people have replied to the tweet to ask Phillips what sacrifices he has made.
Deputy Leader of the Ontario NDP Sara Singh said Phillips needs to face consequences for the trip.
“Everyday folks were separated from their aging parents during the holidays. They’ve missed the birthdays and graduations of people who are precious to them, and they have been separated from nieces, nephews and grandbabies as they’ve grown and hit new milestones over the last year,” Singh said.
“While the rest of us ache to hug our loved ones again, Doug Ford insiders are whooping it up ....”
Ontario Liberal Leader Steven Del Duca also criticized the trip, writing on Twitter, “There needs to be consequences for Minister Phillips’ hypocrisy, but the buck stops with Doug Ford.”
Obviously, I would prefer that people don’t take a vacation at this time ...Dr. Barbara Yaffe
Dr. Barbara Yaffe, Ontario’s associate chief medical officer of health, told reporters Tuesday she couldn’t comment on what Phillips “has done or not done.”
But she reiterated that public health advice is to not travel outside of Canada unless for an “absolutely essential” reason, and to quarantine for 14 days upon returning.
“Obviously, I would prefer that people don’t take a vacation at this time unless it’s an essential reason to travel,” Yaffe said. “And that’s the message we keep telling people.”
Earlier on HuffPost:
This article has been updated with a new statement from Minister Rod Phillips and Premier Doug Ford.
Ontario expects to receive its first shipment of the Moderna vaccine in the next 24 hours and plans to vaccinate more than half of its population by the summer, the chair of the province’s COVID-19 vaccine distribution task force said Tuesday.The...
An Ontario politician who has already been charged once for disobeying COVID-19 rules is blatantly breaking them again.
Independent MPP Randy Hillier posted a photo on Twitter Sunday showing himself and 14 other people at what appears to be a holiday celebration. He used the hashtag “#nomorelockdowns” to accompany the photo, which shows disregard for Ontario’s public health guidelines.
In another tweet, he confirmed the photo was taken Dec. 27.
Ontario has been in a provincewide lockdown since Dec. 26, put in place to combat the rapid spread of the novel coronavirus and ease the strain on the province’s health-care system.
Announcing the lockdown last week, Premier Doug Ford said it was a necessary measure to save hospitals from becoming overwhelmed in upcoming weeks. Currently, no indoor social gatherings are allowed, except for those with members of the same household.
Hillier did not respond to HuffPost Canada’s request for comment Tuesday.
In November, Hillier said on Twitter he was charged for his role organizing a large gathering at Queen’s Park in Toronto. He has opposed lockdowns and masks and has promoted a debunked pandemic conspiracy theory in the Ontario legislature.
Ford previously called the MPP “totally irresponsible” for the protest. The premier said he’s “never figured out” anti-maskers who believe COVID-19 is a hoax, saying, “this is a very serious virus we’re seeing ... around the world, around our country.”
People on Twitter have called for Hillier to resign.
This comes after more than 40 local physicians signed an open letter to Hillier in December, fact-checking his incorrect claims about COVID-19.
“You are spreading misinformation that minimizes the seriousness of COVID-19 to support your personal anti- lockdown and anti-mask beliefs,” Dr. Jeanette Dietrich wrote.
“I urge the public to ignore you and heed the advice of trained health care professionals. Continue to practice social distancing, wear masks, and keep everyone safe.”
Earlier on HuffPost:
Three of the “independent experts” long-term care home operator Revera chose to contribute to its recently released pandemic report have prior ties to the company, raising questions from advocates and family who say the report is unobjective and doesn’t reflect what has really been happening in the company’s homes during the pandemic.
The report, written by a panel tasked by Revera with examining the impact of the first wave of COVID-19 on the company’s residents and staff, said there was a “series of systemic breakdowns that allowed the virus to flourish in long term care,” including a sector-wide shortage of personal protective equipment and a “woeful lack” of laboratory testing.
It also found there were “mixed messages” and inconsistent information about infection prevention and resident cohorting from government ministries, public health units, hospitals and other bodies involved during the pandemic’s first wave.
It does not mention, however, the affiliations Revera has with three of the experts on the panel, whom the company says “contributed their advice and recommendations on a voluntary basis.”
The report does acknowledge the 266 deaths related to COVID-19 in the company’s homes across the country in the first wave of the pandemic. To date, 279 more people have died in Revera’s Canadian homes in the second wave — since Sept. 1, 2020 — according to the company’s media releases.
Revera currently faces multiple proposed class action lawsuits, one of which alleges the company was “systemically negligent” during the pandemic.
Revera ‘hand picked’ external committee
Revera announced its “external advisory committee” in a July press release, saying the group’s goal was to build on the knowledge gained during the pandemic to develop best practices for long-term care and retirement homes.
One of those experts, Bob Bass, is a negotiator who has previously represented Revera in arbitration meetings with unions. Kevin Skerrett, a CUPE pensions researcher involved with the Ottawa Health Coalition, told HuffPost Canada that Bass is well-known in the labour relations community.
There’s “no question” Bass has been paid for his work for Revera, Skerrett said, adding that work has included arguing against wage and working condition improvements.
Another expert on the panel, Dr. Krystyna Ostrowska, has been “contracted” to sit on the company’s infection control and prevention committee, Revera’s chief medical officer of health told Ontario’s long-term care commission in October.
And a third expert, Santiago Kunzle, who is the director of Montgomery Sisam Architects Inc., lists Revera on his website as a company he has a “strong, ongoing working relationship” with. Also listed are Extendicare and Sienna Senior Living Inc., two other large, for-profit, long-term care operators. Kunzle’s firm worked on a Revera retirement residence in Barrie, Ont., according to his website.
Bass, Ostrowska and Kunzle did not respond to HuffPost’s requests for comment in time for publication.
The chair of the panel said there were no conflicts of interest with the experts who worked on the report — but others disagree.
Christine Collins, a member of the Ottawa Health Coalition whose 69-year-old brother is a resident at Revera’s Carlingview Manor in Ottawa, said she believes there were “really obvious” conflicts of interest with the report’s authors. Carlingview was one of Ontario’s hardest hit homes in the first wave.
She also questioned the individual Revera appointed as chair of the group — Dr. Bob Bell, a former deputy minister of health and long-term care in Ontario who worked under the previous Liberal government.
“He was deputy minister at a time when policy decisions were made in favour of for-profit long-term care homes,” Collins said.
She said although Revera said he was an independent part of the team handling the report, she believes the company “knew full well that he would give their message.”
WATCH: Singh calls on the federal government to end for-profit long-term care homes. Story continues below.
Collins’ concerns are echoed by Candace Rennick, Secretary-Treasurer of CUPE Ontario.
“There should definitely be an arm’s length, at least, between the for-profit industry and current and former government officials,” she told HuffPost. “It just doesn’t make sense, and we know that there has been a cosy relationship between the for-profit industry and the current government.”
Skerrett agreed Revera should make the panel members’ work with the company clear, saying although the report does raise some fair concerns, it’s “troubling” that it excludes issues such as concerns around for-profit ownership of long-term care homes.
“The company hand picked a group of individuals that they were comfortable with, and I would say that looks to me like they would be comfortable, they would get a report that … would not be a problem, would not have results or content that the company’s not comfortable with,” he said.
Susan Schutta, a spokesperson for Revera, said the majority of the people on the panel — including Bell — have never been paid by the company.
“A few of the people who worked on the report have existing professional or consulting relationships with Revera, given that they are the best at what they do,” she said, adding those people were paid for that work but were not compensated for working on the report.
Revera also engaged a “noted health journalist” to draft the report, she said.
“Suggesting that these experts did not provide credible analysis because they consult with our company on other matters is a regrettable mischaracterization of people who have consistently demonstrated excellence in their field and who are world-renown[ed] authorities.”
‘That is what experts do’
In a statement to HuffPost, Bell said he didn’t receive any compensation from Revera — nor would he accept any in the future — and he rejects any suggestion he had a conflict in interest when it came to chairing the panel or writing the report.
“I personally wrote, edited and finalized the report, using the original drafts contributed by the panel members to ensure scientific and clinical integrity was maintained while improving accessibility of the piece and unifying the voice of the various sections,” he said.
He noted he refused to accept edits outlined by Revera’s lawyers, which he understands they asked for because of the “litigious circumstances surrounding [long-term care] at present.”
Bell said there were no conflicts of interest with the report’s contributors and the panelists were not paid for their work.
“Why do it?” he asked. “Because we MUST make Long-term Care and seniors’ care in general higher quality and safer. I think this report is a contribution to that goal.”
The panelists were chosen through a “joint and collaborative effort” between him and Revera, he said, adding there was a “ton of unpaid work” involved — about 40 hours minimum for most people, and an excess of 150 hours for himself.
Ostrowska was not compensated for the “considerable work” she did on the report, Bell said, noting several other panelists with experience in infectious disease “contributed to an even greater extent” than she did.
Bass, meanwhile, “does work for many, many clients in healthcare” and volunteered an “enormous” amount of analysis regarding staffing during the first wave, Bell said.
“I worked closely on his part of the report and I can guarantee that no one influenced what he determined nor what he recommended,” he said.
It was also clear that Kunzle “was independent,” Bell said, adding the architect director’s firm “might” do design work for Revera, as well as other private or non-profit facilities, in the future because “that is what experts do.”
HuffPost reached out to the report’s six other authors. One had no comment, one didn’t respond before deadline and three — Dr. Samir Sinha, Dr. Mark Loeb and Michael Nicin — said they found the report process to be fair and independent. Another, Dr. Allison McGeer, said there were a “range of opinons” voiced at meetings and drafts.
‘I am so upset ...’
Collins found herself getting emotional when she first first read through a copy of Revera’s pandemic report.
“I cried for 20 minutes when I read what they were saying about people with dementia,” she said.
The report quotes an anonymous Revera executive who said it was hard to get residents with dementia to wear masks, and, because some of these residents roam constantly, “to keep them isolated is next to impossible.”
It’s a concern Collins identified early in the pandemic. Her brother Peter is on one of Carlingview’s secure floors for residents who have dementia, and Collins worried in the spring that the other residents wandering in and out of his room — even when he was in isolation after moving into the home from an Ottawa hospital — could be spreading the virus.
“They told me it was my brother’s responsibility to tell [another resident] to get out of the room,” Collins said.
“I am so upset that they take no responsibility for not giving a damn about all of the people that are on the dementia floor. They did nothing, no measures at all.”
According to the report, Revera’s supervisors found it was “somewhat effective” to have staff members dedicated to helping residents in secure units with hygiene.
But Collins alleges the shower room was closed during the pandemic and that her brother never even received a sponge bath during that time. When she called to ask about this, she said she was told her brother had a bathtub in his room — but he’s disabled and can’t climb in and out of the tub on his own.
‘They’re not taking any responsibility’
In the fall, Collins said her brother, Peter, was moved to a new, dirty room when he started displaying COVID-19 symptoms. He didn’t get a change of clothes for the four days he was in the new room, and twice didn’t get a meal delivered, she said.
“They’re not taking any responsibility,” Collins said. “Everywhere I looked when I was looking [at the report] — I saw references to government, hospitals … everybody except themselves.”
“It’s their own lack of care they need to take responsibility for,” she said.
CUPE’s Rennick echoed concerns that Revera’s report is “not objective” and deflects from larger problems, including those with the company’s model.
“It really does overlook how their own for-profit model of ownership has contributed to the sad and deadly realities for people living in long-term care during the pandemic,” she said.
Our pension plan as public service employees should not be making profits on the backs and deaths of those suffering ...Christine Collins
Analysis by the Toronto Star in both waves of the pandemic has found residents in for-profit long-term care homes had worse outcomes than those in non-profit or municipal homes.
Collins worked for Transport Canada for 37 years. As a former public service employee, her pension plan is managed by the federal Public Sector Pension Investment Board — which owns a 100 per cent stake in Revera Inc.
“Our pension plan as public service employees should not be making profits on the backs and deaths of those suffering, like my brother, and those dying in Revera homes,” she said.
Revera spokesperson Larry Robertson previously told HuffPost the focus on ownership models “is becoming a distraction” from talking about the challenges and “real reform” needed in the long-term care sector.
He said Revera does not make a profit from the delivery of care.
Panel chair: ‘No editorial influence’
The Public Service Alliance of Canada (PSAC), which has 140,000 members’ pensions invested with PSP Investments, has been among the organizations calling for Revera to be taken public.
In an online post, PSAC President Chris Aylward called the company’s pandemic report “a slick corporate public relations exercise.”
The PSAC post points to a Canadian Medical Association Journal article that found for-profit homes had larger COVID-19 outbreaks, and more resident deaths, than non-profit or municipal homes.
“Given this, one would expect a report produced by ‘independent experts’ to devote at least a small section to examining these findings in greater detail,” the organization said. “Instead, the report is completely silent on this.”
Revera’s report says “critics allege” for-profit homes choose to employ part-time staff because of the lower cost, but says that’s not true. It states it is “more cost-effective” to hire full-time employees because there is less turnover and lower onboarding costs.
We had the pen on writing this report.Dr. Bob Bell
Schutta, the Revera spokesperson, said Revera is the only long-term care operator to “undertake this level of external scrutiny” and make public its findings.
Speaking on CBC’s The Current, panel chair Bell pushed back on criticism that the report doesn’t include information about outcomes in for-profit care homes. He said the funding provided to long-term care homes is “tightly regulated in Ontario” for both not-for-profit and for-profit providers.
“The panel did not comment on the issue of various models of [long-term care] ownership. We were reviewing data from Revera — not from all LTC providers,” he said in his statement to HuffPost.
He said the panel did study the impact of resident density and risks associated with multi-resident rooms, which he noted are mainly in Ontario homes owned by for-profit companies.
On the CBC, Bell also said Revera allowed the experts working on the report to see their data and ask questions.
“We had the pen on writing this report,” he said. “There was no editorial influence from Revera.”
As of Dec. 3, the ministry had issued at least six mandatory management orders and 14 voluntary contracts to homes that needed more support managing a COVID-19 outbreak.
A voluntary agreement — where a home makes a contract with a hospital — allows for the hospital to provide additional support, though at the control of the facility’s potentially negligent management, Natalie Mehra, executive director of the Ontario Health Coalition (OHC) said at a Thursday press conference.
Management orders, meanwhile, are issued when a home’s management is “deemed incompetent” and a hospital takes over. Mehra said the support provided through these orders varies, but typically it means hospital staff take over management functions at the home, and help with infection control and staffing.
But many homes experiencing bad COVID-19 outbreaks have not received management orders — and other interventions have come “inexplicably late,” only after high infection rates and death tolls, the OHC said in its report.
“There’s just massive scores of homes with large outbreaks with no interventions at all,” Mehra said.
She said although some hospitals continue to support long-term care homes, they face capacity issues that prevent them from helping in the same way they did during the first wave.
“The problem is they don’t have the capacity to do that, and there was no plan in the summer made to build that capacity,” Mehra said.
The province should have brought back retired nurses and done massive recruitment for teams that could support homes, she added.
More than 2,500 long-term care residents have died of COVID-19 during the pandemic, according to provincial data. And the numbers are growing through the second wave. By the OHC’s count, 18 residents have died in the last 24 hours and there have been 115 new COVID-19 infections in the last day in long-term care homes across the province.
Many of Ontario’s long-term care homes have “crumbling” staffing levels that are worse than in the spring when the pandemic first took hold, and there are also “critical” problems in cohorting residents, Mehra said. Staff at more than a dozen homes say they are short on personal protective equipment (PPE), such as gowns, gloves, disinfecting wipes and N95 masks, she said.
The ministry has given $540 million for homes to deal with the pandemic’s second wave, including funding for staffing support.
Because we’re at the point where we were in the first wave when the military was called in.Natalie Mehra
But with the number of new infections and deaths continuing to grow, Mehra is left wondering why there isn’t more help for homes dealing with outbreaks.
“Because we’re at the point where we were in the first wave when the military was called in.”
The Ministry of Long-Term Care is “committed to doing everything we can” to support long-term care homes during the pandemic, Mark Nesbitt, a ministry spokesperson, said in a statement to HuffPost Canada.
Measures taken by the ministry during the pandemic include “rigorous” inspections for the province’s long-term care homes, emergency funding, staffing support and increased testing, as well as appointing temporary management to some homes.
He said some homes and hospitals will continue with “informal partnerships” after a mandatory management order or voluntary management contract ends.
The ministry has approved temporary management of 25 long-term care homes, Nesbitt said. The province has also announced $1.9 billion in funding to create more than 27,000 new jobs in long-term care.
Interventions came ‘too late’
The province’s emergency interventions — including sending in military teams, rapid response teams from hospitals or support from the Red Cross — have been “improvements,” the OHC said.
But it added these measures have been inconsistent and often implemented too slowly.
Dr. Amit Arya, a palliative care physician and OHC board member, emphasized the need for a low threshold for intervention in care homes.
When there are more than 100 cases in a home and people are crying out for help, the response is often “too late,” he said.
Lack of accountability a ‘huge failing’
Arya has been in homes during the pandemic where his team would say, “Imagine if we were here two weeks ago ... we would have saved lives and we would have saved so many people from suffering.”
He pointed to Quebec, which appointed an infection control manager to every long-term care home over the summer.
If that had happened in Ontario, he said, “the outcome would have been likely very different.”
There is no accountability ...Natalie Mehra
“It’s very appalling that even at this stage, we don’t have accountability around infection control, we don’t have government oversight in each of the homes about what is going on on a day-to-day basis, how they’re cohorting patients, how they’re testing, how they’re donning and doffing PPE,” Arya said.
Nesbitt, the ministry spokesperson, said the ministry works with the local public health unit and health integration network, along with other partners, when a long-term care home is experiencing an outbreak. This includes working to improve infection prevention and control measures, shoring up staffing and ensuring homes have adequate PPE supplies, as well as daily calls, he said.
However, OHC’s Mehra said the ministry hasn’t used its powers to issue fines or revoke home’s licenses during the pandemic.
“There is no accountability, no real accountability, for the homes that fail to provide the basics of life and the basics of safety,” she said. “That is a huge, huge failing.”
Earlier on HuffPost:
As the first wave of the COVID-19 pandemic swept through Canada’s long-term care homes in the spring of 2020, more than 500 workers from one of the country’s largest operators stopped showing up for work.
Revera, which operates more than 500 nursing homes in Canada, the United States and the United Kingdom, saw 266 resident deaths at its Canadian long-term care homes during the first wave of the COVID-19 pandemic.
The company has drawn criticism for its handling of the pandemic across the country, including in Manitoba, where two of the company’s homes have a combined total of 81 deaths during the second wave. Revera is a wholly owned subsidiary of the federal Public Sector Pension Investment Board and has faced calls to be taken public amid the pandemic.
WATCH: Long-term care residents, health-care workers to be among first to be vaccinated in Canada. Story continues below.
Even in homes without COVID-19 outbreaks, “workers offered no explanation for their absences” and did not respond to the company’s efforts to reach them, Revera’s report said.
Fear likely played a “significant role” in staff absences, in addition to other reasons like the single-site staffing order, sick leaves, quarantine orders, pregnancy or parental leaves, needing to provide child-care and concerns about spreading the virus to vulnerable family members.
“In the context of COVID-19, long term care homes quickly became high-risk environments,” the report states, pointing to the deaths of three personal support workers (PSWs) in Ontario in less than three weeks.
“It is not a stretch to imagine that fear kept many frontline care providers from going to work.”
Revera has kept those people on its employee roster and has not taken any punitive measures, according to the report.
The Canadian Emergency Relief Benefit (CERB) may have also been a disincentive for staff from working or caused people to not apply for the part-time positions available, the report suggests. The benefit paid out $2,000 per month or $500 per week, “slightly more” than a part-time employee in long-term care would make for working three days in a week.
The report states that Revera dealt with the staff absences by giving more hours to part-time workers, but the absences created a “desperate scramble” to find staff to fill the “growing gaps.”
It cites “failed attempts” to recruit PSWs who were available because they weren’t working in home care as they were before the pandemic, as these workers couldn’t be directed to work at a long-term care home by their employers.
Some PSWs — not only from Revera’s homes — have spoken out about the difficulties of working through the pandemic.
“To go to work every day to see your residents die, is a horrible way to work,” PSW Jennifer Cloutier said at a press conference focused on the staffing crisis in September.
“We were living below poverty as it was … and by doing one job, we’re basically sinking further in[to] poverty,” said another PSW, Kelly Stephenson, referencing the government order that required long-term care workers to only work at one facility to slow the spread of the virus.
“We’re tired of being called heroes and angels and not being treated as such,” Stephenson said.
Permanent pay increases needed: experts
Sharleen Stewart, president of SEIU Healthcare union, which represents Revera staff in retirement and long-term care homes, told HuffPost nursing home staff feel “disregarded” and “disheartened” that the issues they’ve been raising alarm bells on for decades haven’t improved.
“They’re feeling like it is just not worth risking their lives and the lives of their family members, when a lot of promises have been made verbally, but action has not been seen on the ground.”
A survey by the union toward the end of the first wave found 30 per cent of its members were not returning to work — a figure Stewart called “extremely concerning.”
The most pressing change, she said, is for workers to be given a decent, living wage with benefits.
Without improvements, long-term care workers — predominantly women, Stewart noted — will choose to work elsewhere, instead of working double shifts at short-staffed nursing homes when they’re already burned out.
Of course these workers would make the very practical and sane decision not to risk their lives ...Vivian Stamatopoulos
Expert and advocate Vivian Stamatopoulos echoed concerns that the eight per cent number seems low.
She questioned whether the figure only refers to staff hired by Revera or if it also includes agency workers, whom she said are not prohibited by the single-site staffing order and could be contributing to “exploding outbreaks” in care homes.
A Revera spokesperson did not return HuffPost’s request for comment Monday.
“Of course these workers would make the very practical and sane decision not to risk their lives in potentially dangerous working conditions,” Stamatopoulos said. “Of course they would make the decision to take the CERB, instead of to be paid marginally over minimum wage to risk their lives, their families lives and residents’ lives.”
If Revera did not permanently increase staff wages to reflect the difficulty of the work, “then they didn’t learn anything,” she said.
Ontario’s temporary wage top-up of $3-per-hour for eligible long-term care workers isn’t enough of an incentive to keep people working in the sector, she said.
A spokesperson for the Ministry of Long-Term Care said the purpose of the wage increases is to support the retention of staff and increase the supply of workers.
“The province will closely monitor this program across multiple settings to assess the impact of the proposed wage increases on service levels, recruitment, retention and overall supply,” the spokesperson said.
To address the “revolving door” of workers in long-term care, operators also need to proactively mandate 4.1 hours of direct care per resident per day — something the Ontario government has committed to achieving by 2024-25 — and implement better staffing ratios and make permanent pay increases, Stamatopoulos added.
The Ontario government gave $540 million for the long-term care sector to handle the second wave of the pandemic, including funds for staffing support.
The Ministry of Long-Term Care is also developing a comprehensive staffing strategy that will be delivered by the end of the year, the spokesperson said.