The tragic loss of life in long-term care homes due to COVID-19 exposed many of the problems that have plagued Ontario’s Long-term Care Home system for many years. Strategies such as stronger policies, more regulations, investment in staff, and support from specialists have been tried. These strategies were insufficient and failed to appropriately address the inherent weaknesses in the current system.

The impact of COVID resulted in horrific and tragic events. And if changes don’t occur to the current medical/institutional model of care in many LTC homes, the future could hold more viral outbreaks. It is very challenging for staff in these facilities – under the present system – to provide appropriate and respectful care. Care that includes the physical, psychological, social, spiritual, and cultural needs of residents. These needs are described in Ontario’s Long-Term Care Homes Act.

Factors that contribute to the current system:

  • Too few staff.
  • Not enough hours of direct care.
  • Staff working in more than one LTC home.
  • Not enough Personal Protective Equipment.

These are well documented factors. And they have existed for some time in LTC homes. The present LTC home system will still be one that causes and prevents quality of life for residents, staff, and families – even if/when these factors are addressed by the Ontario government.

Current State of LTC Homes in Ontario:

Medical Model of Care:

  • Focus on diagnosis and treatment.
  • Institutional environment resembling a hospital.
  • Long hallways filled with laundry carts, drug carts, and food carts.

Task-Oriented Approach:

  • Care delivery is task-oriented rather than person-centered or relationship-based.
  • Staff focus on feeding, scheduling, and bathing.
  • Fun or entertainment is scheduled and not spontaneous.
  • No priority for developing relationships with residents.
  • Staff sit with residents only if they have extra time.

Leadership and Decision-Making:

  • Leadership makes decisions with little input from frontline staff.
  • Minimal staff involvement in decision-making processes.

Staff Recruitment and Training:

  • Staff hired based on education qualifications, not suitability for LTC work.
  • Low emphasis on problem-solving, critical thinking, caring for seniors, communication skills, and empathy.
  • Training mainly delivered through videos, with staff signing off after viewing.
  • Lack of discussion, mentoring, or role modeling post-training.

Family and Caregivers Involvement:

  • Families/caregivers often feel unwelcome and that their input is neither welcomed nor needed.
  • Lack of value placed on family/caregiver input for enhancing resident care.

Regulatory Compliance and Culture

  • Current regulatory/inspection system is punitive which does not provide positive results.
  • Positive results would come from using cumulative reports of LTC home inspections and data to guide timely improvements and engaging family councils, residents, families, and front line staff in this process.

Cold and clinical warehouses where people go to die must change. We need warm, compassionate, homelike places where residents can truly live. Ontario’s LTC homes urgently need a revolution in how they provide care.