Ontario Premier Doug Ford's government will reveal new legislation Thursday for the province's long-term care homes, where COVID-19 outbreaks killed more than 3,800 people during the pandemic.
Advocates for seniors are describing this as a now-or-never moment for Ontario to improve long-term care and the living conditions of the vulnerable elderly who reside there.
The government is pledging that its bill will bring better accountability, enforcement and transparency to the nursing home sector and enshrine residents' rights.
The long-awaited legislation has been repeatedly promised and foreshadowed by the government since a commission slammed the province for failing long-term care residents both before and after the COVID-19 pandemic began ripping through Ontario's 626 homes.
Minister of Long-Term Care Rod Phillips announced on Tuesday plans for Ontario to beef up enforcement by doubling the number of long-term care inspectors and by mounting proactive inspections of homes, something the Ford government all but scrapped shortly after taking office, as revealed by a CBC News investigation.
Systemic changes needed
The long-term care sector needs more than just a change in legislation or stricter enforcement, says Lisa Levin, CEO of AdvantAge Ontario, an association representing more than 200 not-for-profit and municipally run homes.
"We need to transform the system," said Levin in an interview with CBC News. "We are at a critical juncture now in long-term care. If we don't have significant changes now, I don't know if we ever will. This is our moment. This is our opportunity to really change the system."
Ontario's long-term care homes have been underfunded and under-resourced for years, Levin said.
"Unfortunately, it took the tragic death of thousands of people through COVID-19 for the public and government to recognize that we need major changes," she said.
Levin says the government is "heading in the wrong direction" by awarding for-profit operators 60 per cent of its contracts to build new long-term care homes.
The group that represents predominantly privately owned facilities, the Ontario Long-Term Care Association, recently released its recommendations for reforms.
Stronger enforcement, penalties
People whose loved ones have lived in long-term care are looking to Thursday's bill with much anticipation.
Vivian Stamatopoulos began her advocacy before the onset of COVID-19 when her grandmother was living in a home and became a prominent spokesperson during the pandemic.
The system "really needs drastic reformation," said Stamatopoulos, an associate teaching professor at Ontario Tech University in Oshawa, Ont. She's concerned that legislative amendments alone won't make a significant difference.
"The problem has never been that there aren't enough regulations," she said in an interview with CBC News. "The problem has always been that they are not upheld and that we consistently allow bad actors to repeatedly break the law with impunity. That is the fundamental issue."
She wants to see hefty fines and a clear threat of criminal charges against the owners and operators of long-term care homes that flout the rules.
"Really put an incentive on them to change how care is provided in these facilities, knowing that it will come back to them in the end," said Stamatopoulos.
She questions whether the Ford government will bring what she calls "actual, meaningful change to hold these bad actors to account" given its move last year to absolve homes from liability for COVID-19 deaths in all but cases of gross negligence.
Cathy Parkes, whose father, Paul, died of COVID-19 last year while living at Orchard Villa in Pickering, wants to see a clear indication that nursing home operators who provide inadequate care will have their licences revoked.
"There needs to be a step of really severe penalties when you have homes making the same mistakes repeatedly," Parkes said in an interview. "Not just a written warning, not just a voluntary plan of care, but let's actually start fining them, and to a certain point then removing their licence."
'This is the time to make changes'
The Ontario Association of Residents' Councils brings together the councils that represent people who live in each long-term care home. OARC has given Phillips detailed recommendations for legislative reforms.
"This is a critical, critical point in time," said Dee Tripp, the association's executive director.
She says public pressure to improve the long-term care system is aligned like never before with the government's willingness to do so.
"We have been living with a staffing crisis in long-term care for decades. This is the time to make changes," said Tripp in an interview
The government's promise that the new legislation will enshrine residents' rights is puzzling to some in the sector because a residents' Bill of Rights is already embedded in Ontario's existing Long-Term Care Act.
It has 27 clauses, affirming that everyone living in a long-term care home has the right to be treated with courtesy and respect, to be properly fed and cared for, and to live in a safe and clean environment.
Existing laws lack teeth, says advocate
Samir Sinha, director of geriatrics at Toronto's Sinai Health and University Health Network, says the biggest problems in long-term care aren't with the legislation.
"I think certainly there might be some things that can be improved upon, but really, the story has been that this is a government that has actually failed to use a lot of the powers that it's had," Sinha said in an interview.
"The current Long-Term Care Act actually does have all these tools and has always had these tools available."
Jane Meadus, who leads the Toronto-based Advocacy Centre for the Elderly, has a similar view.
"The biggest problem with the legislation that we have now has been the fact that there's been no teeth," Meadus said in an interview. "We really need to see some sort of teeth in the legislation so that when there are problems, it just doesn't get swept under the rug."
For Meadus, the quality of care in a home is largely about staffing levels.
"If you don't provide enough funding, homes aren't going to be able to meet the standards," she said. "We have to get more staffing in long-term care homes."
The Ford government has pledged to raise the minimum standard of one-on-one care provided to each resident to four hours per day, with a target date of 2025. The most recent budget earmarked an additional $4.9 billion for the plan.