The long-term-care system has been failing patients and families for decades. COVID-19 is shining light on the tragedies brought on by inaction

In her four decades working in long-term care, Dr. Jean Skillman saw firsthand how the system failed her patients and their families.
She worked alongside administrators who toiled for 60, sometimes 70 hours a week just to keep the homes operating at a basic level. She witnessed nurses and personal support workers under strain, taking on three jobs to make full-time hours.
“You can’t do that and give good care,” said Skillman, who retired from practicing in the Cambridge, Ont. area in 2016.
The homes often scrambled to schedule enough staff, what she saw as the result of business decisions by the homes’ owners and boards that undercut the quality of care residents received.
Homes relied too heavily on part-time staff to avoid paying benefits, paid low wages for the work and had to spend too much time on paper work to meet ministry inspection requirements, Skillman said.
“The system promotes it and then blames the worker, which I think is wrong,” she said.
It was those people in thankless jobs, as well as the administrators on the ground, who were repeatedly slapped with scathing inspection reports, she said.
Meanwhile, the government and, in the case of for-profit homes, the boards, continued to uphold the status quo.
Though there have been reforms within long-term care over the last decades, making it among the most regulated industries in the province, the system itself — which institutionalizes the elderly and places the most responsibility on some of the most precarious workers — has remained largely unchanged.
There have been six health ministers over nearly 20 years, many echoing promises of change while staring ahead at a long-term care system that continues to founder with the same challenges.
Tragedies unleashed by COVID-19 have once again turned the public attention to our beleaguered system of caring for seniors, looking for answers.
For decades, the Star has shone a light on nursing home failures. The articles have exposed problems and shown what can be fixed.
There was the harrowing story of Natalie Babineau, the 93-year-old who died in hospital after suffering from a deep bedsore that her family said had turned gangrenous. Then-Health Minister George Smitherman wept over pictures of Babineau’s wound and vowed to fix a system in despair.
Another Star series revealed how thousands of nursing home residents had been prescribed risky antipsychotics to manage their agitated or aggressive behaviours because homes do not have adequate trained staff.
A 2011 investigation detailed rampant physical and sexual abuse, including rape. The report found more than 10 care home residents were verbally, physically or sexually assaulted each month.
The Star also did an in-depth look at a radical, new model of providing long-term care, one in which every decision is guided by the principle of treating residents like they are truly at home.
Taken together, these Star articles also tell a story of inertia.
Now, once again, the public is watching in horror as another long-term care home tragedy unfolds. A grim tally of loved ones who have succumbed to COVID-19 outbreaks grows, revealing the appalling conditions residents still face.
When COVID-19 first hit care homes, Skillman worried about how those sharing rooms and those with dementia — who can’t be expected to wear masks and consistently wash their hands — would make it tough for staff to stop the spread.
“What went through my mind is that everybody was going to die,” she said. “I thought we’d see mortality rates of 90 to 100 per cent eventually.”
Once again, policymakers are promising change.
In April, as the death toll from COVID-19 in nursing homes was mounting, Premier Doug Ford called the widening cracks in the long-term-care system a “wake-up call to the world.”
In one emotional speech, he spoke of the need to form an “iron ring” around vulnerable seniors.
“When they look back on this, when the history books are written, we will be judged on how we looked out for each other,” Ford said. “But even more importantly we will be judged on who we looked after.”