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On Wednesday, July 29, Premier Doug Ford and Dr. Merrilee Fullerton released details of the provincial government’s independent commission into long-term care (LTC). The commission, which was first announced by the government on May 19, aims to “address a crisis decades in the making”.

The commission will investigate how COVID-19 spread within long term-care homes, how residents, staff, and families were affected, and how the government and other parties responded to the pandemic. The commission has full authority to hold hearings, deputations and summon any persons as they conduct their investigation.

A report, which is expected by April 30, 2021, will include recommendations that Premier Ford says the government will address.

Chief Justice Frank Marrocco has been named Chair of the commission. Marrocco is an Associate Chief Justice of Ontario’s Superior Court and previously served as the provincial government’s lead counsel for the Walkerton tainted water inquiry in 2002. Other experts on the three-member panel include Dr. Jack Kitts, who was the president and CEO of The Ottawa Hospital for 18 years, and Angela Coke, whose career spans almost three decades in Ontario’s civil service including a number of senior positions at the Ministry of Health and Long-Term Care.

A short background on the commission

The commission was formed as the result of COVID-19’s devastating impact on long-term care homes across the province. To date, over 1,800 LTC residents have died due to COVID-19 related complications, and 387 out of the 626 homes in the province have reported outbreaks. At the height of the pandemic, the Canadian Armed Forces (CAF) provided support to five homes in the GTA who suffered critical staffing shortages as a result of the virus.

On May 19, the government first announced the independent commission, which was earmarked to begin in September. However, on May 26, the CAF released a report detailing concerning findings within those five homes. In response, the government recalibrated to push the commission up to July.

The CAF have since departed Ontario’s LTC homes and over 10 homes across the province remain under the temporary management of their local hospital.

Terms of reference

As laid out in the terms of reference, the mandate for the commission is clear:

The Commissioners shall investigate and provide a report of findings and recommendations respecting:

How the pre-COVID-19 state of the long-term care homes system, including the relationship to other aspects of the health care system, contributed to the COVID-19 virus spread within long-term care homes and how residents, staff, volunteers, visitors, family members and others were impacted;

The adequacy of measures taken by parties, including the province, long-term care homes and other parties, to prevent, isolate and contain the spread of COVID-19, including the adequacy of existing legislative and regulatory provisions, policies, practices and specifications on infection prevention and control of infectious diseases in long-term care homes;

The impact of existing physical infrastructure, staffing approaches, labour relations, clinical oversight and other features of the long-term care system on the spread of COVID-19 in the long-term care homes;

All other relevant matters that the Commissioners consider necessary to investigate the cause of the spread of COVID-19 within long-term care homes; and

In considering the current government initiatives and reforms in the long-term care homes system, any further areas that should be the subject matter of future action by government to help prevent the future spread of disease in long-term care homes.

What impact will the commission have on long-term care?

The commission has the authority to request information and summon any persons to conduct their investigation. This poses a challenge to homes and operators who are currently managing new infection control directives and a new COVID-19 reality.

With broad terms of reference, it is unclear who the commission plans to speak to and what role private homes and operators will play. It is, however, clear that operators and for-profit homes will be involved. Public Health, which is notably missing from the terms of reference, will also need to be included to address the adequacy of measures taken to prevent the spread of COVID-19.

Additionally, compared to the Wettlaufer inquiry, this commission has a wide scope and their recommendations have the potential to overhaul the entire system.

What about other health sectors?

During media questions, Dr. Fullerton identified the importance of integration and the important role acute care will play in the path forward for LTC. We can expect other sectors — including pharmacy and home care — to also play a role in the recommendations, as drug management was addressed in the CAF’s report and capacity has posed a long-term challenge.

Finally, the recommendations and findings from the commission will potentially impact other congregate settings including group homes, residential care and shelters.

What’s next?

Although the report isn’t due until next spring, we can anticipate that the government will continue to take action on long-term care in the short-term (e.g. new beds, redevelopment of older homes, action to address staffing challenges in long-term care, and enhancements to infection control protocols including training of staff).

We will continue to monitor hearing timelines and individuals who are called to testify. While the commission has the authority to call on politicians, former and current, there will need to be compelling evidence to do so. It should be noted that former Premier Mike Harris did testify at the Walkerton inquiry, but there were clear policy decisions made by his government that were the focus of the inquiry at that time.

The government is also expected to release a report on long-term care staffing by the end of the week.

If you have any questions about the commission or the path forward for long-term care, please contact your Santis Health lead.