TORONTO — The email came late on a Friday evening and it was long.
“I am reaching out in response to your article ... and to request that you please update it to better align with the factual landscape as it relates to inspections in long-term care,” minister of long-term care Merrilee Fullerton’s press secretary Krystle Caputo wrote to HuffPost Canada on Dec. 4, shortly after 10 p.m.
Her email toured a “factual landscape” that was missing some significant landmarks. Like many of the minister’s own talking points, Caputo’s defense of the government relied on information that was true but incomplete, and potentially even misleading.
The email was in response to an article that said the Ministry of Long-Term Care had only done comprehensive inspections of 11 of the province’s more than 600 nursing homes over seven months of the COVID-19 pandemic. It was based on information in a report from the province’s long-term care commission, which was struck to find out how COVID-19 spread so rapidly through these facilities, killing 2,408 people as of Monday.
The commission flagged the government’s approach to inspections as a “key gap” that failed residents.
Under previous governments, the ministry did fulsome inspections or “resident quality inspections (RQIs),” in hundreds of homes every year. After the Progressive Conservative government came to power, however, the number of homes that got RQIs dropped to 27 in 2019 and just 11 throughout most of 2020, the commission said.
Ontario still does thousands of other inspections every year, which are more narrow and look into specific complaints or “critical incidents,” like a resident falling and hitting their head.
This left the government with an “incomplete picture” before the pandemic, the commission said, because reactive inspections are “very unlikely” to identify issues with personal protective equipment and infection prevention and control policies.
Caputo’s email said that the government changed its approach after two independent reviews.
“The ministry shifted towards a risk-based inspection framework in the Fall of 2018 following a recommendation by Ontario’s Auditor-General in her 2015 report,” Caputo wrote. “It allowed us to respond to urgent concerns and to clear an inspections backlog that had been accumulating.”
‘Obviously wasn’t the right decision’
But the auditor did not recommend cutting RQIs. She made that abundantly clear at a press conference the following Monday.
“We did not recommend them to stop their comprehensive inspections,” Auditor General Bonnie Lysyk said. “That was a judgment call that somebody in the ministry made that, in hindsight, obviously wasn’t the right decision to make.”
At the time of her report, the ministry was doing comprehensive inspections at the expense of urgent complaints, for example, that a resident was being abused or wasn’t being fed, Lysyk explained.
“What we recommended is that, continue doing your inspections — we never said stop their inspections — continue doing your inspections, but factor into those inspections long-term care homes that you are seeing have more incidences and more complaints, so that when you’re selecting which homes to go to, go to the high-risk homes first,” Lysyk said.
She thanked the reporter for the chance to set the record straight, saying her recommendation had “totally been turned around in the public forum.”
Fullerton’s press secretary also told HuffPost their inspection method was “validated by Justice [Eileen] Gillese.” The justice led the government’s public inquiry after a nurse murdered eight people in long-term care homes over the course of nine years.
Gillese declined to be interviewed, telling HuffPost she’s not allowed to speak to journalists because she’s a sitting judge.
Her report, like Lysyk’s, said the government needed to do a better job of identifying which homes were really struggling to provide a safe environment and prioritize the most urgent inspections.
It did not recommend cutting RQIs.
In response to questions for this story, Caputo said the government has done more critical incident and complaint inspections than previous governments did.
“RQIs are one type of inspection, and are still being used as appropriate, among other inspection formats,” she said by email. “Last year, over 2,800 inspections were conducted, which represented a meaningful increase over previous years. This allowed us to respond to urgent concerns and to clear an inspections backlog that had been accumulating.”
“RQIs are one type of inspection, and are still being used as appropriate, among other inspection formats.”
Minister Fullerton has not been available to take questions from reporters since the commission’s report came out last week. And now that the legislature adjourned early, it’s unclear when she’ll answer for it. Not that her comments have always been clear or representative of the grave situation she has on her hands.
Fullerton has made comments in the legislature that she later denied making.
During question period on Oct. 19, she said: “Our homes are doing well with staffing. There are no issues with staffing collapse in our homes.” An hour later she contradicted herself: “I don’t believe I’ve ever said there are no staffing issues.”
The next day, Fullerton said she only meant homes with outbreaks of COVID-19 were doing well with staffing. But front-line workers at some homes that have outbreaks continued to say they were working short-staffed. Fullerton and her staff continue to refute it.
On May 20, the Globe and Mail reported that some home administrators and local health units aimed to keep long-term care residents out of hospitals in order to shore up space for other COVID-19 patients. Andrew Watt was quoted saying his mother, Nina Watt, did not want to leave hospital for long-term care but was told it was her only option. She was dead three weeks later.
On June 9, HuffPost reported the story of Paul Parkes, who died at Orchard Villa long-term care home after his daughter says staff refused to transfer him to hospital or give him oxygen.
“But there was never a situation where residents would be stopped from being moved to hospital ...”
On June 24, Fullerton addressed the issue in question period.
“If the resident or their guardian or their family wants them to be moved to a hospital, that is their right, and that must be the case,” she said. “But there was never a situation where residents would be stopped from being moved to hospital if that’s what they wished.”
When HuffPost then reported that the minister had denied patients were refused hospital stays, Fullerton’s former press secretary said the story was wrong and suggested other headlines that she would prefer HuffPost publish. (HuffPost declined to change the headline but added an update to the story.)
Caputo said Monday that hospitals are forbidden from turning away any patients whose lives could be in danger without their care. She also said long-term care homes must admit residents to hospital “when clinically required” and with the resident’s preference taken into account.
Accused of ‘playing a callous numbers game’
Other talking points that the minister has relied on paint an incomplete picture. This fall, Fullerton cited the percentage of homes that did not have outbreaks as proof of her government’s success in handling the pandemic. But she didn’t include homes where only staff had tested positive.
But some outbreaks that started with a single staff case quickly spiralled out of control.
Tyndall Nursing Home in Mississauga, Ont., for example, had one staff case on Nov. 5, according to the ministry. Two weeks later, 180 staff and residents had the virus and 17 people were dead. The death toll there is now 33 people.
After Fullerton’s comments Nov. 16, the Ontario NDP accused her of “playing a callous numbers game” that “downplayed” the situation.
“Using these cold, manipulated statistics to justify the Ford government’s lack of action is inexcusable.”
“So far, 2,145 residents of long-term care have died of COVID-19 in Ontario. More than 250 of those people have died in the second wave, and hundreds more are already infected,” MPP Teresa Armstrong, the NDP’s critic for long-term care, said in a press release.
“They are in pain. Their families are terrified and devastated. Using these cold, manipulated statistics to justify the Ford government’s lack of action is inexcusable.”
Caputo did not respond to questions about why the minister excluded these homes from her statistics and whether that downplayed the danger people were in.