On March 1, 2021, Atin Ito Publisher Leonardo Santos had a very candid, interesting and revealing discussion with Ontario’s Long Term Care Minister Merrilee Fullerton.
Atin Ito requested to interview her after an announcement was made on February 24 by her and Premier Doug Ford on the province’s historic campaign to accelerate training for up to 8,200 Personal Support Workers (PSW’s) to be ready to work in Long Term Care by the fall.
- Ontario Invests in Historic Campaign to Accelerate Training for Personal Support Workers
- A better place to live, a better place to work|: Ontario’s long term care staffing plan
- Ontario investing $52.5 million to recruit, retain and support more health care workers
- The Long Term Care Homes Public Inquiry Final Report
The pandemic has revealed a number of issues that affect senior care not only in Ontario but in many parts of Canada as well. Minister Fullerton addressed a good number of the issues that had been publicized as well as those that may need more attention.
ATIN ITO: Good afternoon Minister Fullerton and thank you very much for joining me today.
MF: You’re very welcome and thank you very much for your interest.
ATIN ITO: Last week, you announced that the government was investing $115 million for training of PSW’s for long term and home care. Would you care to share additional information on that?
MF: Absolutely. It is for training for PSW’s for long term care and also for the home care community as well. It is for 8,200 in total, 6,000 positions for new PSW’s and 2,200 for PSW’s that are in the programs already. And it’s for all the 24 Ontario Public Colleges across the province and it is a total of a 24 week program. The first 12 weeks is for in class training with some exposure to long term care homes so they get a concept of what it is like in the long term care environment. And the next 12 weeks are for work placements. For the 6,000 PSW that are starting new and are starting in April so coming very soon, they’re eligible for about $5,000 in terms of support for cost. Basically, it is a scholarship. And for the 2,200 that are already in a program like this, they’re eligible for roughly $2,000 in support. And this is all a grant from the government. And so it’s a fully funded program and they’re receiving the grants, they don’t have to pay them back and a total of 24 weeks. So it’s a rapid training program with what we call experiential learning. So that they get into the homes early, understand what it is, understand what it’s like and so that if it’s not for them, they can decide early. But if it’s something that they’d like to continue then they can and they will be provincially funded with those dollars I mentioned.
ATIN ITO: It’s a worthwhile investment for sure but does it fully address the shortage in PSW’s for long term care homes?
MF: That’s a very good question. That echoes back really to our monumental commitment of $1.9 billion that we’ll be putting in by 2024 to 2025 but we’ve already started this year putting dollars in to our staffing plan. And that staffing plan was created in part and advised on by our expert panel that was advising on the staffing that we needed. And so when we look at the 8,200 that we’ll be creating in this program, we know that this is just the beginning because we need about 27,000 new positions in long term care to meet our commitment to 4 hours of care, on average of direct care per resident per day. And that goes back to the $1.9 billion by 2024 to 2025 that I mentioned. So if we’re going to increase the hours for resident care, then we also need to have more staff even above what we need to stabilize the sector right now.
ATIN ITO: So this is one of the steps that are being undertaken to be able to address the shortage in staffing?
MF: Yes, you’re right it’s the longer term. So what we did initially was to address the emergency crisis that we had with Covid, re-deploying people from hospital, making more flexible arrangements so employers could find people to fill the positions, making sure that we had what we called the resident support aid and looking at all the different measures that we took initially for the emergency response and then the stabilization was looking at making sure that we could retain people with the pandemic pay and then the temporary wage increase. And now this is the longer term strategy for an aging population we absolutely need this and more and so this is the start.
ATIN ITO: Since you mentioned Covid-19, the long term care homes were the most adversely affected by the pandemic particularly by the number of infections and even deaths that had occurred at the start and ongoing during the pandemic for several months till the lockdowns, reopening and lockdown again, the second wave and maybe a third wave, hopefully not.
MF: Hopefully not. It’s been a very trying time. Long term care homes have been on the frontline not only in Ontario but across Canada. Except for the Atlantic provinces which have not been hit hard but have also had outbreaks and around the world. And you know, these are the most vulnerable citizens that countries have. And so long term care homes have been hit hard across the world. I really want to thank all the personal support workers, our nurses, our doctors, everyone who has been on the frontlines, helping our homes, and our hospitals came in to help with the staff, the medical officers of health, public health, the community paramedics, all the PSW’s who have been working so hard. It truly has been heartwarming to see the commitment and the dedication that personal support workers particularly have shown in the face of Covid-19. Just amazing and I want to send them my gratitude.
ATIN ITO: The pandemic has revealed some issues relative to long term care in the country. In fact, there is the Long Term Care Covid-19 Commission that you were recently referenced to as far as your notes were concerned as early as February 5th 2020. Would you want to share some of the insights that you had relative to what the transcript contained as far as the commission was concerned?
MF: First of all, it was of great help to be able to have the commission. I know it’s something people wanted to understand what happened. And we got 3 very credible commissioners who have listened to people, whether residents or family members or staff or labour groups or advocacy groups. They have been listening for months now and really it was very important for me to have that opportunity and I really appreciated that. The insights we look back on and we say okay, what would have helped the situation? Certainly, it would have been to have those older buildings, those buildings built in the 1970’s bought up to date. The previous government simply did not build many homes during its tenure. And if we look at places like B.C., they did better. They only had 24% of their long term care homes that were 4-bed ward rooms. In Ontario, it was 63%. So we had almost 3 times as many ward rooms. And those are the rooms with 4 people to a room. And that was the old 1970’s homes that had that. And so our government committed right from the beginning to a $1.75 billion commitment to redeveloping the long term care homes. We committed to 15,000 new beds in 5 years and 30,000 new beds in 10 years. So we knew that there was a tremendous amount of work to be done and so we started well before the pandemic but certainly, other places like B.C. had kept up over the last 10-15 years and Ontario had not. It’s the same with the staffing. When we looked there was a staffing crisis leading into the pandemic and we were trying to address that before Covid-19 hit. Using the Justice Gillese inquiry recommendations, we implemented a staffing study through an expert panel that advised us and as soon as they provided their report, we started to act on that as well. And so the staffing and the older buildings were major problems going into this but worldwide, the world is coping with a shortage of tests, a shortage of PPE’s as we all know and those had an impact in the first wave.
ATIN ITO: I understand that you’ve taken a lot of action even before the commission began its work interviewing various resource persons as far as care homes are concerned. But you have been referred to in particular as one of those who had anticipated very early on at the start of the pandemic that you were very concerned about asymptomatic spread. Why is there a notion that the government didn’t do enough at the start to try and avoid perhaps transmissions as well as deaths?
MF: Well in hindsight. You know I think hindsight is 20:20 as the expression goes and if I dig back into that time, nobody really understood how it was transmitted. You know there were anecdotes. And that was where I was getting my information. I was trying to understand what was going on Italy, Spain, China and elsewhere. But there was no specific research or evidence at that time and so all the public health experts, all the scientists, the chief medical officers of health. They were all trying to collect and gather information, specific information that would have provided them with a path forward. And it was very much a collaboration with the federal government as well. And that certainly was my understanding. So my role as Minister of Long Term Care did not put me at any public health tables. I was not an expert in public health. I was not an expert in the science. It was simply evolving and in my role, we were following the advice of the experts and all the people working so hard to understand this virus. So I was a family doctor, almost 30 years and certainly understood the importance of doing everything we possibly could to keep our residents safe and the science just wasn’t there.
ATIN ITO: Okay. Thank you for clarifying that. The other issue that had been discussed are the cases of the “For Profit” long term care homes that seemed to have fared worse than the non-profit or the municipality run care homes. Would you care to elaborate further on that?
MF: If we look back at a study that demonstrated this. It was the age of the home that was a prime driver of the severity of the outbreak. And the community spread or the number of cases of Covid-19 in the public health unit around the home was the prime driver for the outbreak in the first place. And if you look back, you can see that many of the for profit homes were not given approval to redevelop under the previous government. And so they had homes of the old standards and we know those 4-bed ward rooms were in those older homes and that was a big problem which we acknowledged very early as a government but you can’t just rebuild instantly these homes. And that is something we are endeavouring to do now, creating more modern long term care homes, accelerating the builds. There are 4 homes that are going up on 3 hospital properties to make almost 1,300 beds in the Toronto area. We know the urgency here but also doing programs like the community paramedic program where people can be managed in their homes longer with community support and home care. And so a lot of people do want to stay in their homes longer. So that is an important program. But if we look at the for profit, it isn’t whether it is or is not for profit or municipal. Ultimately we need many solutions and the for profit homes I think if you look at the background, the age of the home, and their location and the number of Covid-19 cases in the area explained a lot of things as to why they were hit so hard.
ATIN ITO: So, the government is taking action to address those?
MF: Yes. That’s my line (very comely laugh and smile). Absolutely and we’ve been doing that since the very beginning. It’s a campaign promise back in 2018. And so as soon as the Ministry of Long Term Care was created, we needed to understand what the hold-up was, what was taking so long. So we developed a modernized funding model to address regional differences. For some reason, the allocations had gone out but the homes weren’t being built and so we had to take some time to understand that. Once we did, we were able to get homes up and running and we have about 10,000 new homes that are in the queue right now, starting to be built and we have another 12,000 in redevelopment. And so, it’s a very important program. But we do need to address keeping people in their homes longer as much as they want and as much as can be managed. It’s a combination of efforts and the staffing. Between the staffing are $1.9 billion, the long term care redevelopment, $1.75 billion, the community paramedics and the IPAC or the infection prevention and control measures that are so important for our long term care homes, getting people trained in infection prevention and control and the specialists who give advice. We’ve created hubs to be able to provide advice to the homes. And that expertise is also in short supply. For this announcement, the scholarship fund for PSW’s. We understand how important it is to be able to support them in this process and to be able to give them training so they can feel competent, informed and trained and to provide support for them in the long term care homes as we come out of this. Hopefully, there isn’t a third wave. But we’ve also brought in the specialized care center to help homes that might feel that either they don’t have enough staff or they feel overwhelmed by cases in the past. All our case numbers are very good today. Things are doing much, much better. Thanks to the vaccine I believe.
ATIN ITO: Another issue that has cropped up relative to care for seniors are for those PSW’s who work in the homes of the seniors. In fact, I interviewed Roman Baber (MPP for York-Centre) in early December and he filed the caregiver and home worker protection act of 2020. He was basically alluding to abuses that are not reported for PSW’s who are caring for seniors at home ranging from non-payment to actual physical and even sexual abuse in some cases. What will the government do about this?
MF: Certainly from the Ministry of Long Term Care perspective, there’s absolutely no tolerance for anything like that. Home care is under the Ministry of Health so that is not something the Ministry of Long Term Care manages but there is no tolerance for this and it speaks to the importance of making sure that the proper training is done, making sure that our inspections are robust and I should mention there that public health units do inspections in our long term care homes. The Ministry of Labor does inspections as well and our inspectors are in homes as well to make sure that the scrutiny is there. And certainly, we think that there is need to look at the inspections as we go forward to make sure that they’re supportive of the residents, to make sure that their residents are at the center of these inspections and so we are looking at all these measures to modernize the long term care sector.
ATIN ITO: Well, it seems to be multi agency effort and solution that needs to be undertaken to address this issue very carefully because a lot of these people belong to visible minorities and sometimes are not even permanent residents. They are on work visas and they think they have a path toward permanent residency (and even citizenship) and this somehow prevents them from reporting these abuses and therefore, the legal processes don’t take place.
MF: Well, we need to make sure that everyone knows that there is a family support and action line that anyone who has concerns, things that they’re worried about in the home, can call. They can call that action line and one of our inspectors will address that and they do go out and assess those. Sometimes it requires a visit. Sometimes it requires conversations with the people involved. But what inspectors activated at that point take these matters extremely seriously. What we want to do in long term care is to make sure that these problems are brought to light and that we address them. And so it’s very important to me as the Minister of Long Term Care and it is something we’ve been working on to improve.
ATIN ITO: I wish we had more time. I know you have very limited time Minister but before I let you go, would you care to give some closing remarks? I’d love to have another session with you on these things.
MF: I would love to do that. I just really appreciate your interest because long term care has really been neglected for many, many years. I am a family doctor for many years, retired now but I was a family doctor for almost 30 years and so this problem is long standing in long term care. We need to make sure that long term care is integrated with the acute care sector and integrated with the community and we need to redevelop and modernize long term care so that our residents are at the center, our staff are supported and not only trained but retained. And so this is a step forward with this accelerated PSW scholarship program and I am just very grateful that you’re interested and appreciate that.
ATIN ITO: Yes very much interested Minister. Not only as a member of media but also relative to the visible minority communities that are somehow involved in the care for seniors and other residents in the country.
MF: Yes and that’s such an important point because this program really provides the experiential learning and we need diversity and I think it’s so important for PSW’s of diverse backgrounds and diverse ethnicity to be able to participate in this. We didn’t want any barriers to getting into this program and I hope you’ll spread the word and thank you.
ATIN ITO: We most definitely will and thank you very much once again for your time Minister. Have a great day!
MF: Have a great day too. Bye.
Publisher’s Note: Atin Ito welcomes any reactions, any other relevant information and submissions from all interested parties regarding the contents of this article. Please email us at info@AINewsMediaOne.com.
About Minister Merrilee Fullerton
Dr. Merrilee Fullerton is a medical professional who has spent her career helping people in her community. She was elected in 2019 and is a Member of Provincial Parliament for the riding of Kanata-Carleton. In June 2019, she was asked by Ontario Premier Doug Ford to serve as Minister for Long-Term Care.
A graduate of the University of Ottawa Medical School, Merrilee practiced locally, first serving out of the Carleton Place Hospital and then as a family physician at Med-Team Clinic in Kanata. Dr. Fullerton has been very active in professional medical associations and local health care organizations, including advisory roles with both the Ontario Medical Association and Canadian Medical Association, and membership in the City of Ottawa Board of Health and the local LHIN serving Ottawa and area. She is a constant advocate for better universal health care services, particularly long-term care service.
About Leonardo Santos:
Leonardo Santos is a graduate of the University of the Philippines with B.S. Industrial Engineering and Master of Business Administration (MBA) degrees. He has had a number of professional and leadership roles in a number of IT and Telecommunications companies in the Philippines prior to becoming a Permanent Resident of Canada.