Peel Region gets half the long-term care funding compared to some areas of Ontario
When representatives from municipalities across the province mingled with provincial ministers at the 2019 Association of Municipalities of Ontario conference in Ottawa, no one in the room knew the next conference would be virtual.
During the gathering, Christine Elliott, Ontario’s health minister, announced public health units would transition to a new funding formula in the coming year. It meant Queen’s Park would only provide 70 percent of a region’s healthcare costs while municipalities had to cover the remaining 30 percent, a change from the prior 75/25 funding model.
According to Peel Region’s 2020 budget, there had been plans to change the funding model to 60/40 in 2021. But that increase in dollars from provincial taxpayers is currently on hold.
Minister of Health Christine Elliott
The situation in Peel’s long-term care and retirement home sector, like much of Ontario, has been dire since the beginning of the pandemic. Of the 625 deaths due to COVID-19 in Peel since the start, 411 were LTC or retirement home residents.
The five facilities run by the Region of Peel have fared much better than the other homes in the sector. Twelve of the 411 deaths involved outbreaks at the five facilities run by the Region. Residents in many private, for-profit facilities, which have failed to provide a reasonable standard of care, have been devastated by the pandemic.
Camilla Care Community, a private facility in Mississauga owned by Sienna Senior Living, accounted for 74 resident-deaths due to COVID-19.
But the standard of care in the Region’s five facilities is now being jeopardized and concerns over inadequate funding from the Province are being raised while the elderly care sector is in crisis.
The Region of Peel operates Peel Manor and Tall Pines in Brampton; Malton Village and Sheridan Villa in Mississauga; and Davis Centre in Caledon.
More than 400 residents of long-term care in Peel have lost their lives to COVID-19. The vast majority of them lived in private, for-profit homes.
The new funding model announced in 2019 was not a good sign for the Region of Peel, which receives public health dollars through the Central West Local Health Integration Network (LHIN) which includes Brampton and Mississauga Halton LHIN, the two worst funded LHINs in the province. Funding goes toward hospitals, community care programs and long-term care homes.
The Pointer obtained 2020 funding figures for long-term care from the Province and they do not bode well for Peel.
Central West LHIN received the lowest funding in Ontario for LTC homes in 2020, at $170 per resident, and Mississauga Halton LHIN received the second lowest, at $176.
The South East LHIN, which includes Kingston, Quinte, Lanark and Grenville along with other municipalities, tops the list, at $404 per resident for LTC, more than twice the per capita amount Peel’s two LHINs received for long-term care. The North West LHIN received $363.60 of funding for LTC per capita in 2020 and nearby Hamilton Niagara Haldimand Brant received $362.34. (Figures were not provided for two LHINs, Waterloo Wellington and North East.)
Discussions on LTC homes during the Region’s 2021 budget deliberations put funding centre stage. Nancy Polsinelli, Peel’s commissioner of health services, said the cost to deliver aid in its five LTC homes is increasing, but the amount of money the province is providing is not following suit.
The region’s taxpayers are contributing $102.74 million toward operating costs to maintain the current level of service. Despite the impact of the COVID-19 pandemic, there has been no increase to full-time staffing at the five homes. Only 742 full-time staffers, just like the previous year, will be part of Peel’s LTC team. A regional spokesperson told The Pointer 410 of the staff members are nurses and personal support workers (PSWs).
Regional staff had to work just to keep this number from going down. In April, Premier Doug Ford banned PSWs from working in more than one home to slow the spread of the virus. It led to 14 percent of Peel’s full-time staff leaving their LTC positions, creating a shortage.
The spokesperson said 67 regional employees were redeployed to the five homes. Through funding from the Province’s safe restart agreement, the Region also hired 37 contract staff on a two-year term. None of these new hires are PSWs or nurses. The spokesperson said the individuals will help with screening, activities, housekeeping and inventory management within the homes.
“The staffing within our long-term care homes is regularly monitored and assessed, and we will continue to make adjustments as required to meet the needs of our residents. If the need arises for additional staff, based on the need and position, we will consider redeployment of municipal staff or hire more temporary staff utilizing additional funding from the Ministry of Long Term Care,” the spokesperson said.
Maintaining staffing levels comes as the demand for LTC homes in the region increases. In total, 994 people were on the wait list for four of Peel’s five LTC homes in June 2019. As of October 2020, the waitlist had increased to 1,172.
Staff have also been brought over from the Region’s Adult Day Services program to work in LTC homes. The day program works with seniors in the community who aren’t ready to move into congregate care settings but require assistance with day-to-day activities and to prevent them from suffering a range of damaging conditions due to social isolation.
“Managing complex care increasingly dominates this work. More than half of the people who come to Peel’s day programs have dementia or some type of cognitive impairment. Close to three quarters of the program’s clients need intensive support, such as medication management,” Polsinelli said.
The in-person program has been on hold since March of last year due to the pandemic and is being temporarily replaced with a virtual program. Like LTC homes, the demand for this program continues to increase as well; 420 people are currently on the waitlist. The 2021 Peel budget does not propose any new services or staff members for the program, putting blame on the provincial government’s lack of funding for the inability to grow the much used resource.
Many of Peel's programs that help seniors living with dementia or other medical issues have been significantly altered as a result of COVID-19.
“Increased investment in community support services, including programs like our Adult Day Services program, will support seniors and their caregivers, allowing them to age in place for as long as possible,” the regional spokesperson said. The Pointer asked the Ministry of Health about funding for the program but did not get a response ahead of publication.
Polsinelli indicated the problems don’t stop with the pandemic. Once the world starts to see a consistent level of normality, funding issues will still exist. The Region has submitted a presentation to the LTC COVID-19 Commission, speaking to the ongoing pressures the sector has faced and how they can be addressed.
One of the recommendations is to increase support for person-centred care. “The Province needs to prioritize the emotional wellbeing of people living in long term care homes to enable health service providers to improve quality of life outcomes for seniors,” the presentation states.
In order to implement this, Region of Peel staff recommend the Province re-evaluate the funding model for residents with “responsive behaviours,” a term that describes actions or words people with dementia use, to ensure funds match up with staffing resources based on needs that must be addressed.
Krystle Caputo, the press secretary for Merrilee Fullerton, Minister of Long Term Care, pushed back against suggestions that her government has not provided adequate LTC funding, telling The Pointer the ravaging of LTC homes was due to the previous governments. “We have provided PSW wage enhancement programming that has enabled homes to hire over 8,600 frontline workers…Our government is fixing a broken system and making long-term care a better place for residents to live, and a better place for staff to work.”
A week ago, Fullerton came under fire after her testimony before the Long-Term Care COVID-19 Commission was released, revealing she had failed to push for increased safety measures inside LTC homes early in the pandemic, despite her own concerns. The transcripts of her testimony show Fullerton made her concerns clear to her government, but she did not go public with them and retreated when the PCs, led by Premier Doug Ford, would not put stronger measures in place to protect seniors, despite Fullerton’s suggestions.
Ford and his government have faced heavy criticism for the lack of funding to hire PSWs, for his protection of private companies in the sector through legislation that would blunt the ability to sue those who neglected their responsibilities and for failing to enforce safety standards in LTC and retirement homes even after the crisis revealed alarming practices inside dozens of facilities.
According to new research by the National Institute on Ageing, more deaths and positive cases in Ontario among staff and residents have been reported in the second wave compared to the first.
Out of the 1,396 care homes in the province, 408 have been affected by the second wave of the virus, compared to 479 homes in the first wave. Yet the second wave has seen 2,225 resident-deaths, compared to 2,072 in the first wave.
Critics, including the Opposition NDP, accuse the PC government of failing to act after the first wave laid bare what was happening in LTCs across Ontario.
Currently, 13 homes within the region have ongoing outbreaks. Peel Manor, Tall Pines, and Malton Village, three facilities owned by Peel Region, are on the list. Sheridan Villa and The Davis Centre, the two other LTC homes run by the Region, resolved their last outbreaks in January.
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