Globe editorial: Canada has to fix what ails the country’s nursing homes

It takes a lot to surprise a Canadian soldier. They’re trained for the worst, so when they’re thrown into something that shocks even them, it must be bad.

Which is why two military reports on the conditions encountered by troops seconded to long-term-care facilities in Quebec and Ontario this month carry such weight.

Sent to homes with high COVID-19 infection rates, they were left stunned by everything from the inhumane treatment of residents, to absenteeism, to the theft of personal protective equipment and drugs.

The worst abuses were in Ontario, where more that 300 Canadian Armed Forces personnel were deployed to five hard-hit homes. In Quebec, where 1,484 CAF personnel are assisting in 23 homes, soldiers found no abuse but were taken aback by the dysfunction they saw.

The revelations have struck the country like a thunderbolt. On Wednesday, Prime Minister Justin Trudeau called them “deeply disturbing." Ontario Premier Doug Ford called them “gut-wrenching.”

Mr. Ford also said his government would take over management of the five Ontario homes mentioned in the military report, and that a commission on the state of the province’s long-term-care system would begin its work in July.

But even before these revelations, Canadians already had reason to be alarmed. It’s been known for weeks that 81 per cent of COVID-19 deaths in Canada involved residents of long-term-care facilities. Nearly all of those deaths are in Ontario and Quebec.

An Angus Reid poll of 1,777 adults conducted May 18-19, before the military reports were made public, found that 66 per cent of Canadians believed that long-term care should be brought under the Canada Health Act.

In considering all this, there are two distinct issues: The management, and mismanagement, of many long-term care facilities during the pandemic, and the state of those facilities in “normal” times.

COVID-19 has preyed on seniors in homes because of obvious vulnerabilities. The combination of ill-trained staff, many underpaid and moving among facilities; the advanced age and underlying health issues of many residents; and close living quarters were a recipe for disaster. The dangers were known, and in many cases not properly prepared for.

Governments – particularly Ontario and Quebec – clearly need to do a better job of inspecting homes, and insisting on (and paying for) better levels of staffing, training and equipment. They also need to do a better job of quickly locking down LTC homes when a virus breaks out. On that last point, the exact opposite often happened, again especially in Ontario and Quebec.

When the pandemic hit, many seniors in hospital were hastily transferred to LTC facilities to make room for an expected surge of COVID-19 patients. That exacerbated the crowded conditions in these facilities, and may even have brought the disease through their doors.

Some provinces managed better, and got better results. British Columbia had the first nursing home outbreak, yet its numbers of cases and deaths were kept relatively low.

Better funding for long-term care, to allow for more and better staffing, training and facilities, makes sense. So does tough regulation and inspections. We’re less sure about nationalizing all LTC facilities. There have been deaths in homes run by large for-profit companies, non-profit groups, and governments. They have happened in small towns, and in cities. Companies with multiple homes have seen outbreaks in one home, and not in others.

What is telling, however, is that the most serious outbreaks have been confined to Canada’s two largest provinces: Quebec and Ontario.

Eighteen per cent of homes across the country have had outbreaks, according to the National Institute on Aging, which has been tracking the disease in LTC facilities. But those figures are driven by two provinces. Of the 16,791 cases of COVID-19 among Canadian LTC residents, nearly 16,000 are from Ontario and Quebec.

The shocking scenes recorded by Canadian soldiers, and the massive death rates in two provinces, demand a response. Even before COVID-19, Canada’s long-term-care sector was ill. That has to be addressed. But in doing so, governments must be careful to distinguish symptoms of the pandemic from the sector’s many pre-existing conditions.