As the parliamentary assistant to the Minister of Long-Term Care, I want to speak about the proposed amendments to the Fixing Long-Term Care Act, 2021.

To respond to the challenges currently facing the health system, our government released the Plan to Stay Open: Health System Stability and Recovery. This plan includes a suite of changes and an additional $37 million this year, and $62 million annually moving forward, to help ensure Ontarians are getting the right care in the right place and to help avoid unnecessary hospitalizations.

This funding includes: $20 million to create a new local priorities fund, delivered by Ontario Health, to support timely interventions based on community needs; a $5-million boost to Behavioural Supports Ontario so the program can increase specialized staff and access to therapeutic supplies and equipment; $2.6 million for the Baycrest Virtual Behavioural Medicine program—these are just some of the funding investments included in the plan.

The plan also includes the proposed amendments to the Fixing Long-Term Care Act that I’m here to detail today. Because we are acting now to secure the stability of our health system, it is paramount that we maintain stability as we continue our recovery and are faced with new challenges moving forward.

Our current challenges will not be new to anyone here. We all know much of the focus over the last few months has been on hospital emergency departments, and rightfully so. However, emergency departments are a part of a much larger health system. Long-term care is a critical part of this system as well. There are actions we can take now to address these challenges—actions that will help us to avoid overstraining the health system and establish better models of care.

One of the main ways to help with hospital capacity challenges is to ensure that patients are getting care in the appropriate setting. There are many patients in hospitals across the province whose care needs could be met elsewhere, for instance, in long-term care—alternative-level-of-care patients, ALC. There are now approximately 6,000 ALC patients in this province. Approximately 39% of these people would be better served in long-term care. Moving patients out of the hospital and into long-term care frees up much-needed space in hospitals for patients who require hospital treatment. This also benefits the ALC patients since they are being moved to a more appropriate setting where they can receive the care they need.

That’s why, as part of our plan to stabilize the health system, I’m seeking to amend the Fixing Long-Term Care Act, 2021, in order to improve how we transition ALC patients to long-term-care homes, because our priority is for people to live and receive care where they can have the best possible quality of life, close to their family and friends.

In hospitals right now, there are currently about 1,900—when this bill was first introduced; this number has grown—ALC patients waiting for long-term care. Some of these patients have been waiting for more than half a year, even though they no longer require hospital treatment. This contributes to backlogs in acute care services in hospitals because they occupy beds that other patients urgently need. When they cannot be discharged, these patients continue to receive care but in the wrong setting: an acute care setting instead of a long-term-care-home setting. The hospital is not the appropriate place for them to be.

That is why I am putting forward proposed amendments that, if passed, would allow us to continue conversations with ALC patients and support the movement of some patients to temporary care arrangements in long-term-care homes while they wait for their preferred home. It is important to note that this would only apply to ALC patients who are eligible to receive, and would benefit from, care in a long-term-care home but who are either waiting in hospital for their preferred long-term-care home or do not wish to apply to a suitable long-term-care home. This would only happen after conversations with a placement coordinator and after efforts have been made to obtain consent. By allowing a placement coordinator to assess and authorize an ALC patient’s admission to a long-term-care home without their consent—and we were just talking about assessment—this amendment will, if passed, enable attending hospital clinicians to discharge patients from the hospital to a more appropriate care setting that better meets their needs.

These changes, if passed, may be met with some concern at first—certainly I had concern at first when I initially started to read it—and there may be initial barriers to implementation. But parameters within the changes will help ease these concerns, as they did for me.

One of these parameters is that the home must be within a specific distance from the patient’s preferred location, including that it is near a partner or spouse, loved ones and/or friends. I would like to repeat that one: One of these parameters is that the home must be within a specific distance from the patient’s preferred location, including that it is near a partner or spouse, loved ones or friends. Another parameter is the requirement that the long-term-care home must be able to meet the ALC patient’s care needs, whatever these needs may be. In addition, field guidance will be developed to support implementation and promote ongoing conversations with ALC patients, which will encourage consent and choice.

Long-term-care placement coordinators will be encouraged to make ongoing efforts to re-engage with patients who have not consented at frequent points throughout the placement process. At any stage in this process, patients can change their minds and consent, or choose an alternative care option.

Furthermore, hospital patients who have applied to live in a long-term-care home but have been moved into another suitable home temporarily will remain on the wait-list and be prioritized to be permanently moved once a bed becomes available at one of their preferred homes. So, again, people that are moved into a suitable home temporarily will remain on the wait-list and be prioritized to permanently move once a bed becomes available at one of their preferred homes. They do not lose their place in the queue. They can also choose to remain permanently in the initial home that they are moved to. Change is hard. They may like their temporary home. The changes will also recognize the importance of partner and spousal reunification in long-term care.

These proposed legislative amendments will, if passed, reduce ALC patient volumes and support their movement out of hospitals now and in the future. This change is crucial because it would help ensure that patients who need hospital treatment can get the emergency treatment, surgeries and other hospital services they need when they need it. At the same time, it would make sure that ALC patients receive care in a more suitable setting that will offer a better quality of life while they wait for their preferred long-term-care home, moving from being a patient in a hospital unnecessarily to being a resident in a long-term-care home which meets their care needs.

The Ministry of Long-Term Care is also taking several other actions that will ease the strain on the health system. These include the following:

—opening up long-term-care beds that no longer need to be held for pandemic-related isolation purposes, through a minister’s directive put into effect on August 23, 2022;

—reactivating long-term-care respite programs for high-need seniors to prevent possible hospitalizations;

—expanding specialized supports and services to support movement out of hospitals and to avoid entry into hospitals; and

—enabling community partnerships to provide more supplies, equipment and diagnostic testing in long-term-care homes, to prevent potential hospitalizations.

These interconnected actions, along with the proposed changes to the legislation I detailed earlier, will help reduce the number of ALC patients in hospitals and ease the strain on hospitals now and in the future. This will, in turn, reduce the risk of a hospital bed shortage at the peak of a potentially challenging flu season and possible COVID-19 wave in the fall and winter.

This proposed amendment is part of a broader strategy from our government to ensure recovery and stability in the Ontario health system. As always, our government is working hard both to help Ontarians stay healthy and to ensure that the appropriate level of care is available when it is truly needed. The goal is to ensure that Ontario’s health care system is stable and strong so that Ontarians can count on the system today, tomorrow and moving forward.

Ensuring that the long-term-care sector is stable and that residents experience the best possible quality of life, supported by safe, high-quality care, is a priority for our government. That’s why, at the end of last year, we introduced the aforementioned Fixing Long-Term Care Act, 2021. This landmark piece of legislation was proclaimed into force on April 11 and speaks to our government’s ambitious plan to fix long-term care in Ontario. This plan centres on three key areas: building modern, safe, comfortable homes for Ontario seniors; improving staffing and care; and driving quality through better accountability, enforcement and transparency. We’re taking action and making progress under all three of these areas.

When it comes to building homes, for instance, we have made historic investments. We have invested $6.4 billion to build 30,000 new and 28,000 upgraded long-term-care beds. We are making incredible progress on these projects and already have more than 30,000 new and 28,000 upgraded long-term-care beds in the development pipeline.

The fact that we have already reached our targets is made even more impressive concerning the supply chain and other issues that have affected the construction sector in the last couple of years. Of the 365 projects that are in the pipeline, 115 projects have proposed to be part of a campus of care model. This model focuses on healthy seniors’ living and integrating the long-term-care home into the broader health care system.

Additionally, with the redevelopment of older homes, the prior system of three- to four-bed ward rooms is being eliminated and all homes will now be up to modern design standards.

We also recognize the diversity of our aging population. That’s why 39 of the announced projects have proposed to serve Ontario’s francophone population and 30 have proposed to serve Indigenous communities. The progress we are making and the bed allocations we are announcing on a monthly basis are just what this province needs. We are building beds for our loved ones in the communities that they call home.

We also marked the sales of unused government properties to build new long-term-care homes in Etobicoke, Hamilton and Mississauga. These sales are part of the surplus provincial lands program. The program uses the sale of unused government properties to secure much-needed land for building long-term-care homes in large urban areas of the province where available land is costly and difficult to secure. The program opens the door for additional uses for unused land, such as affordable housing and recreational facilities.

Another innovative program we have created to build is the Accelerated Build Pilot Program. In February of this year, we celebrated the completion of the first brand-new long-term-care home built under this program.

Of course, when building new and upgraded homes, it is vital to ensure that there are enough staff to provide care within the homes. That’s why strengthening staffing is a key part of our government’s plan to fix long-term care. When it comes to staffing, our central commitment is to increase the hours of direct care provided by registered nurses, registered practical nurses and personal support workers. We aim to increase it from the 2018 provincial average of two hours and 45 minutes per resident per day to a system average of four hours per resident per day over four years. To achieve this ambitious target, we are investing up to $4.9 billion by 2024 to help create over 27,000 new full-time positions for registered nurses, registered practical nurses and personal support workers in long-term care. This includes a commitment to invest $1.2 billion and $1.8 billion for staffing increases in the 2023-24 fiscal years, respectively.

In addition, this funding will support a 20% increase in direct care time by allied health professionals, including physiotherapists and social workers by March 31, 2023. The focus must always be on the residents and providing them with the care they want and need. To build this culture, the ministry will continue to engage with residents, essential caregivers and families to understand what quality of life and quality of care means to them.

We’ve already taken many steps this year to achieve our ambitious staffing goals. This year we are providing $673 million to long-term-care homes to hire and retain up to 10,000 long-term-care staff. This is a major investment that will lead to more direct care for residents. We will continue to do what is needed to ensure that there are enough staff in long-term care to meet our target of providing a system average of four hours of daily direct care per resident.

In addition to all of the progress we are making on long-term-care staffing and capital development, we’re also making progress to drive quality in long-term care. We are achieving this through instituting better accountability, enforcement and transparency in the sector. A key factor in driving quality is the inspections system. The inspections system exists to keep residents safe, and the ministry continually assesses information and reprioritizes inspections daily based on harm or risk of harm to residents. As part of the work to fix long-term care and ensure long-term-care residents’ safety, our government is investing an additional $72.3 million over three years to increase enforcement capacity. This will allow us to hire 193 new inspections staff, which will double the number of inspectors across the province in the 2022 fiscal year. This will make Ontario’s inspector-to-long-term-care-home ratio one of the highest in Canada.

With these new inspectors, we will have enough inspectors to proactively visit each home every year, and proactive inspections will be conducted alongside the continuation of reactive inspections, which are the best way to promptly address complaints and critical incidents. Some of the province’s new inspectors will have an investigative background, and this will ensure that the inspectorate have the skills and certification needed to investigate and lay provincial offence charges when warranted.

The new proactive inspections program adds to the current risk-based program of responding to complaints and critical incidents. The program also takes a resident-centred approach by allowing for direct discussion with residents, so that the focus is on their care needs, as well as the home’s program and services. The results from proactive inspections will help the government determine where the sector can benefit from additional resources, including guidance material and best practices.

Our government has also created and expanded the innovative Community Paramedicine for Long-Term Care Program. Ontarians who need long-term-care services frequently report that they prefer to remain in their homes for as long as possible. Our government listened by launching the Community Paramedicine for Long-Term Care Program to help seniors remain stable in their own homes, while also providing peace of mind for their caregivers.

This program was announced in October 2020 for five communities, with a total commitment of $33 million over four years. The program was then expanded to additional communities with a further commitment of $137 million over four years, and last fall we announced that we were investing another $82.5 million over two and a half years to expand the existing Community Paramedicine for Long-Term Care Program to an additional 22 communities. This final expansion made the program available to all eligible seniors across Ontario.

The program provides individuals eligible for long-term care and soon to be eligible for long-term care with 24/7 access to non-emergency support through home visits and remote monitoring. The program also leverages the training and expertise of paramedics in a non-emergency capacity, to help seniors and their caregivers feel safe and supported in their own communities. This has had the added benefit of potentially delaying the need for care in a long-term-care home.

As of this summer, there are more than 23,000 individuals receiving care through the Community Paramedicine for Long-Term Care Program. This is yet another action we are taking to help maintain the stability of our health care system while ensuring that Ontarians receive the care they need and deserve.

It is extremely important to our government to hear from the people within long-term-care homes when moving forward with our plan to fix long-term care. That’s why we’re always connecting with residents, essential caregivers, families and long-term-care staff, including registered nurses, registered practical nurses and personal support workers. The feedback and insights that we receive from people on the ground in long-term care are invaluable and help shape the solutions and directions of our government. This will continue to be true moving forward, as we continue to innovate and evolve in long-term care and in the broader health system.

For the reasons I mentioned at the beginning of this speech, this is a critical time for action in Ontario. That’s why we’re doing everything we can to fix long-term care and to ensure that our broader health care system is stable. That’s why I’m here today, joined by Minister Calandra, to put forward proposed amendments to the Fixing Long-Term Care Act. Through these proposed amendments and the other actions we are taking, our government is taking a holistic approach to solving the challenges facing the health system. This is the only approach that will work, because of the interconnected nature of our system. Using this approach, we will ease the current strain on the health system and help ensure that every Ontarian has access to care when they need it, where they need it.