As the parliamentary assistant to the Minister of Long-Term Care, I thank him for this opportunity to speak to the proposed amendments to the Fixing Long-Term Care Act, 2021.

It’s an understatement to say that the last couple of years have been challenging for the long-term-care sector and the broader health care system. COVID-19 challenged all of us, and it continues to challenge us today. There were also many learnings and realizations that should not be lost. The shortfalls in our health care and long-term-care system were exposed.

I am proud to be part of a government that has set such a high priority to improving our systems, providing a higher quality of care and being prepared for the future with new health care facilities, resources and staffing. To this end, our government released the Plan to Stay Open: Health System Stability and Recovery. We are acting to secure the stability of our health system. It is paramount that we maintain stability and we continue our recovery and be prepared for new challenges moving forward.

In keeping with the staffing challenges evidenced across the health system, the strain on home care workers, nurses and administration has also increased. Patients are waiting for long periods of time in hospital emergency departments. They’re also waiting for long periods in hospitals to be transferred to a bed in a long-term-care home. Furthermore, health care workers across the health system have not had the time they need to rest, recharge and recover from the increased pressure brought upon the system from back-to-back Delta and Omicron waves. The picture is made even more serious when we look at the challenges we could face in the fall and winter, our flu season.

If no further action is taken to strengthen the health system, Ontario could experience a 2,400 hospital bed shortage by the peak of a potential flu and, perhaps, another COVID-19 wave later this year. As Minister Calandra mentioned, much of the focus over the last few months has been on hospital emergency departments, and rightfully so. However, emergency departments are part of a much larger system. Long-term care is a critical part of this system. These amendments 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 an appropriate setting. There are many patients in hospitals across the province whose care needs could be met elsewhere. Long-term care is one of those places. These are referred to, as you know, as alternative-level-of-care patients: ALC. Many of these patients have care needs that can be met in long-term-care homes. Moving these patients out of the hospitals and into long-term care frees up much-needed space in hospitals for patients who require hospital treatment. This also benefits the ALC patient since they are being moved to a more appropriate setting where they can receive care again. These are patients who want to move from patients to being residents in a home, a long-term-care home.

That’s why, as part of our plan to stabilize the health system, we are seeking to amend the Fixing Long-Term Care Act, 2021, in order to improve how we transition ALC patients into 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 ALC patients waiting for long-term-care homes. Some of these patients have been waiting for more than half a year, even though they no longer require hospital care. We are all aware of the challenges our hospitals are experiencing. Having ALC patients in hospitals contributes to backlogs in acute care services in hospitals because they occupy beds and use staff resources that other patients urgently need. When they cannot be discharged, these patients continue to receive care, but in the wrong setting. The hospital is not the appropriate place for them to be. They no longer need acute care, but are in an acute care setting.

The proposed amendments we are putting forward would, if passed, support the movement of some ALC patients to temporary care arrangements in long-term-care homes, in an appropriate setting, 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. And 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, but with their best care in mind, 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 and there may be initial barriers to implementation. But parameters within the changes will help ease concerns.

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. 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 and help with their comfort level. Long-term-care placement coordinators will be encouraged to make ongoing efforts to re-engage with patients at frequent points throughout the placement process. At any stage in the process, patients can change their minds or choose an alternative care option.

The next part—this is very important to me, in particular, and to the whole program: 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 permanently move once a bed becomes available at one of their preferred homes. In other words, they won’t lose their place in the queue. Change is hard, so they can also choose to remain permanently in the initial home that they are moved to.

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 them. At the same time, it would make sure the 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. We’ve all probably been in long-term-care homes. You see the social interaction, the laughter in the dining halls, and the extra care they get—allied health services and other services that are available in a long-term-care home that aren’t available while they’re waiting in a hospital in an ALC environment.

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 coming into effect on August 23, 2022;

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

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

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

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 and 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. Informing all of this work are the lessons that we learned from the COVID-19 pandemic. This includes the changes to the legislation we are proposing today.

It is no secret that COVID-19 exposed long-standing issues in the long-term-care sector—issues that were the result of decades of inaction and underfunding. The pandemic shone a spotlight on a system strained by critical staffing shortages, increasing capacity pressures, complex and diverse resident needs, gaps between staffing levels and resident needs, and other challenges that the long-term-care sector was experiencing well before the COVID-19 pandemic.

Health care workers on the front line have worked day after day, long hours, to protect our friends, families and loved ones, to provide them with the care they needed. Our government has taken many steps to support our front-line health workers in long-term care and help the sector through the pandemic. To this end, we’ve invested billions of dollars in COVID-19 emergency funding, which has helped the sector to respond and cope with the multitude of challenges that have accompanied the pandemic.

From the earliest stages of COVID-19, the government took decisive action to support all long-term-care homes, staff and residents. 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. That’s what these amendments are about. Ensuring that the long-term-care sector is stable and that their 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 around 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 long-term care homes, for instance, we’ve made historic investments. We have invested $6.4 billion to build over 30,000 new and 28,000 upgraded long-term care beds. We’re making incredible progress on these projects and already have more 30,000 new and 28,000 upgraded long-term-care beds in development.

Of the 365 projects that are in the pipeline, 115 projects have proposed to be part of a campus of care model. The model focuses on 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. No more ward beds.

We also recognize the diversity of our aging populations. 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 is what this province needs. In the first three months of this year alone, our government announced bed allocations in every corner of the province. 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 also 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. The new home, named Lakeridge Gardens, is built in Ajax and is located on the same grounds as the Ajax Pickering Hospital. The home will be part of a campus of care at Lakeridge Health to ensure residents have access to the specialized care they need and access to the broader health care system in Durham Region. The proximity of long-term care to other services like this will contribute to greater collaboration, communication and efficiencies in our system.

Of course, when building new and upgraded homes, it is vital to ensure that there are enough staff to provide care within these homes. That’s why strengthening staff 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. And as the minister has previously stated, 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 and 2024 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.

Increasing staffing levels is important, but it is just as important that the right culture of care is present in the staff. The focus must always be on the residents and providing them with the care that they want and they 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 have 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 major investment will lead to more direct care for residents.

A month earlier, we announced a $73-million investment over three years to train and provide clinical placements for over 16,000 personal support workers and nursing students. This enabled the creation of a new program known as the preceptor resource and education program for long-term care. This program provides more opportunities for career development within long-term care and ensures that PSW and nursing students receive critical hands-on experience to better serve the needs of residents. Clinical placements are a key part of nursing and PSW education and provide students with critical hands-on experience under the supervision of experts or existing long-term-care staff.

Positive clinical placement experience supports recruitment, because many students take jobs in the homes where they completed their placements. At the same time, it provides existing long-term-care staff with an opportunity to oversee those students. 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 the progress we’re making on long-term care staffing and capital development, we’re also making progress to drive quality in long-term care. We’re achieving this through instituting better accountability, enforcement and transparency in the sector.

Another important aspect of driving quality is ensuring that residents have the food and nutritional support that they need. That’s why we invested over $40 million in additional nutritional support funding for long-term-care homes this year.

A key factor in driving quality is the inspection system. The inspection 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 resident safety, our government is investing an additional $72 million over three years to increase enforcement capacity. This will allow us to hire 193 new inspection staff, which will double the number of inspectors across the province in the 2022 fiscal year. This will make Ontario’s inspectors to long-term-care homes ratio one of the highest in Canada.

The new proactive inspection 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 programs 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.

Another important way to drive quality is by amplifying the voices of residents and their families and caregivers and listening to their insights and experiences. The Fixing Long-Term Care Act requires every long-term-care home to take a survey of residents, families and caregivers to measure their experience with the home. Homes must make every reasonable effort to act on the results of the survey to improve the home.

The Fixing Long-Term Care Act also requires every home to implement a continuous quality improvement initiative that must include an interdisciplinary quality improvement committee for the home. The committee is intended to support an ongoing culture shift in long-term care that encourages continuous quality improvement through collaboration between the long-term-care homes, staff and leadership as well as representatives from the residents’ council and family council. Among its responsibilities, the committee makes recommendations regarding priority areas for quality improvement in the home.

To improve transparency under the third pillar of our fixing long-term care plan, our government launched the Long-Term Care Homefinder website earlier this year. This website and search tool provides prospective residents and their families with a one-stop shop to find and compare long-term-care homes across the province, and it also provides them with other resources to help them to make an informed choice when considering long-term care. In addition, we have continued to expand the behaviour-specialized units, also known as BSUs, across the province. BSUs provide specialized care to individuals with responsive behaviours that cannot be effectively supported in their current environment and for whom all other applicable services, like regular long-term-care beds and community supports, have been fully explored. Specialized care in a BSU is required due to the frequency, severity or level of risk that the individual poses towards themselves, co-residents, visitors or staff members. This includes $5.9 million to establish four new BSUs in Ajax, Scarborough and Toronto. We’re also investing $3.6 million to continue the operation of three BSUs established in 2019 in St. Catharines, Mississauga and Whitby.

Ontarians who need long-term-care services frequently report that they prefer to remain in their own 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 is a great program. 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 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 environment to help seniors and their caregivers feel safe and supported in their own communities. This has the added benefit of potentially delaying the need for care in a long-term-care home or a hospital visit.

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 for 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 direction our government pursues. 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 are 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, 2021. 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. Using this approach will ease the current strain on the health system and help ensure that every Ontarian has access to care when they need it and where they need it.