Long-Term Care Under the Microscope

Published on
October 7, 2020
Written by
Jason Grier
Read time
10 min

On March 9, Canada's first COVID-19 death occurred in a BC long-term care home. It would not be the last. As the month unfolded, distressing insights were confirmed in Italy: most of those dying from COVID-19 were the elderly. This would prove to be true of the Canadian experience, as well. However in Canada's example, the health care setting where those seniors would die was markedly different. Data from the Canadian Institute of Health Information report deaths in long-term care made up over 80 percent of Canada's COVID-related deaths, twice the average of other developed nations.

Why was Canada's experience so different? Why did so many of these deaths occur in long-term care homes, where there are no critical care facilities and relatively low medical support availability, compared to other countries? Are there people, institutions or policies that should be held accountable? These will be questions that families, health care leaders, and policymakers will be trying to understand for many years to come.

As we begin to enter the second wave, what can we learn about what's to come in the post-pandemic examination of the Canadian experience? Perhaps we can take some lessons from the Commission of Inquiry on the Blood Systems in Canada, known as the Krever Inquiry and its report, as well as inquiries into the Canadian experience with SARS nearly two decades ago.  The Krever Inquiry was an investigation into the Tainted Blood Tragedy, Canada's "worst preventable public health disaster," causing about 2,000 Canadians to be infected with HIV and 30,000 HCV infections due to inadequate measures to protect Canada's blood supply. Canadian decision-makers cut costs and neglected sample testing to manage Canada's blood system at considerable prices in terms of disability, death and the impact on health care resources. The aftermath would also result in over $1 billion in compensation for those infected between 1986 and 1990, including massive legal fees. Thirty-two criminal charges were against the Canadian Red Cross Society, scientists at Health Canada, and Armour Pharmaceutical Co. The Canadian Red Cross Society also lost its role in administering Canada's blood program, replaced today by Canada Blood Services and Héma-Québec.

The goal of the independent SARS Commission, created in June of 2003 and completed in January of 2007, was to investigate the Ontario government's response to the SARS epidemic.  One of a number of inquiries looked into the SARS epidemic, which killed 44 Canadians. Like what followed the Krever Report, numerous lawsuits were filed the years following the SARS outbreak, including a class action brought forward by nurses against the provincial government, Abarquez v. Ontario, for their failures. Legal action was also taken against hospitals and physicians for failing to meet their obligations of private duty of care for patients. While the most significant legal efforts were ultimately unsuccessful, they shone a significant spotlight on the critical question of who should be held to account for the failure of health systems and individuals operating within it.

The Canadian experience with respect to not only the spread of COVID within long-term care homes, but the decisions are taken at both a systemic level as well as by clinicians and facility administrators that resulted in Canada being the world leader in terms of LTC deaths. Like the tainted blood tragedy and SARS epidemic, the public they will demand answers and accountability of those responsible.

There are already investigations underway, including an independent commission inquiry launched by the Ontario government, a large-scale Coroner's Inquiry in Quebec, and an investigation by the Quebec Ombudsperson. Like the "Ontario Long Term Care Home Negligence Class Action" and the "CHSLD class action," class action lawsuits are also ongoing, and we may expect more legal action and inquiries to follow. As more details regarding government response and private interests during the COVID-19 pandemic unfold, we predict lengthy and costly aftermath, long past the discovery of a vaccine and a declaration of victory over SARS-CoV2.

A decade or more of lawsuits, inquiries, investigations, and inquests would appear to lie ahead, not just concerning long-term care but also across various issues and policy decisions. Will those involved, be prepared for what's still to come when the dust settles for the rest of us?

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