Bill 37’s four hours of care requirement too ‘watered down’ and ‘unenforceable,’ committee told

Increasing the number of hours of direct, daily care for nursing home residents to four hours is one of the much-boasted aspects of the PC’s long-term care reform legislation, but stakeholders speaking to the legislative assembly committee yesterday called the measure “watered-down,” “magical thinking” and “unenforceable.”

The most common criticism was that Bill 37, Providing More Care, Protecting Seniors and Building More Beds, doesn’t actually guarantee each individual resident will get four hours of daily care, but rather sets a “target” that residents across all Ontario long-term care homes receive an average of four hours of care by 2025.

“It is disappointing to see that this move has been watered down and … establishes an aggregate goal for the province as a whole,” Alzheimer Society of Ontario CEO Cathy Barrick told the committee.

Other witnesses, such as Ontario Council of Hospital Unions president Michael Hurley, were less diplomatic.

“The fact that it’s [just] a target in this legislation is a concern,” he said. “This can’t be magical thinking on the graves of all these seniors who perished during Covid.”

Many advocated to amend the bill so that the average is calculated on an individual-facility basis, rather than provincewide, and posted publicly. Otherwise, it will be impossible for people to know which facilities are falling short of their obligations, witnesses noted.

“By making it an average across the province, it actually hides more than it reveals,” argued Matthew O’Reilly, a researcher for United Steelworkers. “When you start talking about what’s happening in the average home, you miss the real challenge, which is identifying the poor performing homes and then helping those poor performing homes. As the legislation is currently written, it hides the poor performing homes, and that’s a problem.”

Ontario Nurses’ Association president Vicki McKenna urged the committee to amend the bill to include a hard requirement for a minimum standard of care for each nursing home. Having a provincewide target also makes it effectively impossible for inspectors to enforce the mandated four hours of care, warned Ontario Health Coalition executive director Natalie Mehra. 

“This is just window dressing; it looks good, but it is meaningless,” she fumed.

The bill also proposes that the four hours of direct care target be phased in from 2022 to 2025. Several witnesses said this timeline is unacceptably long.

“Tragically, 2025 is too long for many of our residents to be able to wait to benefit from this standard,” noted David Hauch, CUPE Ontario’s long-term care coordinator.

The bill also does not provide a staffing plan to achieve four hours of daily care. Hauch said his organization estimates 50,000 staff will need to be recruited to make that happen, adding steps need to be taken to stop the loss of staff from nursing homes. One thing that can be done to increase retention is repealing Bill 124, Protecting a Sustainable Public Sector for Future Generations Act, the PC’s controversial legislation that caps salary increases for certain public workers to one per cent per year, O’Reilly added.

Even if the staff are there, another question that Bill 37 doesn’t answer is how to delegate work hours between various staff at LTC facilities. McKenna suggested hours be split as such: 20 per cent to registered nurses, 25 per cent for registered practical nurses and 55 per cent for personal support workers, with a nurse practitioner assigned for every 120 residents. The Registered Nurses’ Association of Ontario made a similar recommendation.

Some other points raised during the committee hearing:

• There was much consternation about Bill 37’s amendment of the preamble of the Long-Term Care Homes Act to change a passage committing the province to the “promotion of the delivery of long-term care home services by not-for-profit organizations,” to “by not-for-profit and mission-driven organizations.”
  • “The preamble is a betrayal to the citizens of Ontario, the vast majority of whom have demanded an end to profiteering long-term care,” said London Health Coalition co-chair Peter Bergmanis.

• Many witnesses criticized the bill for not including more robust protections for whistleblowers, saying that staff must be able to go to the media or other outside organizations about problems inside their facilities if going through internal channels fails to produce results.

• Some witnesses, particularly LTC industry groups, expressed concern about new enforcement measures creating a “climate of fear” among staff and management in nursing homes. They asked for amendments requiring inspectors to identify themselves upon arriving at a facility and to provide guidance to homes to fix problems rather than issuing penalties.
  • AdvantAge Ontario suggested that publicly run facilities be exempted from financial penalties.

• There were also suggestions that “emotional wellbeing” be added to the list of needs in the bill, which could include things such as culturally appropriate food and access to speakers in a resident’s mother tongue.