TORONTO — Ontario's health-care system must shift its focus away from hospitals and towards strong community care for everyone if it hopes to stave off future crises like the COVID-19 pandemic, the organization representing the province's nurses said Tuesday as it called for urgent, sweeping reforms.
The Registered Nurses' Association of Ontario said hospitals were the only part of the system not overwhelmed by the deadly outbreak, which has killed more than 1,700 people in the province and taken a particularly heavy toll on long-term care facilities.
The Association tabled 13 broad recommendations in a report dubbed Ecco 3.0, the most recent of its ongoing efforts to overhaul a system it argues has shown itself poorly equipped to provide adequate care both before and during the current crisis.
"Because of the many flaws in the system where sectors are siloed and quite frankly sidelined, we have been too slow to protect our communities," Association chief executive officer Doris Grinspun said at a news conference. "These communities are communities where we're extending histories and reconfirming past neglect. It cannot go on."
Grinspun said the 13 recommendations build upon the Association's previous efforts to seek reform, which it presented in reports published in 2012 and 2014.
While work on the current report began in early 2019 long before the advent of COVID-19, Grinspun said the pandemic and its aftermath have made the need for change more evident and pressing.
The report calls for a fundamental shift in the health-care system's focus, saying the provincial government should rely less on hospitals and concentrate instead on making sure strong primary care is available to all. This should include ensuring people in settings such as the shelter system can access consistent, strong health-care outside of the hospital system year-round, the Association said.
The report also calls for community health care to be expanded to include mental health and addiction services, as well as stronger home-care options financed through a more flexible funding model.
But many of the Association's most urgent recommendations focus on long-term and congregate care settings, which have born the brunt of the pandemic over the past several weeks.
More than 1,200 long-term care residents have died of COVID-19 in the province, and 174 homes have outbreaks of the virus. The grim data has prompted Premier Doug Ford to promise a review of the province's long-term care system, though he has stopped short of granting the opposition New Democrats' request for a full public inquiry.
Prime Minister Justin Trudeau commented on the need for change in long-term care systtems across the country on Tuesday and pledged to help the provinces make improvements once the crisis has passed, but offered no particulars.
Grinspun said the Ontario government, which is in the process of revamping the health-care system, must ensure long-term care facilities are better integrated in the planned changes if it hopes to avert future tragedies.
She argued long-term care facilities should be included in the regional health teams that are central to the redesign and which are already cropping up across the province. Doing so, she argued, would give settings like nursing and retirement homes a say in key health-care issues and ensure their staff receive personal protective equipment as quickly as workers in other facilities.
Ontario's Ministry of Health was responsible for long-term care up until last year, but Grinspun said an "archaic" funding model has kept those centres sidelined and understaffed for decades.
The government's current plans, she said, offer a chance to address the situation.
"We're not saying throw away the model," she said. "We're saying recalibrate, speed it up, and let's work together so we have all health sectors, all health workers, all Ontarians at large with a strengthened health-care system."
Ontario Health Minister Christine Elliott suggested there's no need to make such inclusion mandatory, saying the Association's key recommendations are already happening naturally as regional health teams take shape.
"Most of the teams that have come forward already as local Ontario Health Teams do have long-term care included as part of their group because we want to create an integrated care experience for people across the province," she said. "That is something that all regions understand. They also want to have public health involved because we've seen how important public health is as part of this pandemic."
The Ministry of Long-Term Care deferred to the Ministry of Health for comment.
This report by The Canadian Press was first published May 12, 2020.
Michelle McQuigge, The Canadian Press
