Doug Ford's government promised 1 inspector for every 2 long-term care homes. That hasn't happened

Premier Doug Ford's government is falling short of its promises to conduct annual inspections of every long-term care home in Ontario and to boost the ratio of inspectors to homes, according to information obtained by CBC News.

The government announced a plan in October 2021 to double the number of long-term care inspectors, so that the province would have one inspector for every two nursing homes in the province.

There are 624 long-term care facilities in Ontario. However, figures provided to CBC News this week by the Ministry of Long-Term Care show that only 234 inspectors are currently working in the field.

That's well short of the 312 that would be needed to meet the promised ratio.

Earlier this year, the government declared that it had already hit its target. "Ontario now has the highest inspector-to-home ratio in the country, surpassing our goal of having one inspector for every two homes in the province," then-minister Paul Calandra said in a February news release.  

Meanwhile, new data shows the government is also failing to meet its pledges on what are called "proactive compliance inspections" — a comprehensive inspection that doesn't just investigate a specific incident.

The government had promised "enough inspectors to proactively visit each home every year, while continuing reactive inspections to promptly address complaints and critical incidents." 

Ontario conducted just 61 proactive compliance inspections in 2022, according to data in a new report by the advocacy group Concerned Friends.

Few homes getting proactive inspections 

Fresh figures the Ministry of Long-term Care provided to CBC News this week show just 92 such inspections have been conducted so far in 2023.

To do a proactive inspection on every home within a year, the province would have to increase its 2023 pace by a factor of five.    

"All long-term care homes in the province will receive an annual proactive inspection by the end of 2025, while the ministry continues to respond to critical incidents and complaints," said a ministry spokesperson in an email to CBC News. 

The official said the ministry had 138 inspector positions in June 2021, then added 156 inspectors by 2023. 

"At present, a recruitment for more than 50 additional inspectors is underway. The conclusion of this recruitment will ensure we further exceed the doubling of the inspectorate," the spokesperson said.

Concerned Friends, which has been advocating for the rights of long-term care residents for more than 40 years, describes the number of proactive inspections as very disappointing. 

"The complete inspections of all the standards are done relatively infrequently to this date," said Alice Gaudine, a registered nurse and board member of the group, Living in Kingston.

"We'd like to see major improvements [to the long-term care system] and it's hard to imagine how this will happen without a lot of increased resources," said Lorna MacGregor, a social worker who volunteers with Concerned Friends to review the inspection reports. 

Annual inspections all but scrapped before COVID 

Before 2018, Ontario required that all homes face at least one thorough, unannounced "resident quality inspection" (RQI) per year.

Soon after the Ford government came to power, it all but scrapped those full-scale inspections, so that only nine homes underwent them in 2019.

An investigation by CBC's Marketplace found the government made that move despite ministry research that showed the proactive inspections were the only way to reliably find weaknesses in infection control practices. 

Then the COVID-19 pandemic ripped through Ontario's long-term care homes, leading to the deaths of more than 4,000 residents. 

Cho defends new inspection regime

The government announced its revamp of the inspection regime in the fall of 2021, bringing back a revised form of the RQIs called proactive compliance inspections.

Minister of Long Term-Care Stan Cho is defending the government's system.  

"It's not just the volume of inspections that are important, it's the quality of inspections," Cho said at a news conference this week. "It's also the results and how they're processed and presented to the public, but also internally at the ministry to make sure that we're able to act on the recommendations those inspections are bringing forward."

Cho pointed to the $72 million the government put into a three-year program to bolster the inspection regime, which started last year. 

"We are making the whole process easier, simpler, faster by making sure that [inspection] reports themselves are not as cumbersome," he said. 

Ontario's long-term care inspection reports are publicly available online. These include both the full-scale proactive compliance inspections and the reactive inspections following complaints or critical incidents, such as a resident injury. 

The report by Concerned Friends found that in 2022, the province conducted a total of 1,642 inspections, which is 1,000 fewer than in 2019, the last year before the pandemic. 

Gaudine says from her review of the reports, many of the inspections were triggered by critical incidents that related to  staffing shortages.  

"What tends to happen is a resident wants to get out of bed or something and there's no one else to help," she said in a interview.