J’acusse: Twenty years of neglect in Long Term Care.

As a Behavioural Neurologist with a unique interest in neuro-geriatric care, for the last 20 years, I had the opportunity to do rounds on a weekly basis at several Senior’s residences as well as Long Term Care facilities in Toronto. .


Some of these facilities are non-profit, for-profit, municipally owned, ethno-culturally administrated. Some are only English speaking, while others include languages representing many groups in Ontario. The facilities range from the poorest to the wealthiest groups of seniors in this most diverse and multicultural city.

I am part of a multidisciplinary team that belongs to a University of Toronto’s Teaching Hospitals. This includes psychiatrists, nurses, OT, RT, psychologists, in addition to their respective students representing these disciplines. I can say that our work has been under various political parties and local representatives. Unfortunately, during the last twenty years, I have not seen even a minimal interest from any of them with regard to the badly needed changes in the care and wellbeing of the elderly in care, across the GTA.

What I have witnessed, during my weekly visits is neglect from our leaders. The recent history of high mortality in most of Ontario’s LTC, particularly in for-profit facilities and the lack of a single plan to address these enormous gaps in the physical and mental care of the geriatric population, our leaders, despite of being aware, are not intervening to avoid another “Canadian national disgrace: the Covid 19 unnecessary deaths in long term care”. ” (Lancet January 16-2021).

During this time, the Ministry of Long-Term Care (MOLTC) has worked, in my view, in a totally reactive manner, as a mere reflex, responding only to complains, albeit for a short while, until the next set of grievances starts the cycle again. Rarely, if ever, have I witnessed an active campaign geared at prevention and education for health care workers that originated from the MOLTC.

This ministry seems to lack the power and knowledge, or perhaps imagination, to ensure that LTC residents and staff are cared for in a humane and compassionate manner. In one recent example, the LTC Minister hired more “inspectors“ rather than addressing essential day-to-day priorities like, infection control mechanisms, implementing modern adequate hygienic and safe spaces for all residents, and training for staff. Not to mention the need for an active campaign to hire Nurse Practitioners, and to improve the salaries of all the highly dedicated and caring LTC staff.

In my professional view, the attitude of the government and the LTC minister are dangerous to the health and wellbeing of our seniors who are under their mandate.

Fundamental changes are needed to set-up standards for our aging population.
It is urgent to close the already insurmountable gap in delivery of services between hospitals and LTC.

The Hospital and LTC ethos are wildly far apart, they look as if they are coming from different cultures.

It is of utmost importance to convince the MOLTC to honour their duties. The MOLTC must be part of a comprehensive care for all elders citizens, with the same interest, dedication and proactivity witnessed in our hospitals. Likewise, it essential that this Ministry understand that they have failed to provide long-term care for our elderly population in the same efficient and ethical manner as other developed countries do.

The MOLTC must look back and implement the recommendations already made from studies conducted by different health care professionals, colleges and other serious, respectable, and caring organizations from all over Canada. In light of the pernicious pandemic and the tragic and unnecessary deaths, this change in responsibility is to ensure that a modern vision for LTC is embraced. It’s a challenge that the current MOLTC has failed and unfortunately continues to fail.

Luis Fornazzari MD FRCPC - Behavioral Neurology St. Michael's Hospital - University of Toronto. El Dr. Luis Fornazzari ha sido, a lo largo de casi 5 décadas uno de los principales referentes de la comunidad hispanohablante de Toronto, y una voz de vital importancia en todo lo relacionado con la salud mental, el bienestar, y los derechos de los adultos mayores.