Vaccination Status in Ontario Long-Term Care Homes

 

On Friday afternoon, Ontario‘s Ministry of Long-Term Care released first and second dose vaccination rates for all of Ontario’s 626 long-term care homes.  The numbers are quite interesting. Figure 1 ranks the 34 public health units by the average of the second dose vaccination rates for their long-term care homes.  At the top at 91 percent is Ottawa Public Health followed closely by York Region and Toronto Public Health at 90 percent.  At the bottom are Chatham-Kent, Haldimand-Norfolk, and Timiskaming at 81, 80 and 79 percent respectively.  

 

 

 

While this does not seem like a substantial range, the range is more marked when the individual homes are ranked from highest to lowest as illustrated in Figure 2. Of Ontario’s 626 LTC homes, 5 have 100 percent second does vaccination rates - North Shore Health Network - Eldcap Unit (Algoma PHU), Dundas Manor Nursing Home (Eastern Ontario PHU), The Fordwich Village Nursing Home (Huron-Perth PHU), William A. 'Bill' George Extended Care Facility (Northwestern PHU) and Morriston Park Nursing Home (Wellington-Dufferin PHU).  Of Ontario’s 626 LTC homes, only 13 percent of them have second dose vaccination rates at 95 percent or greater.  About 17 percent of these homes have less than 80 percent of their staff vaccinated with some below 60 percent. Indeed, the drop off after 70 percent is quite steep.

 

 

 

For those that are interested, the northern Ontario public health units are all over the range of vaccination with Northwestern Health Unit at the top and Temiskaming at the bottom.  Thunder Bay District Health Unit, which is at the top of performance for vaccination rates in the general population is near the bottom third when it comes to second does for its LTC home staff. The rates range from 97 percent for Nipigon District Memorial Hospital to 77 percent for Hogarth Riverview.  Southbridge Roseview – the site of Thunder Bay’s major LTC pandemic outbreak is 9^th out the ten district LTC homes coming in surprisingly at only 78 percent with a second doses.  There is substantial room for improvement when it comes to some of the LTC homes in Thunder Bay District given that only one of the ten is over 95 percent for second vaccination status rates.

 

The more interest question is why such variation exists across the province.  There seems to be no obvious regional pattern to the vaccination rates as the dispersion simply in northern Ontario alone would attest. Indeed, when the second does vaccination rates are ranked by averages for Ontario economic region, they range from highs of 88 percent for Ottawa (510) and the GTA (530), followed by 87 percent for Stratford-Bruce (580) and the Northwest (595) with the Northeast (590), London (560) and Windsor-Sarnia (570) at 85, 84 and 82 percent. A regression of vaccination rates by LTC on a constant and economic region dummy variable (eleven but with the GTA omitted as the reference variable) finds a very low r-squared (5 percent) but four regions have statistically significantly lower vaccination rates relative to the GTA.  They are Hamilton-Niagara at 4 percent lower second dose rates relative to the GTA homes, London at 5 percent lower, Windsor Sarnia at 7 percent lower and the Northeast at 4 percent lower. 

 

Even for those  that were statistically significant, they are quantitatively not large differences, So, what explains 95 percent of the variation in vaccination rates across LTC care homes? Good question.  One suspects a lot has to do with home specific factors including local management, staff culture and unique local environmental conditions.  There is room for improvement and the requirement for mandatory COVID-19 vaccination for Ontario long-term care workers by November 15^th is probably the best way to close these gaps.

Reading the Tea Leaves in Ontario's Cabinet Shuffle

 

Premier Ford has shuffled his cabinet and put in place the team for the last year of his mandate with an eye to next spring’s election.  It has been a tumultuous year for the Premier to say the least given the pandemic but with the end of the pandemic seemingly in sight, Ontario’s government now has to plan for dealing with the aftermath of the pandemic as well as the future.  Key portfolios remain in the same hands, but there are some notable changes.

 

Health and long-term care will continue to be important portfolios and here there is both continuity and change.  Christine Elliott remains Minister of Health and is Deputy Premier an indication of both her importance as well as the centrality of health.  As for long-term care, Merrilee Fullerton has been replaced by Rod Phillips.  This change has received a lot of media attention mainly because Fullerton’s departure is seen as a demotion and the resurrection of Phillips comes after last winter’s travel escapade to St. Barts and the theatrical staging to mask his absence.   However, going to Children, Community and Social Services is not necessarily a demotion given the size of the ministry in terms of its budget share.  And as for Mr. Phillips, well he has atoned for his sins and not allowing an otherwise competent person back into cabinet does not seem particularly productive.

 

The more interesting analysis and discussion with respect to health and long-term care is what the challenges are and how Elliott and Phillips will deal with them.  In the case of health, the pandemic has disrupted the system and along with everything else the FAO now predicts that it will take years to address the backlog of surgeries in Ontario that were delayed by the pandemic.  Indeed, the elective surgery backlog will reach 419,200 procedures and the diagnostic backlog will reach nearly 2.5 million procedures by the end of September 2021.  This is on top of dealing with COVID and its after-effects, the risk of another wave in the fall should the variants outstrip vaccination efforts and the human resources issues of a stressed health care sector.  This will all cost a lot of money.

 

As for long-term care, the long and short of the matter is that bed numbers from the early 2000s to the election of the Ford government stayed flat at just under 80,000.  The pandemic and its toll on long-term care homes resulted in thousands of beds being removed from service because they were 3-4 resident bedrooms more conducive to infection spread thereby reducing capacity even further.  On top of this the government has promised raising daily hours of care per resident from 2.75 to 4 hours, hiring 9,000 more PSWs and adding another 30,000 beds to this system.  This will all cost a lot of money,

 

As for money, the spring 2021 Ontario budget provided some interesting projections of spending by general category up to 2029-30.  Between 2020-21 to 2029-30, health spending is projected to rise from $66.7 to $82.0 billion.   This may seem like a lot but if you take the medium-term population projection scenario from the Ministry of Finance, assume inflation of about 2 percent and convert to inflation adjusted dollars, once the COVID-19 spending spike dissipates real per capita health spending can actually be expected to decline by about 11 percent from 2022 to 2029.  In moving forward their priorities, one hopes that both Elliot and Phillips are really good friends with Peter Bethlenfalvy who remains Minister of Finance though his Treasury Board responsibilities now go to Prabmeet Singh Sarkaria.

 

In other news of note, Ross Romano is no longer Minister of Colleges and Universities and has been moved to Government and Consumer Services.  One suspects there has been some displeasure with the handling of that portfolio by Minister Romano given that Ontario is the first province in Canada to see a university declare insolvency and seek creditor protection under the CCCA while simultaneously creating two new universities – Hearst and NOSM.  Such a feat of creative destruction has not gone unnoticed and the move to Government and Consumer Services is hopefully not a strategy to put Minister Romano in charge of a process to have the entire province of Ontario's operations seek CCCA protection given the ballooning size of the provincial debt and deficit.

 

The new incoming minister for Colleges and Universities by the way is Simcoe North MPP Jill Dunlop who moves there from being Associate Minister for Children and Women’s Issues so this is definitely a promotion.  Given that Minister Romano was from the north and thoroughly disrupted a northern university, one is a bit concerned that there may be a curse attached to this portfolio and Minister Dunlop may be fated to disrupt post-secondary education in Simcoe County.  That is of course the home of Lakehead’s Orillia Campus and one wonders if we are in store for the freeing of yet another institution from its administrative shackles by creating another stand-alone university?  Residents of Simcoe County who are planning to create an Orillia University Liberation Army may want to take notes from the Dean of the Northern Ontario School of Medicine.  In a recent virtual town hall, the Dean apparently referred to creation of a new medical university separate from Lakehead and Laurentian as “Emancipation.” I suspect that no one ever truly realized that the poor medical students in northern Ontario had actually been enslaved for the last fifteen years.  

 

On a final note, Greg Rickford is truly now King of the North.  The MPP for Kenora-Rainy River, assumes a merged role as Minister of Northern Development, Mining, Natural Resources and Forestry, as well as Indigenous Affairs.  Mr. Rickford has gained a reputation as being quite competent and unlike some ministers, he never makes the boss look bad.  He follows the last true King of the North who was Leo Bernier, a minister in the Davis government of the 1970s.  And another of my favorite northerners and the only current cabinet minister I have ever had the pleasure of meeting, Vic Fedeli, remains Minister of Economic Development, Job Creation and Trade and is Chair of Cabinet.  Congratulations to both Mr. Rickford and Mr. Fedeli.