In Parts 1 and 2, we looked at the rights-forward agenda emerging in elder law: dementia-specific care and caregiver access, stronger inspection tools, and culturally safe services; and, separately, how the Residential Tenancies Act^[1] governs fees and protections for seniors in care homes. This instalment steps back to the crucible for many of today’s reforms: COVID-19’s devastation in long-term care homes (“LTCs”). The goal isn’t to re-litigate the pandemic, but to translate what courts, commissions, and legislators have said into concrete reforms for the benefit of seniors and their families.

What COVID-19 Exposed

The pandemic didn’t create Ontario’s LTC problems, it magnified long-standing weaknesses: chronic understaffing, multi-bed ward layouts that frustrate isolation, uneven infection prevention and control (“IPAC”), and fragmented oversight. Ontario’s Auditor General later found that these pre-existing issues left homes “ill-equipped” to prevent or contain COVID-19.^[2]

By spring 2020, hospitals were overstretched, forcing Ontario’s government to request federal help. Starting April 22, as part of Operation Laser, Canadian Armed Forces (“CAF”) medical teams were deployed to five of Ontario’s worst-hit nursing homes.^[3]

What CAF personnel documented neglected and malnourished residents, rotten food, and insect infestations.^[4] Residents were found in soiled bedding after going unbathed for weeks.^[5] Staff were observed making “degrading or inappropriate comments” toward residents.^[6] Patients were crying out for help with no response for hours.^[7] PPE shortages, staffing gaps, and systemic failures were exposed.

The toll was staggering. By January 14, 2021, 3,211 LTC residents had died, representing 60.7% of all COVID-19 deaths in Ontario at that point.^[8] By June 14, 2022, Public Health Ontario recorded 4,587 LTC resident deaths.^[9]

Government Action During the Storm

These conditions were so jarring that they spurred immediate public outrage. Premier Ford called them “gut-wrenching” and “shocking.”^[10]

Ontario moved from initial emergency orders to progressively tighter controls and external support:

• Single-site work: an emergency order limiting LTC workers to one home took effect April 22, 2020, to curb cross-facility spread.^[11]
• Hospital partnerships/IPAC surge: hospitals were directed to partner with struggling homes and deploy IPAC expertise.^[12]
• Pandemic pay: a temporary $4/hour wage top-up for eligible frontline workers (including LTC) began April 24, 2020, with subsequent targeted enhancements for PSWs.^[13]

These steps mattered yet key measures (universal masking, cohorting, single-site staffing) were weeks late, given what was already known about asymptomatic transmission and the high risk in congregate settings.

How Courts Framed Accountability

Regardless of the emergency stopgaps, the sheer scale of LTC resident deaths combined with the harrowing conditions documented demanded accountability. The systemic weaknesses – staffing gaps, delayed directives, inadequate oversight – did not just expose residents to unacceptable risks; they also raised pressing legal questions about government responsibility and operator liability. In this climate, litigation became a natural extension of the search for justice, pushing courts to weigh whether Ontario and LTC operators should be held legally accountable for decisions and omissions that had life-and-death consequences.

Two litigation streams continue to shape policy expectations:

• Public law accountability for the Province: In Robertson v. Ontario^[14], 2022 ONSC 5127, the court certified a negligence class action against the Minister of Long-Term Care, holding it is arguable that Ontario’s LTC statute creates a private-law duty to take action when residents’ care and safety may be compromised. The Court struck fiduciary-duty and Charter claims but allowed negligence to proceed to the merits on a full record. This signaled that timely, clear ministerial action during crises is not merely political, it can be justiciable.
• Private-operator accountability: In Pugliese v. Chartwell^[15], 2024 ONSC 1135, the Court certified a negligence claim against a large corporate chain where pleadings allege gross negligence – necessary to clear the Supporting Ontario’s Recovery Act^[16] (“SORA”) shield for defendants acting in good faith. SORA raises the pleading bar but did not foreclose claims alleging marked departures from reasonable standards.

The certification of negligence claims against both the province and private operators reflects the judicial systems acknowledgment that the harms in LTCs were not inevitable. Families who lost loved ones, residents who endured inhumane conditions, and frontline workers who risked everything are entitled to answers, and potentially redress. Robertson and Pugliese show that courts are prepared to scrutinize government delay and operator conduct through the lens of legal duty, not just political responsibility.

Reform: Gains and Gaps

After the pandemic, Ontario introduced the Fixing Long-Term Care Act^[17], accompanied by program changes that together amounted to the most significant overhaul of the sector in years. The Act set a phased path toward four hours of direct care per resident per day by 2025^[18], supported by nearly $5 billion in funding to recruit and retain thousands of personal support workers and nurse.^[19] It also reinstated proactive, unannounced inspections with new authority for inspectors to issue administrative penalties and install supervisors in failing homes.^[20] Homes are now required to maintain dedicated IPAC programs.^[21]

Yet many of the system’s weaknesses persist. Staffing remains precarious: despite wage enhancements, vacancies and reliance on agency workers continue to undermine continuity of care.^[22] The ownership model has also come under scrutiny. Studies during the pandemic showed that for-profit homes experienced worse outcomes than non-profit or municipal facilities, yet the province has continued to award new licenses and redevelopment contracts to large corporate chains.^[23] Finally, while institutional LTC has expanded, alternatives such as aging-in-place supports and community-based housing have not grown at the same pace.^[24] Without stronger investment upstream, nursing homes remain the default rather than the last resort.

Regardless, residents & families now have clearer legal entitlements including care-hour norms, inspection transparency, and caregiver policies. Document your concerns. Use inspection tools. Know your options when standards fail.

Final Thoughts

Rights on paper mean little without real enforcement and accessible remedies. The challenge now is ensuring that the lessons of COVID-19 translate into lasting protections. Seniors and their caregivers must remain vigilant, advocates must continue pressing for systemic reform, and governments and operators must be held to the duties their laws and licenses already impose. Only then can never again move beyond aspiration and become a lived reality for Ontario’s most vulnerable.

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[1] Residential Tenancies Act, 2006, S.O. 2006, c. 17.

[2] Office of the Auditor General, “Covid-19 Preparedness and Management: Special Report on Pandemic Readiness and Response in Long-Term Care” (April 2021), online at page 6: <https://www.auditor.on.ca/en/content/specialreports/specialreports/COVID-19_ch5readinessresponseLTC_en202104.pdf>.

[3]  Canadian Armed Forces “Joint Task Force Central Observations in Long Term Care Facilities in Ontario” online (14 May 2020) <https://eapon.ca/wp-content/uploads/2021/09/JTFC-Observations-in-LTCF-in-ON.pdf>.

[4] Ibid at pages 7, 10.

[5] Ibid at page 7.

[6] Ibid at page 5.

[7] Ibid at page 7.

[8] Science Table: Covid-19 Advisory for Ontario, “COVID-19 and Ontario’s Long-Term Care Homes” (20 January 2021) online: < https://covid19-sciencetable.ca/sciencebrief/covid-19-and-ontarios-long-term-care-homes-2/>.

[9] Public Health Ontario, “COVID-19 in Ontario: January 15, 2020 to June 14, 2022” (2022), online: <https://www.publichealthontario.ca/-/media/documents/ncov/epi/covid-19-daily-epi-summary-report.pdf?la=en>.

[10] The Guardian, “Canada: neglected residents and rotten food found at care homes hit by Covid-19” (26 May 2020), online: <https://www.theguardian.com/world/2020/may/26/canada-care-homes-military-report-coronavirus?>.

[11] O. Reg. 146/20: Limiting Work to a Single Long-Term Care Home.

[12] M. Sawhney, M. J. Lamb, & A. La Delfa “Mobilizing an interprofessional IPAC-SWAT team to long-term care during COVID-19”.

[13] Ontario Newsroom, “Pandemic Pay Provides Support for Frontline Workers Fighting COVID-19” (25 April 2020) online: <Pandemic Pay Provides Support for Frontline Workers Fighting COVID-19 | Ontario Newsroom>.

[14] Robertson v. Ontario, 2022 ONSC 5127 [Robertson].

[15] Pugliese v. Chartwell, 2024 ONSC 1135 [Pugliese].

[16] Supporting Ontario’s Recovery Act, 2020, S.O. 2020, c. 26, Sched. 1 at s. 2.

[17] Fixing Long-Term Care Act, 2021, S.O. 2021, c. 39, Sched. 1 [Fixing Long-Term Care Act].

[18] Ibid at s. 8(2).

[19] Ontario, “Published plans and annual reports 2022–2023: Ministry of Long-Term Care” (updated 15 February 2023), online: < https://www.ontario.ca/page/published-plans-and-annual-reports-2022-2023-ministry-long-term-care?>.

[20] Fixing Long-Term Care Act, supra note 17 at ss. 144-153.

[21] Ibid at s. 23.

[22] Office of the Auditor General of Ontario, “Long-Term Care Homes: Delivery of Resident-Centred Care” (2023).

[23] See, e.g., S. Braedley, “Commentary: Critical to Care – The Problem of Profit in Ontario’s Long-Term Care Home Sector” (20 August 2024) 20:1 Healthcare Policy 41, online: <https://pmc.ncbi.nlm.nih.gov/articles/PMC11905946/pdf/policy-20-041.pdf>; Ontario Health Coalition, “The Private Deals Remaking Long-Term Care” (13 March 2023), online:  <https://www.ontariohealthcoalition.ca/index.php/the-private-deals-remaking-long-term-care>.

[24] Government of Canada, “Aging in Place Challenge Program” (Modified 21 may 2025), online: <https://nrc.canada.ca/en/research-development/research-collaboration/programs/aging-place-challenge-program>.