Duty to Protect? The Troubling Pattern of Legislative Noncompliance and Missed Police Involvement in Ontario's Long-Term Care Sector.

Background: Methods: We conducted a qualitative analysis with descriptive quantitative summaries of MLTC inspection reports issued in 2024. A 20% random sample of Ontario LTC homes was selected, and all associated inspection reports (N = 457) were retrieved. Using predefined keywords ("abuse," "neglect," "police"), relevant reports were identified (n = 193) and analyzed thematically to examine legislative compliance, documentation of police involvement, and enforcement responses. Results: Twenty-one of 193 reports (10.8%) mentioned police and were the focus of our analysis. In 16 of 21 reports, there were accounts of abuse and/or neglect, including theft, fraud, and physical and sexual assault, but police were only notified and dispatched to an LTC home in 2 of the 16 reports (12.5%). The remaining 14/16 cases (87.5%) involved incidents of resident-involved abuse or neglect where police were not contacted. Four of 21 reports (19%) involved noncompliance pertaining to required qualifications and missing or falsified police record checks. The final report cited a prior, second-hand account of police involvement for alleged resident aggression. Conclusion: This study provides the first review of compliance practices of LTC licensees in Ontario and their legal duty to report incidents of abuse, neglect, and other suspected criminal activity to police. Inconsistencies in documentation and variation in violations issued for comparable incidents suggest that these events are often addressed within regulatory or clinical frameworks, with limited documented engagement of criminal processes.