This story is part of The Big Spend, a CBC News investigation examining the unprecedented $240 billion the federal government handed out during the first eight months of the pandemic.
Two of the largest long-term care providers in the Toronto area have received more than $157 million in federal and provincial COVID-19 relief while also paying out tens of millions of dollars in dividends to their shareholders.
Extendicare Inc. and Sienna Senior Living Inc. have paid a combined total of $74 million in dividends this year.
Meanwhile, more than 480 residents and staff have died of COVID-19 at the companies’ care homes in Ontario.
As the pandemic continues, CBC News has taken a closer look at the billions of dollars in financial aid given out by governments to businesses and individuals across the country.
Extendicare Inc. and Sienna Senior Living Inc. both say the taxpayer money they have received has gone directly to boosting staff levels and protecting their residents from COVID-19.
However, despite the influx of public money, families of some residents at Extendicare and Sienna facilities tell CBC News the quality of care has deteriorated.
“Where’s all that money going? Because it’s not going for proper care,” Miriam Dos Anjos said.
Her mother-in-law, Luiza, is a resident of Extendicare Halton Hills, a long-term care home in Georgetown, Ont.
Yesterday, the 75-year-old had her left leg amputated below the knee because a toe infection that had been festering spread to her heel and gangrene set in, the family says.
“This would have been something that didn’t just happen overnight,” said Miriam.
Mike Dos Anjos, Miriam’s husband and Luiza’s son, said the care home should have monitored the problem more closely.
“They didn’t tell us until it was too late. I’m very mad,” he said.
On Oct. 16, after being informed that Luiza’s toe was black and that she’d been rushed to hospital, the family filed a formal complaint with the Ontario Ministry of Health and Long-Term Care.  
A little over a month later, on Nov. 25, the ministry issued notice of four violations at Halton Hills under the Long-term Care Homes Act, including failing to ensure that weekly skin and wound assessments of residents were completed. It’s unclear whether the infraction relates to Luiza’s care. The family says they haven’t heard back from the ministry.
After they lodged their complaint with the ministry, the family installed two cameras with a live feed in Luiza’s room.
“We see her on video at night tossing, turning, yelling in pain from her foot. It’s heartbreaking,” said her son.
The cameras revealed other issues with her care, the couple said.
One clip appears to show a care worker turning off Luiza’s emergency call button and saying, “Stop calling me.”
WATCH | What happened in Luiza Dos Anjos’s room:
Family’s camera shows Extendicare Halton Hills employee entering Luiza Dos Anjos’s room. The employee appears to turn off the emergency call button and tells Dos Anjos, “Don’t call me.”0:14
The family said they complained and the employee no longer works at the facility.
Asked about the concerns raised by some families, Extendicare said it is “absolutely committed” to providing its residents with the highest quality care.
“Any issue regarding resident care should be brought to our attention immediately so we can take swift action,” the company said in a statement. 
Millions spent on COVID-19 response 
Extendicare said that like other health-care providers, it has struggled to find enough staffing this year.
“Staffing long-term care homes during a worldwide pandemic, against the backdrop of an industry-wide shortage of health-care workers, is a major challenge.”
WATCH | A look at CBC’s Big Spend investigation: 
CBC News senior investigative editor Diana Swain discusses what sparked the investigation into the federal governments pandemic spending and why theres different information available in the U.S.1:32
The company said it spent $42.5 million on its COVID-19 response in an effort to protect its long-term care residents and boost staffing $22.7 million of that came from the Ontario government.
It also received another $82.2 million from the federal government, which the company says was used to boost staffing at its ParaMed division, which provides care for people still living at home.
None of the $104.9 million in public money Extendicare received was used to pay shareholders, the company said.
So far this year, the company has paid out $30.5 million in dividends to its investors.
More stories in this series:
The Markham, Ont., company owns 69 retirement and long-term care homes in Ontario, Manitoba, Saskatchewan and Alberta.
It also provides contract services to 53 other long-term care facilities in Canada.
According to Ontario’s Ministry of Health and Long-Term Care, 153 residents and staff have died of COVID-19 in Extendicare-owned or operated facilities in the province.
Sienna pays $43M to shareholders
The Ontario government has given Sienna Senior Living Inc., another Markham-based, for-profit care provider, $53.7 million so far this year.
“Of this total, $26 million was flow-through funding from the provincial government that went directly to front-line team members for the mandatory temporary pandemic pay program,” said Nadia Daniell-Colarossi, Sienna’s communications manager.
The other $27.7 million in provincial funding was spent on hiring additional front-line staff, personal protective equipment (PPE), sanitizing and cleaning supplies, infection prevention and control experts and training, the company said.
Sienna Senior Living said it has spent $73.7 million on its pandemic response so far, including $20.5 million above and beyond what it received in government aid. The company said it has added 1,800 new team members. 
“Protecting our residents and team members is our highest priority,” Sienna said in a statement to CBC News.
Sienna has also paid out $43.6 million to its shareholders this year and insists none of that came from the money it received from taxpayers.
Still, some families of Sienna residents say the company didn’t do enough to improve care and keep residents safe.
According to the Ontario Ministry of Health, 329 residents and staff have died of COVID-19 in Sienna-owned or operated care facilities. Hundreds more fell ill.
Daughter upset with quality of care
The family of the late Mable Douglas says they certainly didn’t notice an improvement in the quality of care at the Sienna-operated Altamont care home in Toronto’s east end.
She survived a COVID-19 infection there in the spring.
In October, the 95-year-old was rushed to hospital after her blood sugar levels had gone unchecked for days and spiked to levels six times higher than normal, said her daughter, Andrea. Mable spent seven days in hospital.
Four days after returning to Altamont, Mable, who had to be fed by staff, aspirated on food that had become lodged in her lungs and died, Andrea said. 
“She heaved for breath, one breath after another, for 14 hours, which went until … she finally stopped breathing,” said Andrea, who was with her mother in her final hours.
“She didn’t need to die this way.”
Since July, Altamont has been hit with at least five care violations from provincial inspectors, including failure to provide clear direction to staff and others who provide care.
At least 50 residents of the facility have died of COVID-19.
Sienna says it has learned a great deal since the pandemic began.
“During wave one of the COVID-19 pandemic, the protocols prescribed by medical experts and the provincial government changed almost daily,” the company said in an emailed statement.
“As the COVID-19 virus became better understood, better measures were enacted. We took those learnings and developed a robust plan to proactively respond to wave two to protect residents’ and team members’ health and safety.”
Ontario pledged to spend a further $540 million on long-term care as part of its fall preparedness plan, which included money for infection control, PPE and minor capital repairs to facilities.

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