I read with dismay today’s opinion article by Andre Picard in the Globe and Mail. The article chronicles the nightmares of COVID-19 for the residents, front-line staff and caregivers of seniors in the publicly-funded long-term care homes and also many retirement and senior residences as well. https://www.theglobeandmail.com/canada/article-if-you-can-get-your-relatives-out-of-seniors-homes-try-to-do-so-as/
The article highlights the long-standing structural, funding, staff levels and facility design issues within long-term care (LTC) homes that serve the most vulnerable seniors in our society. These structural factors mixed with the highly virulent COVID-19 virus, combine to create a “petrie dish” of escalating risk of illness and death. Picard states that if you have a “loved one in long-term care…if they fall ill with COVID-19, they may have a one in three chance in dying”. Put in the context of Ontario alone, this means a significant number of the over 77,000 seniors living in a long-term care home in Ontario could die quickly. Add to this, the high health risks of the front-line staff having to work without adequate Personal Protective Equipment (PPE), this makes for a serious situation.
While I agree with how dire the situation is, I strongly disagree with the quote by Dr. Samir Sinha, a highly regarded Geriatrician who stated, “If my mom was in long-term care, I would pull her out. Now”. This statement borders on cruelty to the already stressed families or caregivers that feel helpless and fearful at not being allowed to physically visit the home, or provide support to their loved one, during this COVID-19 crisis. It also ignores the research evidence and realities of the circumstances of these seniors and their family caregivers. For example, 65% of the seniors living in LTC in Ontario live with dementia/cognitive impairments. 100% of seniors living in LTC homes have multiple health conditions that affect their mobility and functional independence. Add to this, many of the family caregivers are also seniors with underlying health conditions themselves, which also places them at high- risk of illness or death due to COVID-19. Their own dwelling may not be safe, accessible or outfitted (including supplies and PPE) to provide the needed care. Most caregivers are unable to physically manage the medical and other care needs of the person, at the best of times.
On top of this, the families have already been through the traumatic and protracted “long-term care placement” application process to qualify for access to a home. On an emotional level, families already feel guilt and stress of having to make the decision to move their loved one into a home. So, suggesting that they bring their family member home during the COVID-19 crisis is not fair suggestion or a viable option. In fact, it amplifies the feelings that family members experience such as heartbreak, fear, guilt, and immense loss.
Now more than ever, it is time to find the most compassionate, practical, low-cost solutions that support families and residents to strengthen their contact and connection to get through the COVID-19 crisis. Here are some concrete and resourceful ideas that can be put in place quickly on top of the existing infection control actions being taken in these settings.
- Create a specific role that is designated within a long-term care home as the “point person” for families and whose sole responsibility it is to facilitate the contact and connections with families/caregivers. This would reduce the demands on the front-line staff to allow them to focus on providing the higher levels of hands-on care needed by residents.
- Offer these families/caregivers virtual daily check-ins (by telephone or e-visits) to allow them to say some important things to their loved one, share a favourite piece of music, or in some cases, say farewell in their last days of life. Families could also send written e-mails that could be read to the resident by this contact person.
- Provide grief counselling (at no cost) to individuals and families to offer the most compassionate support to offer at a time of crisis. This counselling can be offered in several ways including:
1) Set up an easy online mechanism for caregivers to access qualified professionals for psycho-social and grief counselling (e.g. by social workers and psychologists) using virtual methods
2) Offer grief support (by phone or virtually) to individual caregivers by utilizing some of the trained volunteers in the Hospice Palliative care sector. This sector already has a pool of volunteer resources who are fully trained (and security checked) to listen and help people through grief, loss and bereavement.
This list is just a start.
Let’s find the collaborative solutions to support seniors, their family caregivers and the front-line staff who are working hard to provide the best possible care in this situation.
It’s time to accelerate meaningful solutions that truly help seniors and families to address their very real feelings of fear, separation from loved ones and grief during this COVID-19 crisis.
Sue Lantz, BA, MPA
Managing Director, Collaborative Aging