April 13, 2020, by Sue Lantz, Managing Director

COVID-19 is causing ravaging damage to the people who live and work in various types of residential and institutional settings serving seniors and people with disabilities.  The question is, why are we not going full force to protect these residents and the dedicated front-line staff who are showing up every day to provide care for vulnerable seniors and people with disabilities? The residents are the most frail, medically complex and vulnerable seniors in our society.  The COVID-19 is incredibly virulent, and a lethal combination of confusing, ever-changing symptoms. This makes it so challenging to contain. The front-line clinicians and PSW workers risking their health and lives, and yet they are also the lowest paid healthcare workers in the system. 

In today’s Globe and Mail, Andre Picard highlights the number of long-term care homes experiencing outbreaks in Canada, including some settings where staff members are walking off the job due to their concerns over the health risks in performing their job without adequate protections.   

I wholeheartedly agree with his view that we need to do everything we can do now, to get through the pandemic without much more damage, and after COVID-19, we can focus on the long-standing structural, policy and quality oversight gaps in long-term care, and the broader seniors care system.

https://www.theglobeandmail.com/canada/article-seniors-care-shouldnt-be-a-horror-show-even-when-the-pandemic-is/

WHAT WE MUST DO – ONTARIO

As of Friday April 9, 2020 the number of confirmed cases of COVID-19 in LTC homes or retirement homes in Ontario was 498 residents and 347 staff making it a total of 845 cases.  At that time, the combination of staff and residents was almost one-quarter of the total COVID-19 confirmed cases in Ontario. Of these cases, there were 86 deaths of LTC residents, which represented almost half of the deaths in Ontario due to COVID-19. 

Over the weekend, the number of cases has risen daily by least 6% each day, with the new total of cases at 7,740 and deaths at 291. More details to come on the percentage of these new cases and deaths in LTC homes.

Last Thursday April 8th, Ontario Premier Doug Ford announced his commitment on to dramatically increase the COVID-19 testing in the testing centres and elsewhere.  He called upon healthcare leaders to rapidly ramp up the number of tests to over 13,000 per day.   Also, on April 11, 2020 Alberta Premier Jason Kenney announced that Alberta is stepping up to share their excess supply of vitally needed respirators and personal protective equipment and supplies with Ontario, Quebec and BC.  These measures are a huge help, given the low testing rates and unprecedented shortages of PPE in Ontario.  In late March, the Ontario government also announced $243 million for surge capacity in the long-term care sector, as well as funding for 24/7 screening, more staffing to support infection control, and supplies and equipment to help tackle the COVID-19 outbreak.

Within this context, Ontario must swiftly take the following targeted actions to protect and support the residents, staff by implementing the following increased supports to Long-Term Care sector:

  • Utilize mobile testing teams (and/or pay staff to go to designated testing centres) to ensure that all staff, residents, volunteers with long-term care homes are tested for COVID-19.  While family members are not allowed into homes under the no-visitor policy, exceptions to could be considered to allow families of residents who are dying to have compassionate access to their family member if they wear proper PPE.
  • Ensure that all LTC staff members are provided with Personal Protective Equipment to provide adequate precautions. This would include ensuring the use of N95 masks for those exposed to residents with suspected or confirmed COVID-19 infection. In addition, staff must be able to access changes of masks and PPE in accordance with the precautionary principle.
  • Offer immediate training and support all LTC staff, volunteers and managers in the use of PPE and the evolving public health guidelines on COVID-19
  • Offer counselling/mental health supports for front-line staff as they cope with the stress, loss and anxiety of the situation
  • Move rapidly to fund capacity and support enhancements for the LTC workforce by:
    • providing funding to support workers to work full-time hours in one LTC home location, wherever possible.  This would involve increasing the work hours and thereby decreasing the number of workers going in and out of a LTC home
    • Recruiting or redeploying the appropriately trained staff as per existing LTCHA regulations (versus emergency legislation) to immediately improve staffing and care levels in the homes.
    • Increase the compensation package (wages/benefits) for LTC staff to stabilize the workforce and increase the chances of success of recruitment/redeployment efforts.

These targeted actions during the COVID-19 crisis will help contain the spread and damage of COVID-19 and protect the health and lives of both residents and the healthcare teams within LTC homes.

Longer Term

There will be many legacies of COVID-19, and both positive and negative lessons learned.  When the global pandemic crisis is over, things will not be the same.   We will analyze and reflect upon what we have learned from various perspectives – seniors, families, the community, neighborhoods, housing and health providers and levels of government.  Building on the many lessons and insights we can fundamentally “re-think” of our supply, funding, legislative and policy frameworks, and physical designs of seniors housing, social care and residential/institutional models.   We can, and will do better.

3 thoughts on “Priorities in the Time of COVID-19

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  • April 15, 2020 at 7:56 pm
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    Thank you, Sue. Well said. Apparently, it’s not been about knowing the right thing to do, or what is less than acceptable; the Star and others have been reporting on outrageous conditions in LTC for years and years, saying again and again: we’ve been here before. The pandemic is horrific and those in LTC “perfect targets.” That too has been and is well known. Those in public positions who have to say something know what to say. But following through takes more than words. With you I hope and pray there will be the kind of change of heart that will bring the right priorities and the right commitment to those priorities. We shall see.

    Reply
    • April 19, 2020 at 12:25 pm
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      Thanks Tom – yes, the media have reported the issues in the long-term care sector for years. And, while actions have been taken over the years (e.g. Ontario’s legislative framework for LTC), the situation is so much more complex than this. I feel that by referring these homes “as long-term care” we are using the wrong name! Most residents do not live long in these facilities. In fact, most of the residents are in the last 18-24 months of life. They are often seniors who have the most complex medical needs and live with dementia. Given the changes over the last several years in the resident population, I feel we need to completely re-think the vision and operating philosophy of these facilities, and offer the right types (and staffing levels) of healthcare, psycho-social and spiritual supports. In tandem with this, we can also expand the supply and type of housing and support options by working directly with seniors to co-design these options. The window for concerted action is NOW, and by bringing together individuals, organizations and all levels of government. We can do better!

      Reply

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