Geriatric expert critical of response
Province delayed implementing federal guidelines for long-term care facilities
HALIFAX — Nova Scotia lagged in adopting two specific federal COVID-19 guidelines for long-term care homes — instructing workers to wear surgical masks and testing asymptomatic residents at outbreak sites — that might have minimized a deadly COVID-19 epidemic at Northwood nursing home, says the country’s foremost geriatrics expert.
“The idea is during a pandemic or a fast-moving virus, you’ve got to be quick, you have to take the best evidence and move on that right away, and I can’t speak to why Nova Scotia took a bit longer to implement those things,” said Samir Sinha, director of geriatrics at Sinai Health and University Health Network in Toronto.
“But I’m glad Nova Scotia finally did implement them because everyone in Atlantic Canada can see now how quickly COVID-19 can be deadly when it gets into a nursing home.”
Sinha is also the chief researcher at the National Institute on Aging and provided input into the Public Health Agency of Canada guidelines for long-term care facilities issued April 8. Since then, the institute has documented each province’s progress in adopting the guidelines up until April 21.
Twenty-two Northwood residents have died of the virus since April 18. Sinha’s data indicates the Nova Scotia government implemented the federal guidelines just days before the first COVID-19 deaths at the Halifax home.
One of the guidelines calls for all long-term care providers and visitors to wear surgical masks. It took four days for Nova Scotia to make the recommendation policy on April 12. By comparison, B.C. had the policy in place more than two weeks before Nova Scotia, on March 25.
Three days passed before the province acted on another guideline calling for testing to be done on all residents at outbreak sites. New Brunswick, which has had no COVID-19 deaths at any of its nursing homes, had already started testing residents with mild symptoms nine days before Nova Scotia, on April 2.
“You could say Nova Scotia was a little more reactive than other provinces and took necessary extra precautions after things really started to get bad,” said Sinha.
As of Friday, 93 per cent of COVID-19 deaths in Nova Scotia (27 out of 29) were residents of nursing homes. This is the highest percentage in the country, where the national average is 71 per cent, according to Sinha.
Research conducted over the last month at the Centers for Disease Control and Prevention in the U.S. yielded important findings, showing upwards of 50 to 75 per cent of nursing home residents testing positive for COVID-19 didn’t know they were carriers.
“The two big lessons that have come about are, one, we have to mask everybody working in these environments to make it less likely for workers to pass the virus onto a resident or colleague,” said Sinha. “The other aspect is we’ve been realizing over the last month that with COVID there is a big level of asymptomatic or atypical presentation. “These are big revelations that told us that there are things that we need to be doing.”
The province also took two weeks to enact another Public Health Agency of Canada guideline to limit nursing home workers from working at multiple longterm care facilities. That policy came into effect in Nova Scotia on April 23, three days after New Brunswick and Newfoundland adopted the recommendation.
Along with New Brunswick, Newfoundland and Labrador and P.E.I. also have had no COVID-19 related deaths at their longterm care facilities.
Saltwire Network contacted the Health Department to have the province’s chief medical officer of health, Dr. Robert Strang, explain the lag in implementing the federal guidelines. The department responded by email pointing to a process involved in considering the guidelines and “that each jurisdiction needs to assess the applicability, feasibility and implications of adopting these guidelines within their jurisdiction.”
“If a decision to follow the guidelines is made, there then needs to be communication with all relevant stakeholders before formal adoption and implementation. There is no requirement for provincial/ territorial jurisdictions to adopt national guidelines.”
Staffing shortfalls underlie a systemic issue of inadequate government funding for both not-for-profit nursing homes, like Northwood, but also privately owned facilities, said Sinha.
Back in 2016, the Liberal government axed $8.2 million in provincial funding to 103 out of 134 longterm care facilities, most of the nursing homes for the elderly. The move resulted in staffing layoffs across the province including in Middleton, Port Hawkesbury, Halifax, Dartmouth and Amherst.
The shortfall in funding means essential nursing home workers, such as continuing care assistants, are underpaid, said Sinha. A CCA'S starting wage is $17.56 per hour in Nova Scotia. But many nursing homes in the province, including Northwood, hire essential staff part-time as a cost-saving measure.
Consequently, full-time and part-time CCAS end up picking up additional shifts at different nursing homes in order to make ends meet, while potentially spreading the virus from one facility to another.