Rethinking long-term care

In the Atlantic region, so far we’ve been spared the worst of the COVID-19 pandemic. Numbers have been relatively low and, except for the serious outbreak at the Northwood facility in Halifax, longterm care homes have for the most part escaped the ravages of the virus.

But Northwood is an important bellwether, and one every public health authority in the Atlantic provinces should be keeping in mind.

If you look at Northwood — and, for that matter, at the way the virus has hit the rest of the country — it’s pretty clear that serious changes have to be made before the expected second wave of the virus arrives, perhaps as early as this fall.

When you look at the numbers across the country, the hardest-hit places — not only in Nova Scotia, but in Ontario, Quebec, Alberta and British Columbia as well — have been long-term care facilities.

Not only that, but the facilities that have been the most affected have something else in common: they have had shared rooms, often with three or more patients in close quarters.

(As of early June, Northwood had managed to bring the number of people in shared rooms down to 25, in part, tragically, because more than 50 patients had died.)

In Quebec and Ontario, thousands of long-term care patients have died, and some staggering statistical trails have appeared. In Ontario, upgraded standards for long-term homes were put in place in 1998, but roughly one-third of the province’s homes were grandfathered in under the 1998 rules, allowing them to stay at an earlier 1972 standard — which, among other things, allowed for up to four patients in a room.

That one-third of facilities has accounted for almost 60 per cent of the deaths in long-term care in that province, and some of the most virulent outbreaks there.

It’s pretty clear it’s a status quo that can’t remain. But it’s not just multiple patients in the same room.

A focus on keeping COVID-19 out of long-term care facilities — where patients are often already compromised by other medical conditions — will be critical.

That involves more frequent testing of facility staff, better infection control generally, and a larger pool of trained staff to replace staff who may become infected and unable to work. (Right now, Quebec is training 10,000 new long-term care staff, to have them ready and able to be deployed as early as September.)

There is not much time to prepare and, across the country, it’s become abundantly clear that long-term care facilities have been a hot spot for the virus, and risk becoming the same again.

We’ve learned a lot about COVID-19 during the first wave.

We’ve got to be ready to apply those lessons quickly and effectively — or else brace ourselves for similar infection rates and a similar result.