Keep the faith in long-term care amid pandemic: operators
Gail Metcalfe knows first-hand what's involved with looking after a loved one who needs special care.
For six-and-a-half years, the Charlottetown, PEI resident provided around-the-clock care for her husband Barrie, who had been diagnosed with Parkinson's with Lewy Body dementia at the age of 58.
Two years after his diagnosis, Metcalfe retired from her job when it was no longer safe for him to be at home by himself.
Eventually, it became more than she could handle as she was always tired, lonely, and felt quite isolated. The physical effort required left her drained of energy. Long-term care was inevitable.
Metcalfe moved into an apartment next to the nursing home so she could be available for him and still help with his care.
That's when she began noticing systemic issues with longterm care.
Staff changed frequently over the course of the week, and she says they just weren't used to what her husband needed. It presented issues which interfered with his care, she says. There always seemed to be staff shortages, which left residents with deficiencies in care, and staff would be called in to fill in who had no idea about what each resident required.
“I provided as much care for him as the staff did some days,” she says.
Metcalfe's husband passed away five years ago. Over the past number of months, Metcalfe has felt thankful that COVID-19 did not happen when her husband was in care.
“It brings me to tears to think of how he would have perceived me just ‘disappearing' during the pandemic, and of how uncomfortable he would have been with simple issues like positioning in bed,” she says.
COVID-19, she says, has shown how long-term care has been an issue at the bottom of government's list forever, says Metcalfe.
Metcalfe has served on a provincial committee in PEI studying long-term care, where she provided feedback on the current situation and recommendations on how things need to change.
“It is sad to know that it took something like the pandemic to put in on their radar and to show people with no experience of long-term care, exactly how things happen,” she says.
REVIEW NEEDS TO HAPPEN
Michele Lowe, managing director of the Nursing Homes Association of Nova Scotia, agrees. COVID-19 has shone a light on the systemic issues that exist in long-term care throughout Nova Scotia and Canada, she says.
“We have advocated for many years that an investment by government into long-term care is needed,” she says.
Lowe says long-term care needs to change significantly in Nova Scotia and Canada-wide, starting with creating a vision of how we want to care for elders as a society. She'd like to see a provincial strategy that reflects the acuity level of our elders; a multi-year infrastructure plan that offers dignity and privacy for elders and supports infection control in older facilities; and a compensation plan for frontline staff and the backline staff that reflects their true value, talent, skills, competencies and critical role in long-term care.
All of these issues require urgent attention and, sadly, it may be a pandemic that initiates these changes, she says.
In particular, the Northwood long-term care home in Halifax was hit hard, with more than 50 people dying from COVID19.
Lowe says the recent experience at Northwood is tragic and devastating to the families who have lost their loved ones and to the staff who cared deeply for them. As a result, she says the Nova Scotia government is conducting a review of the events that happened there and also a review of the infection control protocols in long-term care.
“We have 132 long-term care facilities in Nova Scotia and only eight were impacted by COVID-19,” she says.
Regardless, Lowe says, they are very confident that the infection control protocols adopted in nursing homes throughout Nova Scotia are meeting all provincial standards.
“We look forward to learning more about any adjustments that we may adopt as the review unfolds and before the second wave arrives,” she says.
Melvin Layden is regional director of long-term care for Eastern Health in Newfoundland, with responsibilities for nursing homes, personal care homes, and placement services. He says they have learned a great deal over the course of the COVID-19 pandemic and feel the organization is prepared in the event of a second outbreak.
While the pandemic necessitated that they implement strict visitor restrictions and isolation requirements, he says they have learned to work through the associated challenges to ensure safe, quality care for their long-term care residents.
“Because of the existing measures already in place, we are ready to operationalize if there is another wave very quickly,” he says.
For example, Layden says the Eastern Health's long-term care program has kept an inventory of guidelines and processes that were developed and updated in response to the evolving situation, maintained regular pandemic planning meetings, developed screening and testing protocols which, if required, can quickly be adjusted, and minimized cross movement of staff.
DIFFICULT SITUATION
Layden says he recognizes that visitor restrictions were difficult for families. Family members, he says, are a vital connection to residents and may be involved, like Metcalfe, in varying aspects of the dayto-day care of their loved ones.
Family members were also understandably worried for their loved ones and he anticipates that some may inquire about the possibility of caring for a resident at home if there's another wave of COVID-19.
Lowe, however, urges families to remember that many seniors are living with multiple illnesses that require 24/7 care.
Layden adds that if family members would like to take a resident home, any risks or scenarios would be clearly communicated with the family.
“We will assist with the transition to community and involve residents and families in developing a discharge plan so that families understand the specific needs of the resident,” says Layden.
Families would need to have a plan in case there's a disruption in home support services and all care must be done by family members. There is also a risk of exposure of COVID-19 in the community, particularly, if multiple people such as family members or home support workers are required to help care for the resident in the community.
The resident may have to remain outside the facility for many weeks, or even months, depending on the duration of the COVID-19 outbreak. If, or when, the resident returns to a long-term care facility, they may be required to isolate for 14 days upon readmission.
And, Layden says, returning will all depend on whether a bed is still available, as their space may have been reallocated to another resident in need.
Metcalfe believes some families may opt to make other choices for long-term care of family members moving forward. For those who can afford to hire help at home or do not have full-time jobs, maintaining a family member at home might be an option in crisis mode for the shortterm, says Metcalfe.
“No one actually wants to have to choose long-term care, but the reality in today's world is that it requires a lot of sacrifices, especially to your own health, to keep a person at home safely,” she says.
Overall, Layden and Lowe hope people will not lose faith in long-term care facilities and still see it as a viable option for family members.
“When you decide as a family that it is no longer safe or appropriate to care for a loved one at home, accessing the specialized care that long-term care offers is the right choice for families,” says Lowe.
The speciality care provided in nursing homes is very good, and although there are many systemic challenges in long-term care, Lowe says families with loved ones in nursing homes have recognized staff for their high quality of care before and during COVID-19.