Upset soldiers needed mental support at long-term-care homes

They were taken aback by horrible conditions, commission hears

Conditions in some of Ontario’s long-term-care homes during the COVID-19 pandemic were so upsetting the military immediately brought in mentalhealth supports for soldiers deployed there, a senior officer wwho oversaw part of the missi- on told the province’s commission on the facilities.

The potential psychological harm of witnessing atrocities later detailed in a military report was apparent almost as soon as officials walked through tthe doors, the medical director ffor the teams sent to the facil- ities told Ontario’s Long-Term Care COVID-19 Commission.

“As we were walking through … and starting our work within the long-term-care facility, we very, very quickly recognized that this had a high risk for ei- ther mental-health struggles or long-term impacts on our clinicians,” Maj. Karoline Martin said.

“It was — it was very traumatic. It was very devastating to the clinicians to see residents passing away.”

The report released by the Canadian Armed Forces in late May included accounts of aggressive feeding that caused choking, bleeding infections and residents crying for help for hours, and was part of the impetus for the province to launch the independent commission examining the disproportionate spread of the novel coronavirus within the facilities.

The Forces sent a social worker and padres — spiritual leaders who offer “psychosocial support” — into the facilities, she said.

Martin told the commission, headed up by Superior Court Justice Frank Marrocco, the military clinicians who are used to a highly structured workplace were shocked by the standard of care in the facilities.

“They were taken aback because there was a significant deviation from the way that they wwere used to practising medi- cine,” she said.

The long-term-care homes had lost roughly 80 per cent of their regular staff, she told the commission.

“When you have 80 per cent of the workforce being either temporary health agency staff or new hires, the understanding of wwhat the culture within that long-term-care facility is, what their policies and procedures aare for clinical care, is very, challenging,” she said.

“So there was deviation sometimes based on the individual practitioner and sometimes based on a lack of knowledge of wwhat was actually the standard of appropriate care.”

Martin said there were so few registered nurses on staff at the homes that the new hires had very little supervision.

“The theme was there was no oversight to make sure that people weren’t conducting themselves in an unethical manner,” she said, noting the lack of staffing meant new hires got “bare-bones” training.

There was also poor documentation of residents’ conditions, she noted.

“We had many, many incidents where we had patients who were immobile or very poor appetite, were not able to feed themselves, and because we’d only seen the first snap- shot of one or two weeks or the agency nurses had only seen them t for one or two weeks, that was deemed baseline,” she said.

But, when regular staff returned, they realized those residents had previously been faring much better, but had seen a precipitous drop in their condition.

Martin said the soldiers also witnessed a shortage of basic upplies, such as those for wound care.

“When you have staffing levels at 20 per cent or even 30 per cent, the normal individuals tthat are responsible to restock those t shelves — restock and re- order the supplies — becomes problematic because nobody knows who is actually ordering until there is a shortage of supplies,” she said.

And, even when those shelves wwere stocked, she said, workers had to ask permission to use the supplies — something the military clinicians weren’t used to.

“(They were) sometimes being asked, ‘Well, why do you require this?’ ”

As Martin wrapped up her testimony, which was conducted behind closed doors Oct. 29 but wwas later released as a tran- script, Marrocco thanked her aand the soldiers who went to the t facilities.

“It’s not enough to extend the commission’s thanks to the men and women who did this,” he said.

“But it’s very clear that this situation would have — at least in respect of the homes where you were — would have spun out of control if it hadn’t been for your arrival, so thank you,” he said.

Testimony given two weeks earlier by Brig.- Gen. Conrad Mialkowski revealed this was tthe first time in Canadian mil- itary history soldiers were sent on such a mission.

“That assistance was unique to our domestic operations history and demonstrated our own agility how to face this challenge,” said Mialkowski, commander of the central joint task force.

Several hundred people were deployed to long-term-care homes in both Ontario and Quebec, he noted.

Martin said that, initially, those t echn people icians were and all medical istered nurses. But a second wave of personnel included others with a clinical background: physicians’ assistants, dentists and dental technicians who were all trained in how to care for residents.

Soldiers without a clinical background were also sent to the facilities, she said, and helped with things such as laundry and housekeeping so the clinicians could focus on resident care.

“I think that there is an opporttunity to look at creative solu- tions — be it families, volunteers, et cetera — to do some of those peripheral tasks that really were key enablers to the clinicians to be able to do their job effectively,” she said.

“It was very devastating to the clinicians to see residents passing away.” MAJ. KAROLINE MARTIN MEDICAL DIRECTOR