seniors’ homes from the next wave
the elderly has put spotlight on system’s deep vulnerabilities
Isobel MacKenzie called “a lucky break” for British Columbians, whereas an unfortunately timed spring break led to a wave of infected spring breakers returning to Ontario and Quebec, driving caseloads which eventually filtered into homes.
Or as Sinha put the jurisdictional divide, “Days matter with COVID [and] B.C. was able to take control and apply the evidence.”
In Ontario, however, care facilities were left to fend for themselves, he said. Second wave Health officials and researchers largely agree that B.C.’s “Iron Ring” protocol established an effective emergency baseline in responding to outbreaks at seniors’ homes.
It’s a strategy many say was aided by the province’s health authority system, offering a command and control structure that allowed it to quickly centralize the distribution of gowns and masks in the early stages of the pandemic.
Health authorities continue to roll out widespread testing of asymptomatic patients, and in Fraser Health – the hardest hit health authority in the province – officials told Glacier Media that they’re recruiting and training a pool of new contact tracers to be ready for a resurgence of the virus in the fall.
One of the biggest concerns, according to Schwandt, is the potential for a second wave of COVID-19 to overlap with an influenza season.
“Right now if someone has a cough and a fever in B.C., we would say COVID-19 is very high on your list of concerns as a clinician. With flu in the mix or other seasonal respiratory infections like the common cold, it will become much more challenging,” he said, adding that his team is currently analyzing any gaps in testing capacity.
Despite all the precautions, the strict emergency protocols that have protected many B.C. homes from the first wave of the virus have created unforeseen consequences, and some say those oversights are starting to catch up with staff and residents. Closing the gaps It wasn’t until the end of June that B.C.’s nursing homes fully implemented the protocol, something MacKenzie says speaks to the fragmentation of the system.
Every health official and researcher interviewed for this story agreed federal and provincial governments need to work towards national standards for care aide training, pay and oversight of the $1.3 billion in government transfers made in B.C. every year to ensure quality care.
“It doesn’t take a rocket scientist,” said MacKenzie. “We need to move towards offering full-time jobs at a decent salary. It requires training, not extensive training but some training. It absolutely requires a sense of responsibility.”
But many doubt whether such an institutional shift can get off the ground in time for a second wave. Care aides make up roughly 70% of staff at long-term care homes, but there are others behind the scenes who say they’ve fallen through the cracks.
“What sticks out the most to me was how support services – so laundry, housekeeping and dietary – are overlooked, and yet we are the grassroots of the facility. We hold this thing together,” said one worker who manages dozens
The key is nobody has been taking stock of how much unpaid care was actually being provided in these settings [] DR. SAMIR SINHA DIRECTOR OF GERIATRICS, SINAI HOSPITAL
of kitchen and laundry staff serving over 500 residents in Fraser and Vancouver Coastal Health.
The woman, who asked to have her name withheld because she feared repercussions at work, said she has been left shorthanded while health officials bolster the ranks of their care aid colleagues.
“Fraser Health did not consider support services as essential as care, so we suffered quite a bit. When we got hit with COVID, I was a housekeeper, I helped out in laundry, I did dietary aid and I cooked – all in one day,” she said. “I was working 70 hours a week in order to make ends meet.”
Part of the problem is a shadow workforce – made up of essential family visitors – that has been kept out of long-term care since the first lockdown at the Lynn Valley, said Sinha.
“The key is nobody has been taking stock of how much unpaid care was actually being provided in these settings,” he said.
The estimates are massive: 93% of Canadians receiving government-funded home care have a family caregiver involved, according to data from the National Institute on Ageing.
“All that stopped overnight,” said Sinha.
Now, as the province opens up care homes to family, Sinha is urging health officials to build a reserve family workforce for seniors’ homes, one that is trained in the use of masks and gowns and can support staff should the province be hit by a second wave of the pathogen.
“The nuance is during an outbreak if there are family members who want to be partners in care and remain, how do you figure out what works,” he said. “This is not a way to cheap out on the nursing or the care that we provide. This is a ‘both ends’ approach.”
For Dr. Schwandt, balancing the benefit of a family member’s presence with the risk of introducing the virus is something health officials will need to tread for many months or even years ahead.
“We do need to find a way to walk that line.”