Are we about to have a new COVID surge in long-term care?
‘I absolutely am very terrified and worried,’ physician says as numbers near April levels
Seniors advocates and medical professionals are warning we could be on the cusp of another long-term-care catastrophe as COVID-19 cases in Ontario homes hover around similar numbers seen in early April — just two weeks before a massive spike of infections tore through hundreds of facilities.
“I absolutely am very terrified and worried,” said Dr. Amit Arya, a palliative care physician specializing in long-term care who witnessed first-hand the devastation of the first wave in GTA facilities. “We have to really realize that long-term care is not a parallel universe. More spread of COVID-19 in the community increases the risk of an outbreak starting in long-termcare facilities.”
As of Thursday, there were 159 residents and 199 staff members of long-term-care homes with active cases of COVID-19, according to the provincial government. Compare that to 176 long-term-care residents and 141 staff members with COVID-19 as of April 7, according to data collected by the Ontario Health Coalition, anon-profit, non-partisan network of public health care advocates.
The April numbers collected by the coalition are not scientific and likely didn’t capture all infections.
But they are the best data available from that time because the province didn’t start publishing active home-byhome long-term-care outbreak figures until more than two weeks later.
Current provincial data is stark: active cases in long-termcare homes have more than quadrupled since Sept. 1, while the number of homes with outbreaks since then has risen from 13 to 71.
Outbreaks in some areas are severe. Two Toronto homes, Vermont Square and Fairview Nursing home, each have more than two dozen confirmed resident cases, with 27 and 13 confirmed staff cases, respectively.
This past weekend, the federal government gave the go-ahead to the Red Cross to assist in seven Ottawa-area long-termcare homes after the Ontario government reached out for help. Ottawa was recently declared a red zone, the most serious classification public health can assign for the presence of COVID-19, and was one of three regions, along with Toronto and Peel, to be moved back to Stage 2 of reopening last week.
And on Wednesday, the province announced it was prohibiting long-term-care residents in these regions from taking short-term outings for social or personal reasons. That followed an earlier restriction on general visitors to long-termcare homes in these regions, with only essential visitors, including up to one caregiver per resident, being allowed.
But experts say such measures are not enough to stop what could become a full-blown second wave in homes. They say addressing acute staffing shortages in homes is critical to preventing more infections and deaths.
“Homes are still desperately understaffed, many of them more so than at the beginning of the first wave,” said Natalie Mehra, executive director of the Ontario Health Coalition.
She pointed to a recent report in the Ottawa Citizen detailing comments of a worker at Extedicare’s West End Villa in Ottawa who said there have been times at the home when just two PSWs were caring for 60 residents infected.
“That would be impossible even if they weren’t sick with COVID-19. It’s just unspeakable,” said Mehra. “There is no possible way for that few PSWs to abide by PPE changing protocols and all the infection control measures. They can barely make it through the day.”
The staffing shortage has resulted in health workers from employment agencies working in multiple locations and even PSWs providing care to people in their homes as well as in long-term-care facilities, she said. The practice continues, despite a provincial order in April prohibiting health workers from working at more than one long-term-care facility. The reason? The ban did not apply to temporary workers, a measure critics have labelled a “giant loophole.”
Mehra said Ontario should follow the ambitious response of its neighbour, Quebec, which launched a massive recruitment drive in June to not only hire, but also train, 10,000 orderlies (equivalent to PSWs in Ontario). Recruits were paid $760 a week during training and guaranteed full-time jobs paying $26 an hour upon completion. Quebec also hired about 400 managers — one for each long-term-care home — to be responsible for each home’s response to COVID-19. Each manager was also paired with an infection-control specialist to ensure homes followed proper protocols.
“Where was the systemic intervention in the lull that happened from June right through to the beginning of September to get actual staffing up in the homes like Quebec did to build some resilience for the second wave that was inevitable?” said Mehra.
But finding enough people to take up the mantle is a challenge, said Miranda Ferrier, president of the Ontario Personal Support Workers Association.
“Right now this is not a profession that’s very attractive. You’re working in COVID-positive homes, you don’t have enough staff, you’re constantly burnt out, you don’t get the professional recognition,” she said, referring to the fact that PSWs are not regulated like other health professions, such as nurses and doctors.
Ferrier said there are about 135,000 trained PSWs in Ontario but only about 60,000 are actually working.
“It’s not a profession of choice right now, unfortunately, even though it is a very honourable position,” she said. “We are very much in crisis and we run an extremely high risk of catastrophic consequences.”
Donna Duncan, CEO of the Ontario Long Term Care Association, which represents 70 per cent of the province’s longterm-care homes, said her organization “has been clear” with the Ontario government and other stakeholders about the challenges homes face and what is required to keep them stabilized through a second wave of this global pandemic.
“Recent commitments of personal protective equipment, minor capital investments and infection prevention and control resources will begin to address some of the gaps in the system, but will only be successful if they are deployed quickly and enhanced to meet the outstanding system needs,” she said, adding that the number one issue confronting homes continues to be the staffing crisis in long-term care.
“Ensuring the health and safety of our residents and staff in our homes is critical to our ability to recruit and retain a new workforce in long-term care homes. These measures will help us in our recruiting efforts. We need to recruit an army of employees for long-term care,” she said.
“We need to be proactive,” said Arya, saying there is no reason for Ontario not to have acted sooner to address staffing shortages. He pointed to B.C., which has a long-term-care sector about half the size of Ontario’s, but had one-tenth the deaths during the first wave.
This more favourable outcome is credited partly to the fact that the B.C. government hired all front-line long-termcare staff in March, ensuring they received decent living wages, and restricted their employment to one facility.
“If we protect the rights of health workers, if we improve their working conditions, we improve the conditions of care,” Arya said. In Ontario, he added, it appears as though we are “protecting the operators and we’re not protecting who we should be, which is the residents and their families.”