Ontario LTC homes need money and support, not condemnation from Trudeau

Not only are long-term care (LTC) homes fighting COVID-19 but also the prime minister. On April 23, Prime Minister Justin Trudeau claimed “We are failing our parents and grandparents (with the) terrible tragedies in long-term care, this is unacceptable.”

On April 22, Ontario Premier Doug Ford took a more positive and action oriented approach to reducing outbreaks, promising “every option is on the table to get our LTC homes what they need to stop the spread.” He was referring to increased testing of residents and staff and providing “COVID-19 Response Teams” to help homes put in place infection control protocols, resolve staff issues and fulfil personal protective equipment (PPE) needs.

Currently in Ontario homes are forbidden to use volunteers and family visits have been curtailed except in palliative cases. So why do outbreaks continue to grow? It must be staff and visiting professionals who are asymptomatic who are infecting residents. Also, the layout and programming of the home are not suitable to halt transmission among residents. Once inside, COVID-19 insidiously spreads until symptoms show and isolation can take place.

Even new testing of all staff and residents will not stop transmission of infection already in the home. In time, by removal of any infected staff and isolation of infected residents, these numbers will come down. Even then, continuous, perhaps daily testing of all those entering the home and residents, will be needed to stop the escalation. Infection will be contained by isolating those newly infected.

Some of the various practices that make a LTC facility a “home, challenge our control of COVID-19. Approximately 40 per cent of residents are in shared rooms — often two residents per room but in some older homes even more. Every resident in their own private room would allow for more effective isolation, but many cannot afford the private room “premium.” To offer all residents a private room at the basic/shared room rate would require additional government subsidy of over $800,000 per year for a home with 144 beds!

The cost of expanding or renovating existing homes to convert all rooms to private for each of the province’s 630 LTC homes would also be considerable.

Many homes could be more spacious to allow increased social distancing. A dining room for 30 residents with four at a table could be reduced to two and activity rooms could be doubled in size. Wider corridors and larger shower/tub rooms could also help.

Staffing the entrance at least 16 hours per day screening and testing all who enter would be an excellent practice. Homes are currently screening at the entrance but they do not have the budget to do this year round. Also, an unlimited supply of PPE (masks, shields, gloves and gowns) would help stop the spread — think even more money.

We have many “infection challenging” LTC features that turn the “facility” into a “home”: visits by family and friends, performances by school choirs, visiting volunteers, therapy animals and foot care, dental, audiology and chiropractic specialists to name a few. Recreation programs abound; pubs, movie night, community outings, takeout dinners and entertainers. These bring many individuals into the home increasing the chances of infection but all enrich the daily experience for residents. Reducing the number of part time staff, testing of all staff and residents and removing or isolating those infected will help “flatten the curve.” With COVID-19 in the community, LTC homes will need to frequently test those entering to reduce infection. Contact tracing must be completed with each new case and newly infected residents must be isolated and staff serving them must employ appropriate PPE to protect themselves and others.

So is the long-term care world doomed to failure in its current configuration? Unless the prime minister and premier announce new funding to allow for the physical restructuring of homes and increased staffing, we will continue to put remedial efforts in place as COVID-19 outbreaks occur. As you can see, the inclusion of community, the intimacy of dining and other rooms, the sharing of bedrooms and opportunities for close resident contact are all the essence of current LTC home living — but all pose challenges when fighting the spread of infection.

Maybe the prime minister could show more “cacerolazo” (pot banging) and follow the lead of the Ontario government?

The inclusion of community, the intimacy of dining and other rooms and opportunities for close resident contact are the essence of LTC home living