No-visitor policies leave care-home residents without key family support
From the moment she entered a long-term care facility in Ottawa, the elderly woman’s family was by her side, feeding her, caring for her and keeping a close eye on her health during daily visits.
That ended in March when long-term care homes across Ontario brought in strict no-visitor policies because of the pandemic. Within a month, the woman’s health was failing. In mid-April, staff contacted her family to tell them she was unresponsive.
She died two days after being rushed to hospital. By then, she was severely dehydrated, had lost weight and was suffering from kidney failure, says her granddaughter Ilona Miller, a nurse practitioner. Among the first things Miller did when she got into the hospital to see her grandmother was soothe her cracked lips, which were covered with sores.
In order to protect her family’s privacy, Miller has asked that her grandmother’s name and the name of the institution where she lived be kept private.
The elderly woman tested negative for COVID-19, but her family believes she, too, was a victim of the pandemic. And she is not alone.
Families have long provided a crucial level of care and quality control for loved ones in longterm care, hospitals and group living situations. During the lockdown, that care has been removed as part of visitor bans.
Across Canada, families and organizations representing caregivers are calling on governments to let family caregivers back in to long-term care homes, hospitals and group homes where their regular care should be deemed an essential service. Their absence, they say, is putting already vulnerable residents at increased risk during the pandemic.
Julie Drury, the strategic lead for patient partnership with the Canadian Foundation for Healthcare Improvement, says family caregivers play an essential role in the health system and that is more important than ever.
“We must stop viewing family members as solely risks to resident safety when, in actuality, they may be the missing layer of support and protection these residents so desperately need right now.”
She said the visitor restrictions during the pandemic make sense, but essential family caregivers should be exempted. Like Miller’s family, many family members regularly help feed and care for their loved ones in long-term care, hospitals and group homes. Along with providing hands-on care, they check that residents are eating and drinking enough and not suffering from any overlooked ailments.
Their exclusion during the pandemic has left staff in some homes scrambling to try to feed residents, according to a nurse who volunteered to help at one hard-hit Ottawa long-term care home. When she got into their rooms around 7 p.m., their dinners were cold and untouched, she said.
With residents confined to their rooms, no additional help from families and increased staff shortages during the pandemic, staff members say they have very little time to make sure residents eat properly.
The Citizen has spoken with several families who say their loved ones, some of whom were suffering from COVID -19, lost significant weight while in long-term care homes during the pandemic.
Miller questions how her grandmother’s weight loss, urinary tract infection and dehydration went unnoticed for so long once family members were not in the home. Before the pandemic, Miller says, she could recognize subtle changes in her grandmother’s health and would alert the nurse.
She doesn’t blame health-care workers in the facility where her grandmother lived, but says the pandemic has revealed a long-term care system that is poorly equipped to deal effectively with the medical needs of fragile residents.
“The COVID-19 pandemic has exposed serious faults in the system: imbalance of medical versus personal care, (and) underfunded staffing levels that decrease workers’ motivation and predisposes them to work in two or three different facilities to make their salaries.”
She also said the high number of residents that each nurse is in charge of makes it impossible for nurses to do their duties properly. Miller believes all long-term care homes need to have an attending physician or nurse practitioner on site 24/7 to deal with emergencies and that resources should be available for emergency hydration and feeding so residents don’t have to go to the hospital — similar to complex continuing care in hospitals.
Some of those staffing issues are likely to be addressed in the longterm care inquiry the Ontario government has committed to hold beginning in the fall.
Meanwhile, organizations say it is urgent that family caregivers be able to get back to the bedsides of their loved ones as soon as possible.
The Ontario Caregiver Organization says 3.3 million caregivers in the province provide an estimated three-quarters of care “as part of the broader health-care continuum.” That includes families who provide hands-on care to loved ones in long-term care homes and other institutions.
The organization says family caregivers play a role in co-designing policies and programs to improve the health of family members in the Ontario health system. Its CEO Amy Coupal said the organization is exploring ways family caregivers could get access during the pandemic while adhering to infection-control measures.
The Canadian Foundation for Healthcare Improvement has studied the impact of family caregivers in hospitals and found their presence helps change potential medication errors, reduces falls and injuries, and improves medical oversight, communication and the well-being of patients.
It is planning to do similar research involving care homes for the elderly. Drury said anecdotally it is clear family caregivers are providing essential services in long-term care as well as having a positive impact on the health and well-being of their loved ones.
Drury said it has been particularly difficult for families to understand why they are not allowed to care for their loved ones when the government has called for volunteers to help in long-term care homes and even brought in cleaners and other workers from schools.
“They are wondering when it is going to be their turn to get back to the bedside in a caring capacity.” epayne@postmedia.com
The COVID-19 pandemic has exposed serious faults in the system …