`WE SAID WE WOULD NEVER LET THIS HAPPEN AGAIN'
As the second wave of the pandemic hits the city and an Ottawa long-term care home deals with a deadly outbreak, some families say their elder relatives are paying the price for a summer of lost opportunity to learn and improve, as Elizabeth Payne explain
Nearly six months after COVID-19 outbreaks ravaged long-term care homes in Ontario, a second wave has hit. This time, so far, the devastation has been centred at Ottawa's West End Villa, where nine deaths have occurred since an outbreak was declared earlier this month. As with the first wave, much of the political energy in the province is focused elsewhere: this time on schools and testing.
It is hard to avoid the feeling of déjà vu.
Six months ago, while much of the province's attention was focused on preparing hospitals for the pandemic, a deadly COVID-19 outbreak took hold inside Pinecrest Nursing Home in Bobcaygeon, Ont. Before it was over, more than one-third of the home's residents — 29 of 65 people — would be dead.
That was the beginning. Many more such outbreaks and hundreds of deaths would follow, making Ontario and Canada among the worst jurisdictions in the world when it came to COVID-19 and long-term care homes. Across Canada, more than 80 per cent of COVID-19 deaths have been in long-term care.
Ontario's failure to protect vulnerable long-term care residents from the virus has been widely seen as a provincial shame. Now there is growing fear that it is happening again.
Now, there is another deadly outbreak at an Ontario care home, this time at Ottawa's West End Villa as the city enters a second wave of the pandemic. As with the first wave, much of the political energy in the province is focused elsewhere — this time on schools and testing.
As of Friday, 52 residents and 26 staff members have been infected with COVID-19 at West End Villa since an outbreak was declared there less than a month ago. Nine residents have died, leaving families reeling. The death toll has gone up steadily in the past week and dozens more residents and staff members are awaiting test results.
It is, so far, the province's only outbreak of its magnitude since the first wave, although 65 homes have had outbreaks since Sept. 2, affecting 210 residents and staff. Because of how quickly it has spread, some see West End Villa as a warning sign that history is about to repeat itself.
That terrifies Dr. Nathan Stall, a geriatrician and research fellow at Women's College Research Institute in Toronto, who has studied how COVID-19 spread through Ontario's long-term care homes during the early months of the pandemic. Among his findings was that private homes tended to do worse than not-for-profit homes once COVID-19 made its way in.
“It is very shocking and very scary. We said we would never let this happen again.”
Stall says urgent action is needed to prevent another catastrophe, but he does not see that action being taken. Long-term care has not received the attention it requires to prevent a second wave of deaths among residents, he said. “I think we are abandoning long-term care homes for a second time.”
At West End Villa, some family members allege, that is already happening. They say they are seeing a repeat of the kind of practices that contributed to the spread of COVID-19 the first time around. That includes lapses in infection control and staff shortages.
The home says it has strictly followed public health guidelines, increased staffing on the floor where infected residents are congregated, brought in daily medical staff and that staffing is stable. The home's administrator said it overstaffed before the outbreak “out of an abundance of caution.”
Lea Maurice, whose 76-year-old disabled grandmother lives in the home, says her grandmother was left in a room with a sick roommate for 24 hours after that roommate tested positive for COVID-19.
The roommate had been showing signs of illness for days before she was tested, Maurice says. After the roommate tested positive, Maurice says, the home only moved her after relatives complained.
It took another eight hours, Maurice and other family members allege, before the room was sanitized; even then, it was done with her grandmother in the room.
Maurice's grandmother, who is not being named to protect her privacy, has now tested positive for COVID. She had to be tested twice. Officials with the home told family members the original test was inadvertently cancelled by the lab where it was sent for processing.
Maurice said she can't understand why it took so long to move the roommate to protect her grandmother and two other residents with whom they shared a bathroom.
“I feel like at the first sign of any sickness, all residents should be isolated. If they would have isolated (the grandmother's roommate) at the very first sign of feeling unwell, possibly this could have prevented my grandmother from becoming COVID positive,” said Maurice. “What has happened there and is happening is completely unacceptable.”
Maurice's grandmother is on the fourth floor of West End Villa, where residents with COVID-19 are being cohorted. Officials with the home say they have dramatically increase staff numbers on that floor, but families with loved ones on other floors say they are seeing fluctuations in staffing and that standard 12-to-one ratios of residents to personal support workers are not enough.
A family with a loved one on another floor say they witnessed
We are dealing with critical staffing shortages, even without outbreaks.
an unmasked nurse coming into a room to dispense medicine during the outbreak.
West End Villa is now the subject of a class-action lawsuit filed by Seniors for Social Action Ontario, which is calling on the province to issue a cease admissions order for the home. The home has a history of serious incidents, says the group, including the case of a resident whose wound was found to be infested with maggots in 2016.
West End Villa, which is operated by private nursing home company Extendicare, has gone out of its way to keep family members informed during the outbreak, others point out. The home sends daily email updates and has been holding weekly question-and-answer sessions online.
“This is a deeply concerning time for our residents and families and we are in touch with them on a regular basis about our progress as we manage this outbreak,” Kelly Keeler, administrator of Extendicare West End Villa, said in a statement to this newspaper.
Keeler said the home's outbreak procedures “strictly follow the guidelines from our partners at public health, including our infection prevention and control practices.”
“We cohort residents (keeping COVID-19 positive residents separate from others) as we receive their test results to ensure accuracy in cohorting and to prevent further spread. This is the practice in long-term care homes across the province.”
Her statement did not specifically address allegations made by Maurice, saying “we cannot speak to individual circumstances.”
She added: “Our ability to protect the people in our care is the most important part of what we do and we take our responsibility to them extremely seriously.”
Officials with West End Villa say it has significantly increased staffing on the floor where infected patients are being cohorted and its staffing levels are stable. It is also receiving regular support from community paramedics and hospital-based nurse practitioners.
But there are hints there could be limits to extra help long-term care homes are able to get if outbreaks worsen this fall. During the first wave, many hospitals were relatively quiet and staff members were able to fill gaps in overwhelmed long-term care homes that were dealing with large outbreaks with numerous staff off sick and others who went elsewhere.
This time, as hospitals scramble to work through backlogged surgeries and beds fill up, there are few bodies to spare.
West End Villa asked for help from The Ottawa Hospital to assist with the outbreak, the home's staff doctor told a virtual town hall meeting this week. The hospital said it didn't have staff to assist the home “at the present time.”
A worsening staff shortage at long-term care homes has observers and health officials on edge as new outbreaks spread across the province.
Stall said there have been
improvements in long-term care homes since the spring. Among them: a greater understanding that the coronavirus can be spread by those who are asymptomatic or pre-symptomatic; better access to personal protective equipment; and widespread testing, something that is being practised at West End Villa with routine testing and retesting of residents and staff. There is also a greater awareness in Ontario and across Canada of the “extreme vulnerability” of the long-term care sector, said Stall.
Even so, there remain gaps. Stall says the province wasted an opportunity during the summer to do something about the biggest problem — staff shortages.
“We are dealing with critical staffing shortages, even without outbreaks.”
Over the summer, Stall notes, the provincial government made numerous announcements about money for new long-term care homes, but did not significantly address staffing issues, even after a provincially appointed panel detailed severe shortages in homes during the first wave of the pandemic.
“There were a lot of missed opportunities. That is what is really terrifying homes now.”
In answer to a question about long-term care outbreaks, Premier Doug Ford said Friday that frequent testing of staff and increasing pay are crucial.
“I've always said — and it's easy to sit back and talk about it, but we're going to put action to the words — PSWs in the province of Ontario are underpaid, overworked, and until we bring up the pay — which we're doing, because I'm all over Health right now to get this through Treasury as soon as possible — we (can't) attract more people.”
Stall and NDP Health critic France Gélinas both point out that Quebec took extensive action to hire, train and retain long-term care home staff, something Ontario did not do. Pandemic pay, an extra bump of money that incentivized people to work in longterm care, has dried up.
Gélinas said the province has failed to mandate minimum hours of care in long-term care homes, which would require increased staffing. It has also failed to follow the lead of other provinces and make sure personal support workers get paid enough to live on and get full-time jobs.
Gélinas said she believes staffing levels are worse in many long-term care homes now than they were at the start of the pandemic — in part, because staff must work at only one home, leading many to give up and move to retail where they can earn more money.
Long-term care officials have asked the province to create a program in which PSWs could be trained while working on-site at long-term care homes. That has not happened.
The sister of one resident at West End Villa has tried to call Ford in recent days to ask him to set up a grant program, similar to the ones for trades, to bring more PSWs on board. She has been unable to get through. She also wants the owners of long-term care homes where there are large outbreaks and deaths held accountable.
“They should stop focusing on the profit level and paying stakeholders.”
Meanwhile, Gélinas notes that the review set up by the province to look into the high rate of infections and deaths in long-term care homes has not confirmed it will hold any public hearings. The NDP and others were asking for a public inquiry with changes made as it progressed.
“We are in September. Didn't we learn from the mistakes we made? I would say no.”