Staffing tops care-home priorities
Commission on long-term care makes recommendations to reduce COVID risk
Ontario's Long-Term Care COVID-19 Commission issued urgent interim recommendations Friday, saying the province's longterm care homes remain at risk as the pandemic continues to grow.
“We have heard that long-term care homes were forgotten in the initial provincial plans to control the spread of COVID-19 until residents started dying, and pleas that this not be repeated when this crisis is over.”
Among its strongest recommendations was that the provincial government not delay fixing critical staffing shortages, saying a comprehensive plan to do so already exists in its own Long-Term Care Staffing Study, which was released in July.
“Further study of the study is not necessary. What is required is timely implementation.”
That would include mandating that every resident receive a minimum daily average of four hours of direct care — something that has long been recommended and pushed for by advocates. The government also needs to increase permanent funding for more nurses and support staff in long-term, care homes, the commission recommended.
The commission's recommendations that the province move quickly to add more staff reflects concerns of advocates and critics who say the problems are well documented and require urgent action to prevent a repeat of the first wave of the pandemic in longterm care.
But the head of the organization that represents not-for-profit care homes in Ontario said she wishes the recommendations went further. Lisa Levin, head of AdvantAge Ontario, said the province should immediately set up COVID teams to be sent into homes with outbreaks and staff shortages while it works on increasing staff levels.
More than 1,900 long-term care residents have died of COVID-19 since the pandemic began in Ontario. Three-quarters of all deaths in Ontario during the first wave were in long-term care. Ottawa has had some of the worst outbreaks during the second wave, including at West End Villa where 20 residents have died since late August.
The commission said it has heard “heart wrenching” accounts of experiences during the first wave of the pandemic “that resulted in tragic loss of life, suffering and devastating impacts on residents, families and staff.”
Among individuals and organizations, it heard testimony from SEIU, the union that represents 60,000 frontline health workers, including three who died from COVID-19.
Some of its members described being told to take off their masks because they would scare residents and, at one home, having to break into a cabinet to find masks to protect themselves. The union said workers got little response to their concerns about their safety and the safety of residents, especially early in the pandemic when the province ended in-person home inspections.
The report said all witnesses agreed long-term care residents are frailer than they were 10 or 20 years ago and most have some form of cognitive impairment and ongoing medical conditions.
“For that reason, the quality of care and quality of life for longterm care residents depends on an adequate supply and mix of skilled and qualified staff.”
The commission said numerous witnesses described “critical staffing shortages,” which have been long-standing in long-term care and are well documented in numerous reports.
“COVID-19 exposed these challenges in stark terms.”
The commission prodded the province to get moving on fixing those long-standing issues with an “appropriate staff mix” that includes personal support workers, nurses and others.
It also recommended that local hospitals and public health units begin working with high-risk longterm care homes in advance of outbreaks to better support them when outbreaks occur.
Ottawa's Chief Medical Officer Dr. Vera Etches testified that Ottawa Public Health is in close contact with 14 local long-term care homes that could be high risk. The Ottawa Hospital is overseeing two of the Ottawa long-term care homes that have been hardest hit during the second wave.
The commission recommended that infection prevention and control be strengthened with more ministry support, a dedicated person in charge at each home and priority access to testing and quick results.
It also recommended that residents who have COVID-19 have the option to transfer elsewhere to avoid further transmission.
Headed by Superior Court Justice Frank Marrocco, the commission includes Dr. Jack Kitts, former head of The Ottawa Hospital, and Angela Coke, a former senior executive in the Ontario public service.
It was given until the end of April next year to produce a full report, but said it decided to issue some early recommendations because of the urgency of the situation.
“These early recommendations do not represent our final word,” the commissioners wrote.
“Based on our ongoing investigation, our final report will provide an account of what happened in the first wave of the pandemic and provide a broad range of recommendations that deal with preCOVID systemic challenges and factors that contributed to the tragedy in long-term care homes.”
The provincial government has committed more than $500 million to help long-term care homes handle the second wave of the pandemic. It says it will release a PSW staffing plan by the end of the year.