QUESTIONS FOR Azi Boloorchi (MBA ‘09)
A Rotman alumna describes the toll COVID-19 has taken on the long-term care sector.
Tragically, most of Canada’s COVID-19 deaths have occurred among seniors living in congregate settings. Your leadership team assembled an independent Advisory Panel to study the situation. Please describe its key findings.
We convened a panel chaired by Dr. Bob Bell that included experts in geriatrics, public health, infectious disease, infection control, labour relations, architecture, healthcare policy and healthcare design. Their overall finding was that COVID-19 not only exposed cracks within the sector, but also the broken links between it and the system as a whole. This translated into a series of systemic breakdowns that allowed the virus to flourish in long-term care.
Among these breakdowns was a sector-wide shortage of personal protective equipment (PPE) to shield staff and residents from transmitting and contracting infection. While Revera is large enough to have our own strategic sourcing team and we always had ample PPE supply, smaller operators faced a critical situation for their residents and staff. A private -sector led initiative called Canadian Alliance to Protect and Equip Seniors Living (CAPES) launched in April to source and distribute personal protective equipment to smaller senior living operators when PPE was sent to hospitals instead of long-term care homes. Revera overfunded our PPE orders by as much as 35 per cent to make
PPE supplies available to smaller operators. The equipment, including masks, isolation gowns and gloves, was distributed across multiple channels with the reserve supplying those small operators most in need.
There was also a woeful lack of laboratory testing throughout the pandemic’s first wave to identify those who were infected. Another challenge was inconsistent direction on how the virus behaved and how to protect against it. Staff at one Revera home, for example, received training from the region’s emergency medical services personnel — only to be told a day later by the local public-health unit that the instructions were incorrect and staff had to be re-trained.
In the pandemic’s early days, the broad need for personal protection was also misunderstood. For instance, masks were considered unnecessary for people without symptoms. Echoing the stance of the World Health Organization, Canada’s chief medical officer of health recommended on March 30 that masks be worn only by the sick, or those caring for them. That advice soon changed.
The pandemic also exacerbated the sector’s pre-existing problems and historic challenges, which include outdated facilities with multi-bed shared rooms and communal bathrooms. As the pandemic stretched on, the sector’s shortages of personal support workers (PSWS) and nurses intensified and challenged the industry’s efforts to keep staff at appropriate levels. Together, all of these circumstances combined to create a ‘perfect storm’.
Describe some of the steps Revera has taken since that report came out last fall.
The panel made several recommendations, and many have already been implemented across our properties. These include: Establishing regional inventories to provide supplementary supplies of PPE during an outbreak; ensuring the presence of medical directors on site during an outbreak; having one family member per resident be designated as an Essential Care Giver; implementing routine surveillance testing for employees; and enhancing training staff in the management of COVID-19 (which spread unlike other viruses previously managed at our sites).
One of the key recommendations was to eliminate fourbed resident rooms and shared bathrooms in long-term care homes. We have been advocating for this for years — and have also had a long-term care redevelopment program in front of the government for years. Yet before the pandemic, only one site had reached the point of construction. The bureaucracy around this is very challenging in Ontario.
How has the pandemic affected your role as VP of Innovation at Revera?
What drew me to this company in 2015 is that the company is committed to embracing innovation as a lever to improve the resident and staff experience, as well as operational standards. We go about achieving this in a few ways. We have a program dedicated to engaging our residents in innovation, as well as one that engages staff. And we have another program called Innovators in Aging, which has a corporate venture capital fund attached to it, dedicated to getting ideas and innovations from the start-up community and helping them pilot and scale.
We’ve already invested in six or seven start-ups to help commercialize their products. Our criteria are, does it improve the resident experience? Does it help our staff do their job? And, does it have potential to scale? We’ve invested in things like image-recognition for pressure-ulcer management and reduction, and another start-up, Bookjane, is helping to address staffing with automated shift callouts. Some of the other start-ups help us provide better activities and entertainment for our residents, whether by tracking their preferences or offering virtual reality experiences. We accelerated that one during the pandemic, because our residents could no longer leave the facility.
At the beginning of 2021, my mandate was expanded to include data and analytics. One of the areas I am focusing on is understanding our experience with the first wave, based on the data. We want to understand, for instance, what contributing factors make one outbreak more severe than another. My team and I created a machine learning model with the goal to understand outbreak risk factors for sites. If we can understand which factors increase the risk of an outbreak, can put mitigation measures in place immediately.
Describe the challenges posed by ‘the thin pink line’.
Alongside the hundreds of thousands of seniors who live in Canada’s long-term care homes and retirement residences, there is a veritable army of workers who care for them: kitchen, dietary and housekeeping staff; registered nurses; nurse practitioners; doctors; occupational therapists; and
physiotherapists. But by far, the largest employee category in any long term care home is the personal support worker (PSW).
Despite the invaluable role PSWS and nurses play, there has been a shortage of people entering these professions for years. Long before the pandemic hit, the PSW shortage had reached a crisis point. During the first wave — in which 508 Revera staff members contracted COVID-19 and countless more were quarantined — up to a quarter of the company’s full-time PSWS were either unable or unwilling to come to work, and a considerable portion of part-time staff were also unavailable. Staff levels reached record lows, just as workloads reached record highs.
The staffing challenges the sector faces are complex, and they are covered in detail in our Expert Panel Report, which is available online. I would encourage people interested in learning more to read it.
Seniors represent a growing proportion of the population in Canada. Is the senior-living sector ready for this shift?
Housing the aging demographic doesn’t have to be all about retirement residences and long-term care homes. It should be about choice, and that should include home care. Someone with advanced dementia may not benefit from staying at home, and some people prefer the social aspects of a retirement residence; but lots of seniors would love to remain at home and have care come to them.
From a Revera perspective, we have a healthy pipeline of new retirement residences being built. These will be places where people live relatively independently in a congregate setting that offers recreation programs, meal programs and access to care when needed. As for long-term care — which is a medical model for people who need a significant amount of care — I am cautiously optimistic that we will find the political and business will to invest. We need to focus more on identifying the needs of seniors, as a customer segment. We need to really think through the options that we can offer them.
Have there been any silver linings for your organization from this pandemic?
For the long-term care sector, this has not just been a crisis, it has been a tragedy — so it’s very difficult to see any silver lining. But one thing I will say is that the sector really came together. For example, as I have mentioned, larger operators helped fund PPE purchases for smaller operators early on, before supplies stabilized. Another example is that together with Chartwell, Extendicare and Sienna, Revera launched the Seniors CARES Fund to provide emergency financial assistance for workers in the senior living sector experiencing hardship. To date, the fund has awarded $2.5 million to 500 senior care workers. We all recognized that we were in this together and we did what we could to help each other help the people who live in retirement homes and long term care homes.
It was also amazing to see how our staff came together and prioritized residents above themselves. The sacrifices they made were heroic, to say the least — some staff asked for us to put them up in hotels because they could not risk giving the virus to their family, others were flown to outbreak sites to share their expertise and didn’t see their families for weeks. Our staff put themselves at risk daily, and some contracted COVID-19 themselves. Everyone went above and beyond to help, and that really brought us together as a team.
In a broader sense, we all need to embrace the key learnings from this pandemic. Our learnings from SARS didn’t necessarily translate into broader public health and longterm care policies. I am hopeful that this time, they will.
I am cautiously optimistic that we will find the political and business will to invest in our senior-living sector.