How one hospital’s early help for nursing homes paid off
Markham Stouffville stepped in to offer its expertise to local facilities when COVID-19 hit
For long-term-care homes, a helping hand during a pandemic doesn’t always come in the form of face masks or ventilators — sometimes it comes in the form of medical know-how.
So when Dr. Allan Grill, chief of family medicine at Markham Stouffville Hospital, got the call that a nearby longterm-care home was dealing with a COVID-19 outbreak, he immediately offered the hospital’s expertise.
In return, the hospital asked for full transparency from the home.
“It was about what (the home) needed. But we said, ‘if we don’t have an answer today, we want an answer tomorrow,’ ” said Grill. “This wasn’t about pointing fingers. This was about how do we collaborate to support these homes.”
Markham Stouffville Hospital is home to experts in geriatric care, infection control and hygiene protocol — and Grill connected them to the 20 nursing homes in the hospital’s catchment area.
Out of those homes, only one is now in what public health calls the “red zone,” signifying a critical outbreak, according to the hospital. Two are categorized as yellow and the other 17 green — in other words, stable.
Dozens of out-of-control outbreaks in other care homes in Ontario are a stark reminder of what’s at stake. More than a hundred long-term-care homes in Ontario are dealing with a COVID-19 outbreak and at least 1,660 residents have died as of Wednesday, according to the Health Ministry.
Deaths in long-term-care homes account for more than 80 per cent of coronavirus-related deaths in Canada, according to a recent report from the National Institute on Aging.
At least two class-lawsuits have been launched against long-term-care homes in this country, alleging negligence and lack of preparedness for COVID-19.
Markhaven Home for Seniors in Markham was one of Ontario’s first nursing homes hit by COVID-19. Its medical director, Dr. Barry Strauss, said the help they received from Markham Stouffville was invaluable during the early days of the outbreak.
“Medically, we felt we needed backup in terms of access to expertise in dealing with COVID issues because it was so new,” Strauss said.
He also described the anxiety he and others working in the long-term-care sector felt about the arrival of COVID-19 in Canada’s care homes. It was new for everyone, but those working in hospitals had looked at case studies from countries, such as China and Italy, hit earlier — so they could offer smart advice.
“That support enabled a certain comfort level to deal with problems because you knew you had people that would back
ou up and help you,” said Strauss. “That can make a huge difference.”
COVID-19 is an extremely difficult disease to contain — more difficult than most respiratory diseases, said Strauss. The lengthy incubation period and asymptomatic nature of the disease meant that many homes had no idea the virus was making the rounds inside their walls until dozens of residents fell ill.
He said he could not imagine dealing with a COVID-19 outbreak without the hospital’s support. “It would be very difficult to manage without help.”
Yet that’s what many longterm-care homes in the province tried to do. Five were in such dire straits the army was called in to help. Others waited until there were so many deaths it became clear an outside organization, such as a hospital or the Red Cross, had to enter the home to stabilize the situation.
Cheryl Osborne, director of patient care for Markham Stouffville’s emergency care and ambulatory service, said the hospital has not had to take control of a single home in the area. She attributes that to the preventative work dozens of nurses and doctors have done to help homes respond to the pandemic.
Osborne and Grill helped set up two mobile nursing teams that could be deployed to longterm-care homes. These teams provided support to homes struggling with staffing shortages and helped set up infection-control protocols to ensure management had the tools to deal with future outbreaks.
Hand hygiene, personal protective equipment training, cleaning protocols and social-distancing practices were among the issues the nursing teams looked at, she said.
Most important, staff are taught how to do regular audits on themselves so they would be well positioned to continue the work after the nursing team leaves, she said.
And for homes that were not able to arrange a daily visit from a doctor, “We recruited physicians for them,” said Grill. “We prioritized any home that (had an) outbreak.”
And those doctors’ generosity was “contagious,” he said. More and more people began offering their services to the team, easing the burden on the few who started the initiative.
Word of the success of this collaborative approach has spread.
“We’ve had other regions call us and ask for advice on what we were doing,” said Osborne.
Grill hosts and participates in dozens of Zoom calls every week with public health representatives, geriatric specialists and long-term-care home administrators to make all this possible.
He says he has worked 12-hour days, seven days a week since mid-March.
He said he doesn’t know of any other hospital in Ontario’s Central health region that has developed a similar support network for long-term-care homes.
“I can’t prove that what we did prevented outbreaks … but we tried something, we think it’s quite effective and we think it can be duplicated everywhere.”