‘There’s nobody coming to help’
Nursing home residents struggle with loneliness, physical and mental decline amid staffing crisis
With each long-term-care lockdown, John Jarema watched his mother decline.
Before COVID’s first wave kept Daniela alone in her room, she used a walker to join fellow residents in the common area of her west Toronto nursing home, the not-forprofit Copernicus Lodge. Now, in the Omicron wave, 94-year-old Daniela is in a wheelchair, probably for good, her son said.
Once, she knew her way around the home. After the first lockdown, she no longer recognized her room. Now, she can’t leave it.
“I realize that dementia can account for some of this,” Jarema said, “but the mental and physical deterioration is quite evident since these lockdowns came into effect.”
The greatest blow to residents is the loss of workers, with thousands infected and isolating at home, leaving remaining staff on extra duties, rushing from one resident to the next.
Omicron, said Dr. Nathan Stall, is the “pandemic of staffing shortages.”
“The huge fear is that there are almost 4,000 staff members infected across the province, which is twice the previous high of Wave 1,” said Stall, a geriatrician at Sinai Health. “And so, it is truly the lack of people to actually provide handson care that may end up resulting in more harm and death to residents if appropriate staffing is not secured.”
A registered practical nurse said her home has been devastated by the virus, with dozens of staff and essential caregivers testing positive. The home is on full lockdown, with residents isolated in their rooms.
“It’s worse for the residents,” she said. “The only contact they have with the outside world are the PSWs (personal support workers) and the RPNs. We don’t have the four-person ward rooms anymore, but if they’re lucky, they have a roommate. Otherwise, it’s brutal.”
Jarema speaks highly of staff at Copernicus and last week was optimistic that residents in his mother’s unit could soon mingle again as COVID cases resolved. On Sunday, he learned of a new positive COVID test, and, the lockdown continues.
Daniela’s decline is not unusual in homes across Ontario.
While family or friends deemed essential caregivers can now visit during outbreaks, the drain of previous lockdowns has left residents struggling from loneliness and lack of physical movement.
Some no longer speak. Others are severely depressed. Many, like Daniela, spent months in their rooms, losing the strength in their legs and, with it, their independence.
In the infectious Omicron wave, social isolation has worsened as staff caught the virus. Many have no symptoms but learn of their infections through homes’ daily rapid antigen testing. One home caught nine positive cases, all asymptomatic, on a recent weekend.
As workers isolate, many homes are left with a skeletal staff. Those who remain are often exhausted, working multiple double shifts. In a Jan. 14 email to families, Copernicus Lodge management said that while 23 of its 55 staff cases were resolved, “Healthcare facilities are experiencing a crisis in health human resources (staffing) never experienced before.”
In a written statement to the Star, Copernicus said measures to protect against COVID-19 have had “unintended consequences on the physical and mental health of (long-term-care) residents everywhere.”
Toronto Public Health, the statement said, is allowing COVID-free residents with no symptoms or exposures to walk in hallways and eat in their dining room.
“It’s a balancing act,” the spokesperson said. Even though residents have their third or fourth booster shots, there is “no guarantee of immunity to the virus. And while some may suffer less severe symptoms … that isn’t the case for all.”
According to the most recent Ontario Ministry of Health data, 371 of Ontario’s 626 long-term-care homes have active outbreaks with 3,956 COVID cases among workers.
Stall, the geriatrician who is running as a provincial Liberal candidate in Toronto’s St. Paul’s riding, is keeping a close watch on Ontario’s long-term-care data.
Stall said 172 nursing home residents died of COVID between Dec. 1, 2021, and Jan. 23, according to the Ontario data catalogue that tracks COVID cases in long-term care. Death numbers are frequently updated on multiple sources of data, but the tracking catalogue figures show that in the current Omicron wave, 17.9 per cent of all Ontarians who died of the virus were longterm-care residents. In the first wave, from March 17 to Aug. 31, 2020, 64.5 per cent of all Ontario COVID deaths were nursing home residents, he said.
“Given how transmissible Omicron is, and how many are infected, had it not been for the vaccines it is unimaginable what the deaths would have been in Ontario right now, even though we’ve had the tragic loss of life of 172 residents,” Stall said.
Omicron’s swift spread through long-term care — even those homes with strict infection control — is crushing a workforce worn from two years of COVID, with some workers leaving for good.
Long-term-care operators and advocates say some are going to private staffing agencies or jurisdictions like Nova Scotia that aren’t impacted by legislation limiting public-sector workers to a pay increase of one per cent annually for three years. In Ontario’s long-termcare system, that 2019 legislation, called Bill 124, only caps the pay in not-for-profit and charitable homes because municipal and forprofit homes are exempt, advocates say.
“As a result, the staffing crisis is exacerbated in non-profit homes because they can’t compete,” said Lisa Levin, CEO of Advantage of Ontario, which represents not-forprofit, charitable and municipal homes.
“When we are in the middle of such an extreme staffing shortage, the need for higher salaries and enticements is even greater.”
All Ontario nursing homes are licensed and funded by the Ministry of Long-Term Care, but there are some differences. Not-for-profit and charitable homes that generate a surplus put the money back into the home. Private operators can remove profits from certain approved areas of their operation and, for example, share the money with investors. Municipal homes are run by regional or local governments and get additional funding from those taxpayers.
Advocates say that staffing losses are hitting homes across the sector and while acknowledging the importance of limiting Omicron’s spread, many say it is equally vital to give residents the social connections they desperately need.
“I think there is a good proportion who are simply giving up on life,” said Doris Grinspun, CEO of the Registered Nurses’ Association of Ontario (RNAO). “Many are suffering from failure to thrive.”
It’s not just limits on visitors or the loss of outside trips with family. Like Stall, of Sinai Health, Grinspun said residents are “suffering from the isolation of less staff.”
Staff shortages are not new. Long before the pandemic, nursing homes across North America struggled to find workers, although small homes designed for roughly 10 residents say their workers have greater job satisfaction and, as a result, higher staff retention. Since COVID arrived in Ontario’s much larger long-term-care homes, the staff, their employers and unions say workers are depleted, struggling to get through another wave.
Bill 124, the controversial legislation that caps wages of many public sector workers, is partly to blame for the current staffing problem, advocates say, because some nurses are now taking higher-paying agency jobs or accepting offers of better wages from other provinces or countries.
As homes struggle, administrators are sometimes forced to pay agencies double or nearly triple the hourly rates for nurses and personal support workers. Some agencies charge anywhere from $85 to $125 an hour or more for a veteran registered nurse who might otherwise earn just under $50 an hour in a nursing home.
One director of care at a not-forprofit home near Toronto said agencies are cold-calling, asking if she needs staff.
She said her home has enough for now, although it’s a struggle to hire workers attracted to higher salaries paid elsewhere.
“A municipal home pays a lot more than a for-profit and a forprofit pays more than a not-forprofit,” she said. “I couldn’t recruit an RN right now to save my soul, and I need one.”
The international demand for nurses is so high that Grinspun said some agency recruiters wait outside a workplace to catch staff leaving for the day. “It’s like scavengers,” she said. “They are waiting to offer their business card and say call me if you want to work in the U.S.”
The demand is not new, but it is exacerbated by infections and burnout, said the CEO of a not-forprofit home, who agreed to speak anonymously. In long-term care, staff and operators fear backlash for talking publicly.
Before the pandemic, the CEO said the home spent roughly $100,000 a year on agency staffing fees, mostly to cover vacations. That all changed when COVID arrived.
“We probably spent upwards of $1 million on agency staff (in 2021),” the CEO said, adding that if the home had enough of its own staff, the extra COVID hours would have cost $475,000 instead.
After multiple interviews with operators and staff across Ontario, it appears that each home is experiencing Omicron in its own way.
The director of care in a not-forprofit west of Toronto said she ordered six months’ worth of personal protective equipment in preparation but hasn’t had one positive test result.
“Touch wood,” she added. “Touch wood.”
Jarlette Health, a private operator with 14 homes in mostly smaller cities or rural communities, said it has more than enough workers.
Jill Knowlton, Jarlette’s new chief operating officer, said the company worked hard to boost its contingent of nurses, personal support workers, dietary and housekeeping staff by 30 per cent last November, after Omicron modelling predicted a major hit.
“We’re in some of the rural and remote areas that are very challenged with staffing shortages, but we just really kicked into gear,” Knowlton said. In some cases, she said the home attracted workers by paying for accommodation, meals or transportation.
“We’ve carried a staffing level that is much higher than where we need it to be. So, if three staff test positive and they have to go home, we’re not in a critical space because our levels are higher.”
Many homes are devastated by the variant. Some have dozens of staff off work after testing positive, said a veteran registered practical nurse, who requested her name not be used for fear of losing her job. She said many of her colleagues are so exhausted after weeks of double shifts that they’re almost relieved to get a positive test result.
“For some, getting COVID was a bit of a blessing because it meant they could go home and take a break, for themselves,” she said.
After Maureen McDermott watched her 93-year-old mother, Elsie, struggle through the isolation of the first wave at Georgina’s River Glen Haven, she joined others speaking publicly about long-term care. Elsie McDermott died last May.
McDermott worries about a leadership gap at the Ministry of LongTerm Care as incoming minister Paul Calandra (who is also minister of legislative affairs and government house leader) replaces minister Rod Phillips.
The shift comes at a time of new COVID deaths and, McDermott said, the overall deterioration of residents.
“Early in the pandemic, there was a sense of urgency within the government, but right now there’s nothing,” she said.
“We have nothing to offer them. There are no solutions. There’s nobody in charge, just nobody coming to help.”
Albright Manor in Beamsville, near St. Catharines, is one of many homes struggling through a resident and staff outbreak, with one recent resident death and positive test results for 57 residents and 36 staff. Many cases have resolved, the home said.
William ter Harmsel, CEO of Albright Manor, wants the public — and the government — to know there simply aren’t enough workers applying for jobs at his charitable home.
“It’s taking staff longer to help residents get dressed in the morning and shower, and mealtimes sometimes take longer. So, care suffers, unfortunately, and that’s certainly not what we want to see,” ter Harmsel said.
It’s not just the pandemic causing the problem, ter Harmsel said, but also the “inequity” created by Bill 124 that depresses the wages of non-profit or charitable homes like Albright Manor. And while he speaks well of Niagara Region’s municipal homes, ter Harmsel said the fact they have long received additional funding from regional taxpayers is another reason why homes like his cannot compete for staff.
“A home of our size, which is 231 beds, would probably get in excess of $3 million a year if we were a regional home,” he said. “So that’s sort of an elephant-in-the-room discussion no one wants to have.”
He worries that two years after the pandemic began, when nursing homes captured the attention of provincial and federal governments, interest is now fading.
“Hopefully, when this pandemic subsides, they won’t forget about us.”
‘‘ When we are in the middle of such an extreme staffing shortage, the need for higher salaries and enticements is even greater.
LISA LEVIN CEO OF ADVANTAGE OF ONTARIO, WHICH REPRESENTS NOT-FOR-PROFIT HOMES