Hundreds of long-term care and retirement homes across the country are grappling with outbreaks of the novel coronavirus. Multiple cases have led to a string of deaths in these spaces, leaving communities shaken.
The vulnerabilities of care homes housing the elderly, along with the safety of personal support workers, have become an increasing concern. For some, like Melissa, a registered practical nurse who has been working in a Niagara Falls, Ont., long-term care home for a decade, fear is a constant feeling.
Global News has chosen to change her name for fear of reprisal by her employer.
“I’m scared that the residents aren’t going to be kept safe. I’m scared that because they’re elderly, that the resources will be pulled for people that are younger or have a better chance of survival,” she said. “I’m scared that residents may end up dying alone.”
Provincial governments continue to address long-term care outbreaks
One home in particular, the Pinecrest Nursing Home in Bobcaygeon, Ont., has seen 21 residents and one volunteer who was the wife of a resident die of COVID-19.
Other homes with similar outcomes include Lynn Valley Care Centre in B.C., where 11 people have died, and the Seven Oaks care home in Toronto, where eight have died. In Montreal, the Notre-Dame-de-la-Merci home has seen seven seniors die as a result of COVID-19.
As of April 7, Ontario reported that there are 51 long-term care homes in the province that are experiencing COVID-19 outbreaks.
“We are very concerned about outbreaks in long-term care homes. That is a very, very vulnerable group of people that we need to protect, absolutely,” said Christine Elliott, Ontario’s minister of health at a press conference.
“We’ve got very strict requirements now with respect to no visitors, except for palliative purposes, that the staff are checked on a daily basis, and that the residents are still being checked with some of our testing that happens for people who seem well.”
The province also issued a new Emergency Order on March 28 that introduced temporary additional staff members to help in the facilities and allowed homes more flexibility in staff deployment.
Ontario Premier Doug Ford spoke to the concerns about long-term care homes earlier this week at a press conference, stating that the province is “sparing no expense” when it comes to protecting the elderly.
“I just wish we had a crystal ball a month ago, a month and a half ago, to see where this was going but it is all hands on deck. I won’t spare a penny,” he said.
In Quebec, almost a quarter of the province’s long-term care homes are experiencing COVID-19 outbreaks, which amounts to 519 facilities, Premier Francois Legault said at a press conference on April 1.
Quebec has promised $133 million to seniors’ residences so new staff can be hired and Legault also said the province will help pay for hotel costs for workers who want to isolate from families to limit the exposure of others.
‘Am I going to… potentially kill these people?’
For Melissa, she says the large care home she works in has around 230 beds and it’s impossible to practise physical distancing when much of her job involves physically moving residents into a bed or helping them shower.
She and other staff do not have access to masks, as they are reserved for residents with respiratory issues, she said. There needs to be protective equipment available for her and others at all times, she said.
“I feel like we should all be wearing masks all of the time. It’s hard, even the residents, if they could wear a mask, but given certain cognitive impairments, that’s not always possible.”
Many residents have illnesses like dementia and may be frightened by workers wearing masks as well, she added.
Along with some masks, current precautions that are put in place in the home include wellness screening of all staff and residents twice a day along with extra cleaning and sanitizing of the home, she said.
If she felt unwell she would not come to work for the safety of the residents, although she’s unsure how understanding her employer would be if that were to happen, she said. Melissa is also concerned about being asymptomatic and infecting a resident.
“I’m scared because I feel like a loaded gun walking around without a mask on, thinking if I am carrying this, am I going to infect someone and potentially kill these people? ” she said.
The Ministry of Health and Long-Term care needs to mandate that all care workers wear masks, and treat homes as if there’s already an outbreak, she said.
“I feel like that’s the only way to really keep everybody safe. We need to be ahead of it instead of behind it,” she said.
Long-term care homes fear for residents’ safety
On March 30, five long-term care organizations sent a letter to the Ontario government stating that new emergency legislation has removed barriers to care that have allowed workers to prioritize residents over administrative requirements and introducing new measures such as increased access to telemedicine and virtual nursing support.
The Ontario Long-Term Care Association referred Global News to this letter when asked about precautions being taken at care homes.
While Ontario has put in an emergency order, long-term care associations across the country are continuing to prepare for future outbreaks in their homes.
In Nova Scotia, three homes have cases where residents or staff have tested positive for the virus, including one home placing residents in isolation to prevent a spread.
Everyone who comes to work at a Nova Scotia care home has to have their temperature taken along with an assessment test before they enter the building, said Joyce D’Entremont, the vice-chair of the Health Association Nova Scotia Continuing Care Council. She’s also the administrator of the Mountains and Meadows Care Group in Bridgetown, N.S.
There’s also an occupational health line staff can call if they are feeling unwell so they can be assessed, she said. All residents are being screened for flu-like symptoms consistently as well, and she has weekly calls with the province’s medical officer of health, she explained.
But the constant check-ins on staff, residents and provincial support are not easing her and others’ fears about more outbreaks or deaths that have been seen in other provinces, she said.
“Everybody is on edge. We’re all worried, we’re all scared,” she said.
To help support staff, she’s been holding a weekly livestream so staff can ask questions. She also has an open-door policy to her office.
“What I’m hearing up to now is what a good job we’re doing to keep our residents and staff safe,” she said.
D’Entremont has been emphasizing to staff under her directives that a COVID-19 outbreak would be the result of workers bringing in the illness, she said.
“I keep telling my staff, don’t be scared of the residents. They’re not leaving this building, it’s not the residents that are going to make them sick. It’s if they don’t follow the rules the medical officer of health has put into place,” she said.
“So it’s really the residents that should be scared of the staff.”
Widespread testing required to prevent outbreaks: doctor
Long-term care homes are like tinderboxes for COVID-19 outbreaks, as they are similar to cruise ships in terms of residents being older and in close quarters, said Dr. Samir Sinha, director of geriatrics at Sinai Health System and the University Health Network in Toronto.
There are over 400,000 Canadians who are living in seniors’ residences or nursing homes according to the last census, he said.
Elderly people who are in these homes are usually more frail and up to 70 per cent of those living in these residences have dementia, he added.
“The challenge with dementia is if you can’t remember what you eat for breakfast, are you going to be able to recognize your own signs and symptoms?” he said. “That’s why COVID-19 is particularly deadly in frail older adults, especially those living in nursing or retirement homes.”
These residents are also receiving care from multiple people who leave the home and could be asymptomatic. Putting all these factors together within a residence floor and COVID-19 can “spread like wildfire, because it’s highly contagious,” explained Sinha.
Sinha points to a recent study from the Centers for Disease Control in the United States that found when everyone in a home was tested after an outbreak, half the residents who had no symptoms and half the workers with no symptoms tested positive for COVID-19.
This indicates that more widespread testing is needed in these homes to prevent more deaths from occurring and masks should be provided before an outbreak occurs as well, he said.
In Ontario, long-term care workers are also not receiving enough masks or the same employment support when it comes to taking sick leave compared to doctors in a hospital, Sinha explained. This can put more pressure on workers to come in even if they feel unwell.
“What would you do if you’re a low-paid worker… where if you don’t show up to work, you don’t get paid? And you have to put food on the table, what would you do?” he said. “And that’s the sad reality.”
Sinha says he’s put forward recommendations to Ontario to change guidelines and get more widespread testing done in long-term care facilities before an outbreak happens.
“These are those people who are the most vulnerable older people among us… These folks need to be prioritized for testing right now,” he said.
“That’s why I’m advocating so hard, because I don’t want us to miss an opportunity to save a life.”
Questions about COVID-19? Here are some things you need to know:
Health officials caution against all international travel. Returning travellers are asked to self-isolate for 14 days in case they develop symptoms and to prevent spreading the virus to others.
Symptoms can include fever, cough and difficulty breathing — very similar to a cold or flu. Some people can develop a more severe illness. People most at risk of this include older adults and people with severe chronic medical conditions like heart, lung or kidney disease. If you develop symptoms, contact public health authorities.
To prevent the virus from spreading, experts recommend frequent handwashing and coughing into your sleeve. They also recommend minimizing contact with others, staying home as much as possible and maintaining a distance of two metres from other people if you go out.
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