As health officials continue to struggle to contain novel coronavirus causing devastation in Canada’s long-term care homes, experts say there are a number of changes that can be made to ensure this type of outbreak doesn’t happen again in the future.
According to Canada’s chief public health officer, Dr. Theresa Tam, COVID-19-related deaths are occurring “disproportionately” among older adults living in long-term care and seniors homes.
Last week, the Public Health Agency of Canada released new COVID-19 data, which found long-term care and seniors’ homes account for 79 per cent of the total deaths in Canada.
So far, the virus has claimed 3,915 across the country.
Speaking at a press conference last month, Prime Minister Justin Trudeau called the situation “unacceptable,” saying Canada needs to “do better.”
He said in the “weeks and months to come”, Canadians will all have to ask “tough questions” about how the situation occurred.
But experts say the cracks in the long-term care system were evident long before the pandemic began.
And they say once the pandemic ends, there are a number of improvements that can be made to ensure this doesn’t happen again.
‘Profound systemic problems’
Kerry Bowman, a professor of bioethics and global health at the University of Toronto, said there were “profound systemic problems” within Canada’s long-term care facilities before the pandemic ever began.
“It’s such a massive problem and many people that are familiar with it have known about this for a long, long time,” he said.
He added one of the main issues is that long-term care does not fall under the Canada Health Act.
“And so a lot of the oversight, the funding, the protocols under the umbrella of the Canada Health Act really have not been a part of long-term care to begin with,” he said.
But what is also at the core of the issue, Bowman said, is a “really deep-rooted prejudice” towards elderly people.
“We talk in this country so, so much about equality. You know, dealing with prejudice, dealing with all these types of things,” he explained. “But we really tend to skim over our reaction to older people, and I think that that is one of the core features that has allowed this to happen.”
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Structural issues
Colin Furness, an assistant professor at the faculty of information and IHPME at the University of Toronto, said there are also a number of deeply-rooted structural and policy issues with Canada’s long-term care facilities which together have made a “tinderbox out of institutionalizing a bunch of very vulnerable people.“
He said, structurally speaking, many long-term care facilities house more than one resident to a room.
“Presumably, that’s a cost-saving measure, although it’s a bit of a head scratcher,” Furness said. “It’s always struck me as odd that we don’t build long-term care homes that are entirely one resident to a room.”
Furness said another issue is how long-term care facilities are staffed.
“Anywhere you’ve got service workers — people doing caring work — that is low pay, low status, and along with that, (provides) lower amounts of training, you’ve got a recipe for disaster,” he said.
According to Furness, staff are often forced to work more than one job to make ends meet. He said that poses a big risk, especially when it comes to the spread of diseases like COVID-19.
“You have to really re-engineer how they’re staffed,” he said.
What’s more, Furness said workers are not receiving the proper training when it comes to infection prevention.
He said long-term care facilities need to have certified, infection prevention staff tasked with keeping people within the home safe and those who run the facilities honest.
Immediate changes to be made
According to Furness, there are a few things that can be done in the immediate short-term to limit any further spread of COVID-19 in these facilities.
He said ensuring workers have access to personal protective equipment, and that they are trained to use it properly, is “enormously important.”
Another thing, Furness said, is implementing widespread and repeat testing of all staff and residents, regardless of whether or not they are showing symptoms.
“This is an asymptomatic pandemic and people need to really wrap their heads around that,” he said. “You need to test based on the risk, not symptoms.“
Federal oversight and long-term fixes
Because long-term care falls under provincial jurisdiction, Furness said it is up to the provinces to “set the minimum standards of care” and to enforce it.
But, he said, once the pandemic is over, the current standards in place need to be reviewed.
He said moving forward, enforcing the new standards will become “really important.”
“If you have a long-term care home with multiple complaints, you need a way to deal with that, you need a way to escalate that so it’s not a chronic situation,” he said.
Furness said he would also like to see more “proactive” inspections at long-term care facilities to identify and rectify problems early.
Bowman said once the pandemic ends, a national inquiry should be conducted.
He said the outbreak has been a “great revealer” of problems and vulnerabilities within the current system.
“Where our fractures were, wherever our weaknesses were — they’re now glaringly apparent,” he said.
He said while long-term care homes don’t necessarily need to be run by the federal government, officials do need to “stand up and make sure that this inquiry goes coast to coast.”
Bowman said some provinces — namely Ontario and Quebec — have seen worse outbreaks in long-term care facilities than others.
“We could be perhaps learning from other long term care facilities in other provinces,” he said. “But just leaving it to the provinces and just saying, you know, let’s patch it up — that won’t help.”
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