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Fear, stress factors in staffing shortages at Ontario’s long-term care homes amid COVID-19 crisis

Click to play video 'Healthcare workers sound the alarm on 2nd wave impact in long-term care homes' Healthcare workers sound the alarm on 2nd wave impact in long-term care homes
WATCH: Doris Grinspun, CEO of the Registered Nurses’ Association of Ontario, talks about the dire impact of the second wave hitting long-term care homes and the call for more action from the provincial government. – Nov 16, 2020

With officials projecting upwards of 6,000 daily COVID-19 cases by mid-December through its latest modelling numbers, the hardest hit sector of Ontario’s health-care system may not see much relief until the pandemic is over.

Since March, two independent commissions have looked into the effect of the coronavirus at long-term care (LTC) homes in Ontario. The latest report, disclosed in October, revealed that 75 per cent of all deaths tied to the virus were residents from these facilities.

Read more: A look at what has gone wrong in Ontario long-term care amid the coronavirus pandemic

Amid the on-going crisis, 55 per cent of LTCs in the province reported at least one outbreak and cited shortages in staffing as a significant concern.

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The Ontario Hospital Association (OHA), which represents more than 150 public hospitals in the province, believes despite issues with facilities nearing patient capacity amid the pandemic, a lack of workers is potentially a bigger problem.

Dr. Amit Arya, a palliative care physician who works in long-term care facilities, says he’s seen as much as 30 per cent less staff in some homes since the pandemic began.

“I saw people that were seniors, that were dying of COVID-19. They were suffering. There definitely were not enough staff to look after them,” said Arya who found the experience “deeply traumatic.”

Arya says at the beginning of the pandemic, a number of LTC staff who worked in multiple facilities were really left to navigate on their own before the Ontario government discovered evidence of asymptomatic spread and began limiting workers to just one long-term care facility.

Read more: Coronavirus: Ontario hospitals, long-term care homes have little room for 2nd wave surge, inquiry hears

Perhaps the most significant evidence of that was when COVID-19 hit Markhaven Home for Seniors in Mid-March.

By the time an outbreak at the facility was declared over in mid-May, 56 residents and staff had tested positive for the coronavirus and 17 residents had died from complications tied to the infection.

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Personal support worker (PSW) Maggie Gittens, who cared for the first patient to contract the virus at Markhaven, says when it hit the home there was much confusion among staff on what to do.

“One minute you’re told you’re not supposed to do this. One minute your told do this, you know, so you don’t know which way you’re going,” Gittens said.

The chief executive officer of the Registered Nurses’ Association of Ontario (RNAO) Doris Grinspun says the number of PSWs, nurses and families that reached out to her organization with stories of “devastation” and “hopelessness” during the first wave of the pandemic was overwhelming.

“It’s horror stories. What we hear is stories of in the first round going to homes where they had no staff,” Grinspun said.

Click to play video 'Healthcare workers sound the alarm on 2nd wave impact in long-term care homes' Healthcare workers sound the alarm on 2nd wave impact in long-term care homes
Healthcare workers sound the alarm on 2nd wave impact in long-term care homes – Nov 16, 2020

“They didn’t even know where the chart of patients were. Going to homes, not being able to see what medications you need to give to patients. Not being orientated … because there was nobody to orientate you.”

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Sarah, a PSW for more than 20 years who works with a not-for-profit home in Durham Region, says the type of residents facilities see nowadays are “heavier care” individuals that not only suffer with Alzheimer’s and dementia but have issues walking and getting out of bed. (Global News has agreed to shield Sarah’s identity due to concern she might suffer repercussions from her employer.)

“They’re requiring Hoyer lifts to get them up and out of bed and to the bathroom, and to be bathed,” she said. “You know, they’re having to be fed.”

“So it has changed to what it was years ago, and it’s a very heavy job.”

She said her experience was with a team of six that had to care for around 60 residents in the home. Also in the mix was at least one registered nurse (RN) or registered practical nurse (RPN) that administers medications and monitors blood pressures among other medical-related needs.

Read more: Health official turned whistleblower carries flag for families grieving over COVID-19

A typical eight-hour day, according to Sarah, began at 6 a.m. with each PSW preparing between eight to ten residents – waking them, washing them and getting them dressed for breakfast, which typically takes place at 8 a.m.

Amid the pandemic, this all had to be done while wearing PPE in an effort to prevent the spread of the coronavirus.

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“You have to serve them breakfast, which is a good hour. So you’re feeding a lot of them and there’s different diets,” she said.

Lunches are similar and last two hours with a typical PSW having to feed and observe residents while they eat since none can be left unattended.

In between meals PSWs often have to escort residents back to rooms with some having to be returned to a bed, requiring a lift to get the job done.

The work also requires a lot of documentation throughout a given day. Every change in a resident’s condition, how many bathroom breaks were required, and any additional care that was administered must be recorded by a PSW.

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“The details of the documentation are intense,” Sarah said. “And then you can have your break and you’re finished at two o’clock.”

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However, that’s assuming another PSW comes into work to relieve them. Sarah says it was not unusual to have to wait and put in a 16 hour day amid staff shortages during the pandemic.

Read more: Advocates, union question new job category for Ontario long-term care homes

The RNAO’s Grinspun says Sarah’s account is a common theme among the “stories” she’s heard from nurses and PSWs who simply feel they cannot speak out in fear of losing their jobs.

“And so this is why you don’t hear nurses, and in particular RPNs, established in the media,” Grinspun said. “You see them once in a while only because they’re afraid of speaking out.”

Michael Hurley, president of the Ontario Council of Hospital Unions, says about a third of care workers they recruited for a recent academic study into the province’s LTCs “dropped out” when they found out workers in previous investigations were fired for speaking out.

Read more: ‘Delays and confusion in decision-making’ impacted Ontario’s COVID-19 response: AG

“One changed her name legally so she could continue to work as a personal support worker,” Hurley said.

University of Windsor researcher Dr. James Brophy said the “anonymous” workers interviewed for the study had high levels of “emotional anxiety, stress and fear” when recounting the first three months of the pandemic.

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“We had to stop interviews with people so they could compose themselves,” Brophy said.

The study, based on interviews with 10 health-care workers and a poll involving 3,000 hospital union members, revealed that more than 90 per cent of care home workers felt abandoned by the government during the pandemic.

Researcher Dr. Margaret Keith said the study revealed the bulk of those polled took home the stress acquired from an LTC with many admitting they changed clothes outside of their home before running to their shower in fear of passing on the virus to a family member.

“You know, they’re aware of it every second of the day. I think that that’s something that we need to really be addressing,” said Keith.

Click to play video 'The state of Canada’s long-term care in the second wave' The state of Canada’s long-term care in the second wave
The state of Canada’s long-term care in the second wave – Nov 20, 2020

Christina, a PSW of four years at an eastern Ontario LTC, says she not only constantly undressed outside and showered when she came home from work, but also exiled herself to her own room to avoid getting her husband and four kids sick.

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Despite taking the precautions and wearing full-on PPE at work, she eventually contracted the virus when the home became part of a large outbreak in March that claimed the lives of more than 30 residents.

She said passing on bodies to coroners became another unenviable task for care workers at her LTC since a lot was still not known at the time about the transmission of the virus.

Christina also did not reveal her identity to Global News over the possibility of losing her job.

Read more: Ontario long-term care commission will grant workers anonymity

The CEO of the agency that represents long-term care operators says fear is definitely a contributing factor to staffing shortages in the province’s homes.

Donna Duncan of the Ontario Long Term Care Association says fatigue and stress are also factors in the unstable staffing situation.

“Their mental health and well-being has been challenged extraordinarily and in many cases [they] have been traumatized,” said Duncan.

“What we know is that we do need to recruit reinforcements and quickly.”

Duncan says more money for workers isn’t necessarily a solution to the problem pointing out the province’s “pandemic pay” raise initiative in late April didn’t really improve the situation.

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She says more needs to be done in terms of providing proper personal protective equipment (PPE) and quicker testing turnaround times.

“The question is sustainability, not just of the staffing and maintaining the staff that you have, but also the equipment, also the testing capability,” Duncan said.

“You have it now to some degree. The question is for how long?”

Laura Tamblyn Watts, CEO of CanAge – Canada’s National Seniors advocacy organization, says one of the reasons LTCs were able to get by with existing staff prior to the pandemic was help from families who provided additional care.

Read more: Coronavirus: Front-line workers who left LTC homes in May won’t come back, commission hears

During the onset of the pandemic in March, some homes didn’t allow family members to visit loved ones as a precaution to prevent the spread of the virus.

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Tamblyn Watts says the action was “devastating” for some seniors who were impacted “emotionally and mentally” by the omission and felt “imprisoned.”

“So we have cases of people who were essentially starving to death because either they were not being fed or they weren’t getting the cues to eat that you would ordinarily get by sitting together,” Tamblyn Watts said.

Dr. Arya admits the removal of “essential family caregivers” was a factor for a decline in service at some homes.

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“They were kind of the glue that held things together in many circumstances,” Arya said. “So it for sure made the crisis much worse.”

Since May, the Ontario government’s answers to the deteriorating homes have included the deployment of Canadian Armed Forces to five of the worst-hit homes and on-going help from the Canadian Red Cross.

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Going forward the province hopes to tackle future staffing issues in the long-term care sector with the hiring of “tens of thousands” of personal support care workers and up the average time of care for each resident to four hours a day from the current 2.75.

However, that standard will likely not be achieved until 2024-2025.

Read more: Ontario promises new care standard in long-term care, to be implemented by 2024-2025

Sociologist and professor at York University Pat Armstrong says data she’s compiled from the U.S. suggests the average time of care should actually be six hours a day due to the “complexity” of help some patients will likely need.

Armstrong says in order to solve LTC staffing issues, the province simply has to make the work more attractive.

“You have to be really dedicated to be able to work under the conditions that are there now. It’s risky,” Armstrong said.

“These are the highest rates of absences due to illness and injury of any industry right now.”

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–With files from the Canadian Press, Briana Carnegie, Jessica Patton and Lisa Polewski