How to prevent the spread of COVID-19 and other infections at Ontario’s long-term care homes

This is part of Global News’ special series Care Gone Wrong: Inside Ontario’s nursing homes. Click here to learn more about the series

In the months since the coronavirus pandemic began, when Ontario’s long-term care homes were walloped by the deadly disease over the course of several weeks, the effort to protect the province’s seniors has almost been Herculean by many frontline workers and officials.

With the promise of a vaccine to protect Ontario’s most vulnerable residents set against a recent increase in cases at long-term care settings, questions continue to be asked about what more can be done to protect seniors not only in the coming weeks but also in subsequent years and decades.

“Long-term care facilities are the ones that are going to bear the brunt of this infection disproportionately as compared to other health care and other settings entirely,” Dr. Zain Chagla, medical director of infection control with St. Joseph’s Healthcare Hamilton, recently told Global News Radio 900 CHML.

“You will have people infected, but the amount of significant illness and death in long-term care facilities is really unmatched by any other sector.”

Statistics about long-term care facilities posted on the Ontario government’s COVID-19 website help reiterate the stark reality outlined by Chagla.

As of the end of November, around 60 per cent of all deaths in Ontario were of people who lived in long-term care homes. Approximately 2,210 out of the 8,360 long-term care residents across the province’s 626 facilities infected with COVID-19 died of the virus. For the entire province, almost 3,650 people have died and around 115,000 have been infected to date with more than 97,000 people having recovered.

“Long-term care homes are some of our most medically fragile patients. They require significant face-to-face care from providers,” Chagla said, highlighting the unique challenge in providing direct care to seniors and vulnerable residents.

“The distance is minimized and the contact time is maximized.”

From his perspective, Chagla said right now the big focus needs to remain on preventing coronavirus from entering facilities.

He said the essential items are conducting screening and proactive testing of residents and staff; ensuring that there are rapid decisions and responses “as soon as there is a hint” of COVID-19; and maintaining an adequate supply of personal protective equipment.

While Chagla praised utilizing new rapid antigen tests, he warned the sensitivity is lower compared to the full nasal swab tests. Still, he called for using rapid and repeated testing strategies to try to keep a handle on COVID-19.

When asked if the Ontario government’s move to restrict visitor access during the first wave of the pandemic to long-term care homes helped reduce exposure to COVID-19, he said it was effective but it took a toll on many residents.

“There were significant downstream effects to it. We saw elderly and vulnerable individuals get almost a solitary confinement syndrome where they were unable to get that emotional and cognitive impact,” he said, reiterating vigilance in taking the above short-term actions.

Looking at longer-term solutions, Chagla emphasized the importance of having private rooms in Ontario’s long-term care home system to help prevent the spread of infections.

Infection control and building design

During the 2018 election and more recently, the Ford government made commitments to add extra beds to Ontario’s long-term care home system amid a lengthy waitlist.

Barbara Shea, an infection control practitioner and co-chair of the Infection Control Canada Group Healthcare Facility Design and Construction Interest Group, underlined the need to ensure new and renovated facilities incorporate best practices right at the design stage when it comes to minimizing the spread of viruses and infections.

She echoed Chagla in calling for residents to have their own rooms and bathrooms as an important tool in infection control. But she also said functional planning in the design, for example looking at the forecast patient population and designing based on those needs.

Shea said designs need to include ways to provide ample hand hygiene (alcohol-based hand rub at all points of care); proper waste management; up-to-date heating and air conditioning; and isolated storage of clean and dirty linens. As for finishes and materials, she said those need to be non-porous and not have groves or crevices.

“The most effective way of protecting someone is to eliminate a hazard,” Shea said.

“This is always a compromise in long-term care between making something that looks institutional versus something that feels like home.”

When asked about retrofitting existing facilities, Shea said that it’s not always possible to bring old buildings fully into the current standards, adding that standards also shift every five years or so to take into effect best practices. However, if there is a change of purpose of a room or a building, it has to meet new build standards.

Like Chagla, Shea said there are things that can be pushed in the short term to combat the spread of infection. She said there needs to be a focus on increasing cleaning regimens in long-term care facilities, especially for high-touch surfaces such as things like light switches, call bells, doorknobs and railings.

“If there’s a plus to take out of COVID-19, it is the education of the masses about infection control and how they can protect themselves,” Shea said. “It is now ingrained into society.”

How is the Ontario government responding to calls for change?

The Ontario government announced the creation of an independent body, the Long-Term Care COVID-19 Commission, to look at how COVID-19 spread in the province’s long-term care system.

In October, the commission released a set of interim recommendations telling the province it must address critical staffing shortages at long-term care homes as the second wave of the pandemic intensifies.

In a letter to the government, the commissioners said the province must spend more money, on a permanent basis, so the homes can hire more personal support workers and nurses.

“We have heard repeatedly and consistently about critical staffing shortages pre-COVID and the reasons for long-standing recruitment and retention challenges in long-term care homes,” the commissioners wrote.

At the beginning of November, Premier Doug Ford promised to establish a new standard that would see nursing home residents receive an average of four hours of direct care every day — something long called for by advocates.

Ford pledged to achieve the standard by 2024-2025 and said the province will need to hire “tens of thousands” more personal support workers, registered practical nurses and registered nurses to provide the care.

He said when the new standard is achieved, it will represent a major increase over the two hours and 45 minutes of care that is the current daily average received by residents.

After that announcement, Ontario NDP Leader Andrea Horwath said long-term care residents and their families cannot wait years for the new standard to be implemented.

As of November, the NDP introduced four private members’ bills in a bid to secure a four-hour minimum standard of care in nursing homes. The party also included the care standard in the first plank of its 2022 election platform released in October.

Liberal leader Steven Del Duca said that if the government had the political will, it could make the standard a reality much faster.

Meanwhile, the provincial commission on long-term care is expected to submit its final report on April 30.

— With files from Shiona Thompson and The Canadian Press