A Toronto long-term care home where 81 residents died of COVID-19 turned down advice from health officials to use “baby monitors” and “room dividers” to help create up to 20 potentially life-saving rooms for sickened residents, according to emails from Toronto Public Health.
The emails provide new details on how Tendercare Living Centre — a long-term care home in Scarborough — failed to enact an emergency plan to use the building’s fourth floor to isolate infected residents.
The COVID-19 outbreak began on Dec. 4, 2020, at Tendercare and would become the deadliest in the province.
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According to the emails, officials from Scarborough Health Network (SHN) and TPH were notified by Tendercare on Dec. 11 that the home’s original plan to separate infected residents by moving them to a vacant wing on the fourth floor would not be ready for a “variety of reasons, such as no call bells and no curtains.”
“The suggestions by TPH and SHN to address these issues were baby monitors for no call bells and room dividers for the lack of curtains,” a media relations advisor with the City of Toronto, said in draft responses to questions from Global News dated April 20, 2021.
“These suggestions were not agreed upon by the facility.”
The draft responses were never sent to Global News and were obtained under freedom-of-information legislation.
Extendicare said it did not have the “staffing resources” to open the fourth floor.
“This was not one singular outbreak in isolation. Rather, it was one of many outbreaks at the height of the province’s second wave, at a time when the health system was entirely overrun.”
Dr. Nathan Stall, a geriatrician at Toronto’s Sinai Health, said some hospitals used baby monitors as a way for staff to communicate with patients and reduce exposure to staff.
“It seems to me a potential missed opportunity to be able to isolate the infected residents or cohort the uninfected residents on the fourth floor to try and protect them.”
Extendicare, which manages the home, did not respond to questions concerning the claim by Toronto Public Health that it refused advice from health officials related to the baby monitors and dividers to help open the isolation wing.
The company, one of the largest long-term care providers in Canada, said that both Scarborough Health Network and TPH did not have the “resources” or “additional staff” to help support the home as the outbreak spread rapidly in December.
“The home’s staff levels were seriously reduced due to illness. As such, we did not have the resources to open the floor,” Extendicare said in a statement.
Scarborough Health Network did not respond to multiple requests for comment.
On Christmas Day, three weeks after the outbreak began and with 164 COVID-19 cases, North York General Hospital took full control of the home after a request was approved by the province.
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A Global News investigation in May revealed allegations that chaos and lack of preparedness inside the home contributed to the deadly COVID-19 outbreak, even though management had told public health agencies in writing, several months earlier, that it was ready for the second wave.
Documents and interviews with families, physicians, and people who work inside Tendercare showed that although the home had outlined a plan to Public Health Ontario nearly nine months before the December outbreak, the intended isolation rooms of the home were never used.
“I don’t know why it was not prepared,” one personal support worker told Global News.
“They were just talking, but there was nothing being done.”
One doctor who volunteered to go inside the home said it was “shocking” to see the state of the home — months into a pandemic — and said there appeared to be no “overarching plan of management from a medical perspective.”
Extendicare has said it “categorically” disagreed with the doctor’s assessment.
The newly obtained emails also reveal mounting friction between public health officials and Tendercare and a lack of clarity over who was leading the response to the growing outbreak, which appeared to lead to delays in implementing infection prevention measures.
“Despite repeated recommendations made to the facility to use the 4th floor for cohorting, effective cohorting did not begin until December 17, 2020, when the new leadership at Tendercare was brought in,” read the email from Toronto Public Health.
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And while Extendicare has claimed repeatedly that cohorting efforts were “guided” by TPH, the emails from TPH suggest the home was reluctant to accept infection prevention advice.
“We continued to recommend cohorting on the 4th floor, however, the facility would not respond to this recommendation,” a TPH spokesperson said. “As a result, TPH proposed an alternative co-horting strategy that included using the 2nd and 3rd floors where residents were already living.”
Toronto Public Health ultimately issued a rare public health order on Dec. 18, directing the home on how to manage the outbreak, which included separating COVID-19 positive and negative residents and providing staff with training on infection prevention and control.
The health agency also pushed back against the long-term care home’s assertion that the health unit didn’t provide “staff” to help with the outbreak.
“Local public health units’ mandate does not provide human resources/staffing to long-term care homes such as Tendercare,” a spokesperson said in a statement. “TPH does not employ the specialized staff such as personal support workers (PSWs) that would qualify to work in long-term care homes.”
The tragedy at Tendercare became a grim example of the situation in Ontario’s long-term care sector, where more residents died in the second wave than in the first — a scathing indictment of how the Ford government failed to act on calls for help related to staffing, infection prevention, and resident overcrowding.
Ontario’s new long-term care minister, Rod Phillips, who replaced embattled MPP Merrilee Fullerton, apologized last month for a provincial pandemic response that saw nearly 4,000 residents and 11 staff die from COVID-19.
Philips said a new Ontario Long-Term Care Act, to be introduced this fall, will create a framework with implications for operators who fail to meet their obligations.
“Successive governments, including this one, failed residents, they failed families and they failed our staff. On behalf of both past governments and the current government, I apologize for that.”
The province’s damning Long-Term Care COVID-19 Commission report, issued at the end of April, found Ontario was not prepared to respond to a pandemic and had no plan to protect residents in long-term care after years of neglect by past and present governments.
Philips said he would hold long-term care homes “accountable” and ensure home inspections that are more proactive could be included in the legislation.
Asked whether the legislation would include fines for operators who repeatedly break the law, which was recommended in a recent Auditor General’s report, a spokesperson for the ministry of long-term care was non-committal, saying that enforcement options were still being considered, including “financial penalties.”
*With files from Emanuela Campanella and Jigar Patel
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