Senior Care Homes Aren’t Ready for the Second Wave

Contributed by Ron Baecker and Gary Feldman

Ron Baecker is an Emeritus Professor of Computer Science at the University of Toronto and author of Computers and Society: Modern Perspectives (OUP, 2019). Gary Feldman, MD, FAAP, FABMG, is a retired physician who was the Public Health Officer of Ventura County and Riverside County in California for 14 years. They are two of the co-authors of The COVID-19 Solutions Guide.

The COVID-19 Solutions Guide, published in mid-June, described the effects of the first wave of the virus on senior care in North America as follows:

As of early June, over one-third of the known COVID-19 deaths in the U.S. have been to residents and staff living and working in nursing and long-term care homes. As of early May, a shocking 82% of the known virus deaths in Canada have been to those in long-term care. A Canadian Forces report commissioned by the province on Ontario, released in late May, reported numerous incidents of poor infection control, residents being denied food or being fed improperly, residents being treated roughly, and staffing problems. A flurry of lawsuits is expected. In Ontario, a $50 million suit was filed on May 1, 2020, alleging that one of Canada’s largest operators of senior residences and long-term care facilities lacked “proper sanitation protocols and adequate testing to prevent the spread of COVID-19”. In the United States, nursing homes have sought emergency protection from lawsuits alleging improper care.”

More recent data shows how badly Canada fared with regard to safety of its seniors.  The country was by far the worst among 16 OECD countries due to its high percentage of coronavirus-related deaths in elderly care homes. Furthermore, 90% of the COVID deaths in Ottawa, the country’s capital, were to individuals over the age of 70.

What is now happening in Ontario’s second wave? Although infections in August were primarily among those under 40, whose need to party trumped their desire for safety, infections and deaths are now rapidly increasing among seniors. This is despite written pleas, made to the premier of the province in the middle of June by a consortium of stakeholders in long-term care, and separately by the Ontario Long Term Care Association, that the province needed to act decisively to prevent a recurrence of what happened in the first wave. The letters particularly emphasized the need to create in care home an Infection Prevention and Control system similar to what exists in hospital, but there is strong evidence that this was not done.

A recent CBC podcast documents the current situation in Ontario care homes and illustrates it poignantly and heartbreakingly with the story of a daughter and her late mother, who passed away in an Ottawa care home in September.

Despite the attention paid to the devastating effect of COVID-19 on Ontario seniors in the first wave, it is clear that the province and the industry did not institute adequate infection control guidelines — concrete steps to prevent needless infection, suffering, and death:

1.     Emphasize the usual protections against catching the virus: diligent hand washing, social distancing, and the wearing of masks. This can only succeed with proper training and ongoing supervision of staff.

2.     Make use of rapid testing or residents and staff as soon as those tests have been validated and become available.

3.     Develop protocols with nursing and medical staff to monitor residents for infection and symptoms so that appropriate care can begin including transfer to hospital as needed.

4.     Develop regulations so that recovering patients who are no longer infectious will be able to return to their care facility from hospital.  In other words, forbid patient dumping.

5.     Monitor staff to exclude those who have been exposed, who test positive or who are symptomatic from entering the facility.

6.     Ensure that all care home staff only work in one home. This will no doubt require governmental regulation.

7.     Ensure that care homes are adequately staffed, with sufficient capacity so that the care facility does not become understaffed when some staff become infected or get burned out during this second wave of COVID-19.

8.     Adherence to items 5-7 above can only succeed if the pay of care facility workers is at least at an adequate level to make up a living wage. Moreover, staff must have sick pay benefits or else they are likely to need to come to work even though sick, which creates an incentive to hide symptoms.

9.     Institute procedures to allow one or two family members to participate caring for parents or grandparents, under appropriate supervision regarding infection control.

10.   Acquire communications technology to enable messaging and video chats between seniors and family members.

11.   Deploy technology in the room to enable family members to monitor the health status and care of the senior. 

Many of the steps recommended above require significant new funding for the long-term care sector and for almost all care homes.

FOR THINKING AND DISCUSSION

What has been your experience in your community with the quality of care in seniors’ retirement homes?  What have local or state governments done about it? How can we mobilize public opinion and government to adequately support our most vulnerable citizens?

The COVID-19 Solutions Guide is a great resource to consult for your pandemic concerns. Click here to buy the book.

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