31 Hamilton locations did not have a detailed pandemic outbreak plan

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About a month after Ontario declared a state of emergency in response to the COVID-19 pandemic, 31 retirement homes and residential care facilities in Hamilton still lacked adequate plans to respond to a virus epidemic.

In the weeks that followed, some of these homes, including the Roslynn seniors’ residence, where 85 people tested positive and five residents died, saw staff and residents living with HIV, and outbreaks were declared.

In mid-April, public health ordered 43 facilities to improve infection control or suffer consequences.

An analysis of the CBC from each of the orders reveals that 31 establishments (72% of the total number of houses written) were cited for the following problems:

  • Lack of an adequate supply of personal protective equipment or training in the use of personal protective equipment (PPE), which would prevent staff from safely providing appropriate care to sick residents.
  • Lack of a sufficiently detailed outbreak response plan.
  • Lack of written policies and processes for home isolation of sick residents and / or physical removal.

Five outbreaks were cited for non-active screening of residents, staff or visitors, 11 for lack of supplies or capacity for proper cleaning and disinfection of the environment and 24 for not having an emergency plan for allow the establishment to operate safely in the absence of staff. .

Prescriptions were issued to a mixture of retirement homes and residential care facilities following a series of inspections of the city’s housing areas.

At the time, the province had been in an emergency for weeks. It was first declared on March 17, banning public events organized by more than 50 people and closing bars, restaurants and libraries, then extended for two weeks, this time adding warnings to anyone over 70 years or having an underlying health problem, to stay at home and isolate yourself.

A city press release dated April 15 announced the first 31 orders, describing them as “proactive action” to reduce the spread in communal living environments.

Residential care facilities – sometimes called shelters – provide dining and common areas and on-site support for residents, including those with cognitive or mental health issues.

Retirement homes, on the other hand, are generally private residences where seniors can rent a room and live with certain services and supports, often with more flexibility and without 24-hour care and supervision in long-term care homes duration.

Pressure to upgrade facilities continues, with a new round of inspections last week that focused on a number of homes belonging to the same owner group that owns the Rosslyn and new orders issued for several d ‘between them.

Retirement homes must have an infection plan

No long-term care home in the city has received an order, but Dr. Ninh Tran, the city’s assistant medical officer of health, said it was not a shock.

“There is a difference between the length of past experience, past practice, past expectations of long-term care homes compared to retirement homes,” he said in a recent interview.

“We knew they probably had less experience in this area. So we were not surprised to find that many more problems have arisen in retirement homes. “

He added that when the state of emergency was first declared, most of the province’s messages and guidelines were directed to long-term care homes.

“It was more of a strong recommendation … that retirement homes start looking to do the same kind of thing. “

A paramedic pushes a stretcher into the Rosslyn retirement home in Hamilton, Ontario. May 15. Health workers spent the next eight hours transferring residents from their homes to the hospital. (Dan Taekema / CBC)

However, a spokesperson for the Retirement Homes Regulatory Authority (RHRA), which oversees homes in Ontario, said that to get a license, a retirement home must have a prevention and infection control.

RHRA began reminding operators of their infection and emergency planning obligations in January, as well as the need to report to public health any personnel or residents with symptoms of COVID-19, wrote Farrah Bourre in an email to the CBC.

In March 2020, well before the Hamilton facility inspections began, the province also amended the Retirement Homes Act to require homeowners to “follow all of the chief physician’s recommendations regarding long-term care homes.” duration with respect to COVID-19. , “She added.

Orders came after education failed

Public health regulates residential care facilities and began to inspect, quickly realized that they should do the same for retirement and long-term care homes, CBC Dr Elizabeth Richardson said before. Hamilton medical officer of health.

The goal was to “help them make sure they take all the steps that need to be taken in infection control knowing that they are home to some of our most vulnerable people,” she told ‘time.

The orders were issued under the Health Promotion and Protection Act (HPPA), which empowers a medical officer of health to take additional measures to ensure compliance if education alone does not work.

They were not written until after the health unit had carried out inspections and made an effort to encourage and educate facilities to make changes. Some houses did not seem to understand the message.

“We said at this point:” We have tested, we have evaluated, we have educated, we have looked for ways to help you, but at this stage, you must continue or you will be ordered “and this is where we we are, “said Richardson on April 15.

Richardson has since stated that each facility has made changes to make them compliant.

However, the Rosslyn, which has been emptied of its residents and is currently the site of the city’s most serious epidemic, has received a second order.

Paul Johnson, director of the Hamilton Emergency Operations Center, said on Friday that the home did not have a “true understanding” of infection control and that he provided officials with “conflicting information” about access. PPE, noting even when protective equipment was provided to those who worked. at home did not use it “most appropriately.”

Public health officials have cited “major staffing problems” as one of the reasons that Rosslyn residents were transferred to the hospital. (Dan Taekema / CBC)

The Rosslyn did not respond to repeated calls and emails asking for comments about the epidemic and the conditions that led to it.

Johnson, who previously said that assembly centers in the city are doing “incredible work,” said overall, in an update on May 19, that the evacuation of the Rosslyn was of concern to him.

“This really highlights for me … the new look we need to have in gathering places,” he said. “Part of his design work, part of the training and education, part of the funding required in these organizations, but many are struggling under the weight of this pandemic.”

The initial home order indicated the absence of a sufficiently detailed epidemic response plan and the absence of a written process for home isolation of sick residents and / or physical distance, warning that the home was “not sufficiently prepared to respond to a case or outbreak of COVID-19. ”

He also asked the home to take eight measures, including ensuring staff were trained in the use of personal protective equipment, developing a plan to isolate sick residents, and creating a plan. emergency in case of staff shortage.

After the epidemic was declared in Rosslyn, health officials carried out a second inspection on May 14 and wrote a new prescription that reported several issues that the home was said to have resolved in the first.

Tranh explained this by saying that the initial order was supposed to be proactive and to identify potential problems, adding that expectations regarding the home in an active outbreak are different.

More orders issued to homes

Asked that some of the problems identified in the second-order mirror actions the home was to conduct after the initial order, he admitted the question was “fair.”

“I think this is something that we have to look at … in terms of how a house can temporarily or at some point comply and then not comply and what has changed,” said the doctor. “I don’t have a specific answer to that, but I think it’s a well-noted point. “

Public health spent the past week urgently inspecting seven other homes associated with the Rosslyn owners after the outbreak and evacuation.

On Friday, Richardson revealed that new orders had been issued to four of them, again citing basic concerns, including infection protocols and screening for visitors, despite months of the pandemic.

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