Seniors’ advocates and health professionals warn we may be on the cusp of yet another long-term care disaster as COVID-19 cases in Ontario homes revolve around similar numbers seen in early April – just two weeks before a massive spike in infections claimed hundreds of lives. installations.
“I am absolutely terrified and worried,” said Dr. Amit Arya, a long-term care palliative care physician who witnessed first-hand the devastation of the First Wave at facilities in the GTA. “We really need to realize that long term care is not a parallel universe. A greater spread of COVID-19 in the community increases the risk of an outbreak starting in long-term care facilities. “
As of Thursday, 159 residents and 199 long-term care home staff had active cases of COVID-19, according to the provincial government. Compare that to 176 long-term care residents and 141 staff with COVID-19 as of April 7, according to data collected by the Ontario Health Coalition, a nonprofit, non-partisan network of healthcare advocates. public health. The April figures collected by the coalition are not scientific and likely did not capture all infections, but are the best data available from that time as the province has not started releasing active figures on long-term home care outbreaks. until more than two weeks later.
The current provincial data is striking: Active cases in long-term care homes have more than quadrupled since September 1, while the number of homes with outbreaks since has increased from 13 to 71.
The epidemics in some areas are severe. Two Toronto homes, Vermont Square and the Fairview Nursing home, each have more than two dozen confirmed resident cases, with 27 and 13 staff-confirmed cases, respectively. Last weekend, the federal government gave the green light to the Red Cross to help seven long-term care homes in the Ottawa area after the Ontario government asked for help. Ottawa was recently declared a red zone, the most serious classification public health can attribute to the presence of COVID-19, and was one of three regions, along with Toronto and Peel, to be brought down to Stage 2 of reopening last week.
And on Wednesday, the province announced it was banning long-term care residents in those areas from taking short-term outings for social or personal reasons. This followed an earlier restriction on general visitors to long-term care homes in these areas, where only essential visitors, including up to one caregiver per resident, were allowed.
But experts believe such measures are not enough to stop what could become a full-fledged second wave in homes. They say addressing the acute shortage of staff in homes is critical to preventing more infections and deaths.
“Homes are still desperately understaffed, many more than when the first wave started,” said Natalie Mehra, Executive Director of the Ontario Health Coalition.
She pointed to a recent report in the Ottawa Citizen detailing comments from a worker at Extedicare’s Villa West End in Ottawa who said there had been times at home where only two PSWs were looking after 60 residents infected with COVID-19.
“It would be impossible even if they weren’t sick with COVID-19. It’s simply unspeakable, ”Mehra said. “There is no possible way that few PSWs will comply with PPE change protocols and all infection control measures. They can barely make it through the day. “
Staff shortages have led health workers from placement agencies to work in several locations and even PSWs to provide care to people at home as well as long-term care facilities, she said. The practice continues, despite a provincial order in April banning health workers from working in more than one long-term care facility. The reason? The ban did not apply to temporary workers, a move critics called a “giant loophole.”
Mehra said Ontario should follow the ambitious response of its neighbor, Quebec, which launched a massive recruitment drive in June to not only hire, but also train, 10,000 caregivers (the equivalent of PSWs in Ontario). Recruits were paid $ 760 per week during training and guaranteed full-time jobs paying $ 26 per hour upon completion. Quebec has also hired some 400 managers – one for each long-term care home – to be responsible for each home’s response to COVID-19. Each manager was also matched with an infection control specialist to ensure homes were following proper protocols.
“Where was the systemic intervention in the lull that took place from June to early September to put in place staff in homes as Quebec did to strengthen the resilience of the second wave which was inevitable?” Mehra said.
But finding enough people to take over is a challenge, said Miranda Ferrier, president of the Ontario Personal Support Workers Association.
“Right now it’s not a very attractive profession. You work in COVID positive homes, you don’t have enough staff, you are constantly burned out, you don’t get professional recognition, ”she said, referring to the fact that PSWs are not regulated like other health professions such as nurses and doctors.
Ferrier said there are about 135,000 trained PSWs in Ontario, but only about 60,000 actually work.
“It is not a profession of choice at the moment, unfortunately, although it is a very honorable position,” she said. “We are very much in crisis and we are at extremely high risk of catastrophic consequences.”
Donna Duncan, CEO of the Ontario Long Term Care Association, which represents 70% of long-term care homes in the province, said her organization “has been clear” with the Ontario government and other stakeholders on the challenges facing households and what is necessary to keep them stabilized during a second wave of this global pandemic.
“Recent commitments to personal protective equipment, small capital investments, and infection prevention and control resources will begin to address some of the gaps in the system, but will only be successful if they are deployed quickly and improved upon. meet the exceptional needs of the system, ”she said, adding that the numbers problem facing homes continues to be the staffing crisis in long-term care.
“Ensuring the health and safety of our residents and home staff is essential to our ability to recruit and retain a new workforce in long-term care homes. These measures will help us in our recruitment efforts. We need to recruit an army of employees for long term care, ”she said.
“We need to be proactive,” said Arya, saying there is no reason Ontario could not act sooner to address staff shortages. He pointed to British Columbia, which has a long-term care sector about half the size of Ontario, but which recorded a tenth of deaths in the first wave.
This more favorable result is in part due to the fact that the Government of British Columbia hired all frontline long-term care staff in March, ensuring they received a living wage and limiting their employment to one. only establishment.
“If we protect the rights of health workers, if we improve their working conditions, we improve the conditions of care,” Arya said. In Ontario, he added, it appears that we are “protecting the operators and not protecting who we should be – the residents and their families.”
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