Action needed now on long-term care
Posted: June 5, 2020
(June 4, 2020)
By: Nancy Johnson and Roma Smith, Sudbury Star
The following is an open letter to Premier Doug Ford and cabinet regarded expedited action to achieve short-and long-term safety and wellbeing of long-term care residents. The Northeast Family Councils Network, a grassroots group of volunteers from long-term care Family Councils in Northeast Ontario’s Local Health Integration Network, urges the province not to wait to commence its examination of the state of Ontario’s LTC.
We each have, or had, family members and/or friends residing in LTC, and for more than a decade have witnessed severe staffing and resource problems that have driven us to work with families, residents, staff and administrators, to press for improvements.
While to date homes in our region have not been as hard hit by COVID-19 as our neighbours to the south, especially in light of the armed forces accounts, we are concerned about standards of care and conditions of work across the province and are keenly interested in not only stopping further COVID spread in LTC facilities, but also in being ready to face a potential second wave later in the year. We endorse the Ontario Health Coalition’s repeated overtures to you on these issues.
Chronic issues such as critical staff shortages, recruiting challenges, resource deficiencies, and issues with governance, funding and models of care made LTC homes ill-prepared to face this crisis. These areas have already been well studied by organizations such as the OHC, academics, worker and operator organizations, formal inquiries and others and we join OHC and others in calling for a full, transparent, public and inclusive inquiry into LTC structure and culture that can springboard from these reports of valuable work already completed.
But in the meantime we need action now, not September, to rectify ongoing problems and to set us up for better outcomes in anticipation of the second wave.
We call on the government to immediately appoint an independent official who is widely respected and acknowledged as impartial and receptive of all forms of relevant and material evidence, with a broad mandate to investigate and make recommendations to: ? Take immediate action to find and fix ongoing contributors to poor outcomes, as described by families, residents, workers, administrators, and the military, as soon as they are found; ? Make long-term structural changes to models of care, resourcing, funding and governance models that contributed to the pre-conditions that allowed COVID to so rapidly spread through our LTC system.
Families, residents and staff are the boots-on-the-ground, firsthand witnesses to the conditions of work and care before and during this crisis. It is important in both the short-term investigation/action and in the broader inquiry, that their unfiltered voices be heard with unvarnished stories shared by families who have lost loved ones, and by representatives from family councils and networks such as ours who are not funded by government and who have no special interest other than protecting residents and ensuring quality of their lives.
In addition to horrific conditions described in homes to the south, despite staff’s herculean efforts, the prolonged isolation and disconnection from loved ones and decreased stimulation are reportedly accelerating many residents’mental and physical deterioration.
To protect loved ones and hasten safe reopening of homes to families who can assist in their care, we have identified issues needing immediate investigation and action, including but not limited to: ? Enhanced screening and repeated testing of anyone who enters to identify and isolate infected persons and keep them out until they test negative; ? Isolation of identified residents by transfer out, or physical separation; and ? Increased staffing to ensure a safer level.
We are concerned government is relying too exclusively on public health officials and not consulting workplace safety experts who can quickly guide achieving safer homes. They know best that every precaution must be taken to ensure workers are not infected and don’t become unwitting vectors of transmission.
Such immediate precautions were well documented and recommended by the SARS Commission and were followed during the H1N1 and Ebola outbreaks.
Some recommendations include:
? Follow the precautionary principle. Until science is certain (and it is clear to us that it is not), err on the side of safety. Ramp up personal protective equipment use and supply, and equip anyone in close contact with residents suspected or confirmed to be positive, with respiratory protection (at least N95) and full body and face protection; ? Enhance infection control practices such as hand hygiene, disinfection of items brought into a home, wearing of dedicated staff clothing/shoes in home. Do not relax precautions until science is certain it is safe to do so. ? Train and drill (not just with a video) anyone who enters the home, in safe donning, use and doffing of PPE and infection control measures. Even experts like Dr. Samir Sinha are on record as saying this can be complicated, and the military has identified training gaps in southern homes; ? Require all staff to work at only one facility. This restriction must include anyone who enters the home, including hospital volunteer SWAT teams of doctors and nurses etc., and agency nurses. The virus does not discriminate and neither should provincial policy; ? Ensure government safety inspectors are made safe to conduct proactive inspections in all homes with a view to identifying gaps, educating and assisting workplace parties, and enforcing law as appropriate. Empower inspectors to follow the evidence and use it to make determinations and order evidence-based action, not just rubber-stamp current policy which has to date failed to protect workers and residents.
To stop residents’mental and physical deterioration, we suggest LTC homes be opened on a regional or health unit basis to families as soon as possible. Facilitate a safe and monitored re-entry of designated family members into homes that are made safe, and not in outbreak.
It is also important to safely re-institute services such as foot care, optometry, clothing provision and others to enhance quality of life and provide stimulation needed to re-gain and maintain optimum mental and physical well-being.
In the meantime, ensure on-going consultation and communication with families and powers of attorney about the home and individual resident status and needs. When the home is safe for re-entry by families, initiate controlled, safe access by ensuring anyone who enters is trained to follow the same safety and infection control measures as staff and is monitored by staff for compliance.
Interim strategies that some of our members have reported for maximizing safe family/resident connections and improvement of resident morale include but are not limited to: ? Scheduled video chats via tablets and/or large screens for residents capable of this interaction; ? Scheduled “chat shack” where residents who are able can meet privately and talk with family member(s) through a ground-floor room window using speakers; ? Scheduled outdoor meetings with physical distancing; ? Restoration of food choices to residents already deeply demoralized by isolation in their rooms.
It is urgent that you mandate your appointee to investigate and take concrete steps as soon as possible to fix what is going so wrong now.
With dozens of military staff falling to COVID-19 in what they themselves describe as “hazardous conditions” in Ontario and Quebec homes, contrasted with some homes which have managed to keep the virus out, and Hong Kong’s systemic experience of zero deaths in long-term care, it is apparent that much more can be done in the short term.
It is imperative there be no delay in action to achieve safer homes and allow families a safe re-entry to be with loved ones. Lives depend on it. Nancy Johnson and Roma Smith are co-chairs of the Northeast Family Councils Network/Grand Family Council Greater Sudbury.