Care homes face testing road blocks; Public health declined to test new long-term care residents
Posted: April 15, 2020
(April 14, 2020)
The senior leadership at Oxford County’s largest long-term care homes are pushing for increased testing of their residents but say the local public health team is not letting them test incoming – but asymptomatic – residents. Dr. Barry Roth, Woodingford Lodge’s medical director, and Mark Dager, the lodge’s director, said Southwestern public health has declined to process the COVID-19 tests of at least five new residents because they weren’t experiencing symptoms.But testing all residents is crucial, they said, because seniors are more vulnerable to COVID-19 and some, because of other medical issues, may be unable to convey they’re suffering early symptoms of the virus.
“We wanted the knowledge if they have COVID-19 or not. … It would give us more knowledge about this illness in our population,” Roth said. “If we get it at Woodingford Lodge, it would have serious consequences.
“We need to do everything we can to prevent it.”
At the request of the Southwest LHIN, the county-owned homes recently agreed to take eight more residents to free up hospital beds needed for a potential influx of COVID-19 patients.
Dager said the inability to test new residents included both those coming from the hospital and from the broader community.
New provincial testing guidelines issued Wednesday by Dr. David Williams, the province’s chief medical officer of health, however, say all residents coming into long-term care homes need to be isolated for 14 days and tested within that time. Patients being transferred in from hospital should be tested before they’re moved.
That guidance was not in effect when patients were transferred from Woodstock Hospital to Woodingford Lodge. Dager did say all new residents would be isolated for 14 days as a precaution.
In a statement, Southwestern public health’s top doctor pointed to the April 1 guidelines in place at the time the patients were moved from hospital to the care home. Those guidelines called only for the testing of symptomatic patients.
“This has been communicated to the long-term care homes in the Southwestern public health region. We believe this approach makes the best use of available resources and is in line with the evidence and the guidelines under which we work,” said Dr. Joyce Lock.
“Information changes daily as this pandemic continues. Our practices will evolve in line with the available evidence, new guidelines and new directives.”
Public health did not address the latest guidance from Ontario’s top doctor on Thursday that all incoming residents should be tested, or what that would mean for new incoming patients.
Dager noted many residents have cognitive impairments or dementia, which can leave them unable to express possible symptoms.
Throughout Canada and Southwestern Ontario, there have been multiple outbreaks of COVID-19 at long-term care facilities and retirement homes. The outbreaks have proven deadly and spread quickly.
According to the Ontario Health Coalition, which tracks the number of outbreaks in facilities across the province, 86 residents had died as of Friday as a result of care home outbreaks and nearly 350 staff were sick.
The Pinecrest Nursing Home in Bobcaygeon has become emblematic of outbreaks in care homes, where the home’s 30th resident died Thursday morning. Other facilities in Sarnia and Norfolk County have seen multiple virus-related related deaths.
“Long-term care is a communal environment,” Dager said. “When you’re in a communal environment, it’s very difficult to prevent people coming into close proximity to one another because of the nature of long-term care. We have to do our due diligence to keep our staff and residents safe.”
Woodingford Lodge has more than 300 staff, including nurses, maintenance, laundry workers and personal service workers.
Despite strict screening processes and extensive visitor restrictions, health experts recognize care homes are vulnerable to outbreak and isolating residents can be difficult.
“Any new admissions are supposed to be isolated for 14 days and tested within 14 days. That’s a long time,” said Natalia Mehra, executive director of the Ontario Health Coalition. “These outbreaks have swept the homes within 14 days. The requirement for isolation is just impractical. How are they going to do that there is nowhere to put people? “The premise is wrong.
Isolation might be enough if there were proper personal protective equipment and space and staffing and the ability to isolate. That is not the case.”
Dager said COVID-19 swabs are refrigerated until Southwestern public health picks them up for testing, with results available within 24 to 72 hours.
“We need more testing. … We need to swab and the most critical group is in the long-term care setting,” Roth said. “We need to know and we’ve seen the results of what can happen when you don’t know where the virus is.”
Both Roth and Dager commended public health for the work they’ve done during the pandemic, but said their focus is on the safety of residents and staff.
“We shouldn’t be fighting to get swabs tested in this age group and this setting,” Roth said.
“If we’re going to be successful in keeping it out of our long-term care homes, we need to know where it could be.”
To prevent the spread, Mehra and the health coalition are calling for the mandatory testing of all personnel entering care homes.
“The extent to which Ontario is able to stop the spread in longterm care homes and save the lives of people involved depends on how aggressively they move to protect homes against people coming in with COVID-19, even if they are asymptomatic,” Mehra said.