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No-transfer practice at some long-term care homes denies residents rights during pandemic, say advocates

Posted: April 15, 2020

(April 14, 2020)

By: Elizabeth Payne, Ottawa Citizen

In Almonte and across Ontario, long-term care homes are bearing the brunt of the COVID-19 pandemic with dozens of people dying in their beds in recent weeks without loved ones by their side.

Nearly half of the COVID-19 deaths in Canada are associated with long-term care homes. Most long-term care deaths in Ontario have occurred in the homes, and not in nearby hospitals.

Debra Cox, whose father Ross Richards died at Almonte Country Haven, said she was told infected residents would not be sent to hospital for treatment. Richards died on April 6 after he was given supplemental oxygen at the long-term care home.

But Almonte Country Haven’s administrator, Carolyn Della Foresta, said no family has been told that their loved one would not be transferred. Instead, she said, families who have indicated they wished to send their loved ones to hospital in a medical emergency, have been told that, because of COVID-19,  any transfers to hospital now must be approved by the hospital following a phone assessment and consultation.

The home has continued to have these conversations with families upon their request and with physician consultation, transfers have been considered, but to this point no resident has been transferred,” said Della Foresta.   Advocates say transfers from long-term care homes are extremely rare, in what appears to be a widespread, but informal, practice by some homes and health systems in the province. The practice, say advocates, is both discriminatory and likely making the pandemic worse.

Informal no-transfer practices are putting extra pressure on the most understaffed and chronically underfunded sector of Ontario’s health system at a time when many hospitals, which have stopped non-essential procedures, have low occupancy rates and remain relatively quiet while they wait for a surge of expected COVID-19 patients.

Ontario: Total deaths from COVID-19

In order to help fill staffing gaps, the province recently began allowing long-term care homes to bring in volunteers and untrained workers. Meanwhile, long-term care homes have been dealing with the highest concentrations of COVID-19 illness and deaths in Ontario, and some are still facing shortages of masks, gloves and other personal protective equipment.

At Almonte Country Haven alone, 18 residents have died of COVID-19 since an outbreak began last month, making it the epicentre of the pandemic in Eastern Ontario. At Stoneridge Manor in Carleton Place, at least two people have died. There are 15 outbreaks overall at Ottawa institutions, including long-term care homes.

Ontario’s Chief Medical Officer David Williams said there has been no explicit provincial directive not to transfer patients with COVID-19 from long-term care homes to hospital.

But Lisa Levin, chief executive officer of AdvantAge Ontario, which oversees not-for-profit long-term care homes in the province, noted that since many long-term care residents would not survive on a ventilator, “decisions are often made not to send them over. However, some residents would benefit from hospital medical care and those do indeed go to hospital. There is no provincial directive preventing this from occurring.”

Advocates say they have only heard of a handful of cases in which long-term care residents with COVID-19 have been transferred to hospital. Meanwhile, they have spoken with numerous family members who have reported homes having blanket policies not to transfer patients to hospital.

“There is a systematic approach that is not in a directive but nonetheless is happening to deny access to treatment for people in long-term care with COVID-19,” said Natalie Mehra, executive director of the Ontario Health Coalition.

Confirmed COVID-19 cases in Ottawa daily

“This is not right. They cannot blanket deny people access to treatment simply by virtue of them living in long-term care.”

Jane Meadus, staff lawyer with the Advocacy Centre for the Elderly, said she doesn’t know of any long-term care homes that are sending sick patients to hospital, although that doesn’t mean it isn’t happening. “For the most part, they seem to be staying home.”

Meadus said it is discriminatory to deny a person care based on where they live, and not all long-term care residents would respond the same way to treatment.

“You simply can’t have a policy that we don’t send anyone to hospital. This is in contravention of their duty to care.”

While there might be valid reasons for some individuals to remain in long-term care, she said, blanket policies that keep infected residents in care homes could be worsening the spread of COVID-19.

Meanwhile, Cox said she finds it difficult to accept that her father Ross Richards received no medical assistance in hospital while battling COVID-19, even though she signed a document authorizing medical officials to take all necessary steps to save his life in the event of a health crisis when he entered Almonte Country Haven in December.

The 79-year-old Richards had suffered several mini-strokes and had short-term memory problems, but was otherwise healthy, she said, until he contracted COVID-19.

Almonte Country Haven was placed in a lockdown after a COVID-19 outbreak was declared in the facility late last month.

Cox said a nurse phoned her to discuss the outbreak and inform her that infected residents would not be taken to hospital, and that it would not be possible to honour the advance care directive for her father during the pandemic.

“I said, ‘Oh, really?’” Cox recalled. “She said, ‘Yeah, the hospitals won’t accept them.’”

The nurse said dementia patients with COVID-19 wouldn’t do well on a respirator. Cox said she didn’t pursue the issue further, and doesn’t know if the apparent directive came from hospital officials or nursing home administrators.

The home reported that her father had a fever on April 3. Three days later, with his condition deteriorating, Cox asked Almonte Country Haven staff if they would take her father to the hospital.

“I asked them if they could take him to hospital and not put him on a ventilator, and they said, ‘No.’

“Our hospitals weren’t in the middle of a real crisis yet: they weren’t packed with patients,” she said. “They acted like we were in the middle of a war zone even though the war hadn’t hit. It was really surreal.”

Paula Stewart, medical officer of health in Leeds, Grenville and Lanark, which includes Almonte, said the decision about whether to transfer patients to the hospital is made by the individual’s or the home’s physician.

“Some people are being referred to hospital. Many factors go into this decision including the individual and family’s perspective and the presence of other underlying conditions.”

She added: “A transfer to hospital can be very difficult for an older person who is ill, particularly if there is any cognitive dysfunction and it may not make a difference to their health.”

On Tuesday, Premier Doug Ford said the province will send “hospital-based teams” in to long-term care homes to stop the spread of COVID-19 within the institutions. The province also banned staff from working in more than one long-term care home.

Cumulative confirmed COVID-19 cases in Ottawa

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