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Pandemic lays bare the state of elder care

Posted: April 15, 2020

(April 14, 2020)

Just over a year ago, my mother passed away in a long-term care facility near Toronto. We had moved her there about six weeks earlier from a retirement home because she was increasingly frail, confused and risked a serious fall. We believed – wrongly, as it turned out – that she would get better care in the long-term health environment. Retirement homes, after all, are not medical institutions.

A day hasn’t gone by when I haven’t regretted moving her. Most of the long-term care staff tackled their jobs dutifully, but there weren’t enough of them, and their skills and empathy levels varied. So I find it particularly heartbreaking to see reports of frail people in similar facilities infected en masse with the novel coronavirus, many dying from it. But warehousing people will do that sort of thing.

On Thursday, for example, the Almonte Country Haven longterm care home reported that 10 of its residents had succumbed to COVID-19. At least 20 others had tested positive for the virus. Some long-term care residents in other Ottawa-area facilities have also died. And there were 28 deaths from COVID-19 in a single nursing home in Bobcaygeon, Ont.

In Toronto, a similar sample of tragedy: at least 16 people dead at the long-term care Seven Oaks residence. Seven dead at the St. Clair O’Connor Community home. By late Thursday, 73 outbreaks were reported in long-term care homes across the province, with 98 deaths.

Just weeks ago, we all discovered that cruise ships are floating crucibles for infectious disease. But we should have known years ago what would happen to our elders in the sort of long-term care Ontario mandates.

Massive bed shortages mean desperate families generally must take what they can get for their loved ones; long-term care is a rationed system with no healthy competition to spur institutional excellence (though many compassionate professionals try their best). There was a chronic nursing shortage, and a personal support worker shortage – what the Ontario Health Coalition calls “crisis-level staffing shortages” – even before the outbreak. In some places, employees move between different care homes, toting various microbes along for the ride.

In many facilities, residents don’t have private rooms: two, or even four, people share a space, with only curtains separating them. There are often no real options for isolating sick people.

Until this week, testing of long-term care residents for COVID-19 was strictly limited. A measure of how we seem to regard the elderly is that only now has Ontario’s chief medical officer, Dr. David Williams, decided that anyone moving into long-term care should be tested, since the illness engulfs these settings so easily. Consider, as well, that the same provincial official took until Thursday to direct long-term care staff to wear masks inside the facilities (many workers, fortunately, didn’t wait for his edict). Until now, apparently, face coverings were not necessary when dealing with the very frailest of our fellow citizens.

Meanwhile, the province recently loosened standards so that long-term care homes could hire untrained workers, and said the facilities no longer needed a registered nurse around the clock. It was an inevitable reaction to the staffing shortages that were already occurring and are now acute. It brings no comfort.

It’s both dismaying and instructive to see public health officials tiptoeing when asked whether people should remove their loved one from long-term care to help protect them from the virus tide swamping these places. In a proper care environment, it would be absurd to contemplate such an action. But in the surreal world of long-term care, everyone knows many homes can’t fend off serious, contagious illness.

This is the stark picture COVID-19 lays bare. Our frail loved ones are sent into institutional settings so poorly staffed and equipped that it is virtually impossible to prevent deadly disease from infiltrating.

Yes, you’ll say, but they’re old; they’ll die from something. You may not care much. But I do. And I weep for those who will lose loved ones in a system that was never really designed to protect them in the first place. Christina Spencer is the Citizen’s editorial pages editor.

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