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ANALYSIS & RESPONSE: New Directive and Guidelines for COVID-19 in Long-Term Care Homes Inadequate: Coalition Calls for Full Testing, Better Access to PPE, Respect for Human Rights in Care

Posted: April 9, 2020

(April 9, 2020)

Long-term care deaths from COVID-19 now account for almost half of all of Ontario’s deceased, according to the provincial data on infections. The numbers of staff and residents who have tested positive is escalating at a devastating pace. Following an emergency meeting of the Ontario Health Coalition long-term care committee including family councils, unions, health professionals, seniors’ advocates and experts on long-term care, the Ontario Health Coalition called for more aggressive concrete measures to be implemented as soon as possible.

The Coalition also provided a summary and response to the new COVID-19 directive and guidelines for long-term care homes included here. The Coalition is deeply concerned that the new measures released by the Ontario government are not enough to stop the spread of COVID-19 into homes that currently do not have outbreaks, nor are they enough to stem the outbreaks in existing homes and protect staff. There are very few measures in Ontario that concretely support the workforce that has held the system together through crisis-level staffing shortages prior to COVID-19 and now with even more critical shortages as the virus spreads through the homes with devastating speed. In fact the deregulation of existing staffing standards and introduction of lower paid, contracted and untrained staff is not safe and is the opposite of what the Coalition has been calling for to stabilize the workforce.

Putting the spread of COVID-19 in Ontario’s long-term care homes in perspective:

By the most recent provincial data here the number of homes with outbreaks is now 69 and is increasing very rapidly. The number of infected staff has ballooned to 347, infected residents are numbered at 498, for a total of 845. There have been 86 deaths, almost half of the provincial total number of deaths though long-term care accounts for only one half of one percent of the provincial population.

To support the residents and staff in long-term care and to stop the spread of COVID-19 the Ontario Health Coalition is urgently calling for the following measures from our provincial government:

  • All staff must be provided with PPE in accordance with the precautionary principle including N95 masks for those exposed to residents with suspected or confirmed COVID-19 infection. In addition, staff must be able to access changes of masks and PPE in accordance with the precautionary principle.
  • All homes must be provided with training and support to provide proper training to staff in the use of PPE immediately. There are many homes that do not have the ability to do this safely themselves.
  • All staff, residents, volunteers, families and management going into long-term care homes or residing in long-term care homes must be tested. For families of residents who are in palliative care, compassionate access to their family member should be provided while they are waiting for test results with proper additional safety measures.
  • Deregulation of existing staffing standards and the use of contracted out, untrained and volunteer labour cannot be the sole response of our government to the staffing crisis in long-term care. British Columbia, for example has done far more, as has Quebec to a lesser extent. In Ontario we are not calling for the exact implementation of the B.C. model due to the critical level of staffing shortages, but the Coalition is pointing to it as an example that underlines how little is being done here to support the workforce in comparison and the Coalition is calling for the immediate implementation of the following:
    • Provincial government support for the workforce to be able to work full-time wherever possible, with the resources needed to increase to full-time hours and wages for the homes to be able to do this.
    • the most robust possible recruitment of appropriately trained staff as per existing regulations (not untrained and voluntary labour under the emergency regulations) to improve staffing and care levels in the homes.
    • Provincial government resources and policy to immediately provide improved wages and conditions for staff to support the stabilization of the workforce and recruitment efforts.

Ontario Health Coalition Summary & Response to new Directive/Guidelines:

Re. Directive #3 – which has been updated to say that all staff/visitors wear surgical masks (except on break).

Not adequate. All staff must be provided with PPE in accordance with the precautionary principle including N95 masks for those exposed to residents with suspected or confirmed COVID-19 infection. In addition, staff must be able to access changes of masks and PPE in accordance with the precautionary principle.

New Guidelines on Testing -The  new guidelines require: testing within 14 days of admission; expanded the symptoms for staff/residents who can get tested; require testing patients who are being moved out of hospitals but not prohibiting admission of those patients who test positive; are enabling testing for asymtomatic contacts of confirmed cases.

Not adequate: All staff, residents, volunteers, families and management going into long-term care homes or residing in long-term care homes must be tested as soon as possible. For families of residents who are in palliative care, compassionate access to their family member should be provided while they are waiting for test results with proper additional safety measures.

Further, it is not adequate to require new admissions to be tested within 14-days. The majority of the spread of COVID-19 in the homes has occurred within 14-days. Isolation is not adequate as described below.

Further, the homes cannot safely take hospital patients who have tested positive for COVID-19 and those patients should not be allowed to be transferred or admitted.

Updated Directive #3 on Isolation — Homes are required to cohort residents with COVID-19 and staff are required not to work with both residents who test positive and those without COVID-19 symptoms.  Homes are required to isolate new admissions for 14-days and test them within 14-days. New provisions have been made to use spaces within the homes to do this.

We are concerned because this is not practically possible in many long-term care homes. Some of the newer homes may be able to follow this directive, but many homes simply have no way of doing this. The government must come up with a better solution to protect residents and staff and stop the spread of COVID-19 in the homes.

Outright refusals/pressure on families to stop transfers to hospitals — Only a few long-term care residents who have become ill with COVID-19 have been transferred to hospitals for treatment. The Ontario Health Coalition is hearing from families and seeing documentation of pressure being put on families to not transfer their family members who become sick from long-term care homes to hospitals. The Coalition reports that some long-term care homes are telling all families that if their loved one becomes ill with COVID-19 they will not be transferred to hospital.

This is a violation of human rights and the Health Care Consent Act. People must be provided care and support on a case-by-case basis, based on their unique needs and circumstances and in accordance with human rights and legislative protections.

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