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‘This is not right’; Family, advocates worry care homes ‘don’t send anyone to hospital’as policy

Posted: April 16, 2020

(April 15, 2020)

By: Elizabeth Payne and Andrew Duffy, Ottawa Sun (Print Edition)

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

Nearly half of the COVID-19 deaths in Canada are associated with long-term care homes. In Ontario, most of those deaths were in the homes, not in nearby hospitals.

Debra Cox’s father Ross Richards died at Almonte Country Haven. Cox 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 longterm-care home.

In a statement, Carolyn Della Foresta, Almonte Country Haven’s administrator, suggested the home assesses each case as it comes, based on each family’s wishes. Della Foresta added that a transfer would only happen after a telephone assessment by a physician at the hospital.

Della Foresta did not say whether any of the home’s residents had been transferred to hospital.

Cox said a nurse phoned to tell 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’s 79-year-old father had suffered several ministrokes and had short-term memory problems, but was otherwise healthy, she said, before he got COVID-19.

Cox said she didn’t pursue the issue further, and doesn’t know if the directive came from hospital officials or nursing home bosses. She said the home was locked down after an outbreak late last month.

Since then, it’s believed 18 residents at the home have died of COVID-19.

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.”

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 of AdvantAge Ontario, which oversees non-profit long-term-care homes in the province, said that since many residents wouldn’t survive on a ventilator, “decisions are often made not to send them over.”

“There is no provincial directive preventing this from occurring,” Levin added.

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, concerned family members have told them homes have 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 longterm care with COVID-19,” said Natalie Mehra, executive director of the Ontario Health Coalition.

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

Jane Meadus, staff lawyer with the Advocacy Centre for the Elderly, said she doesn’t know of any homes that are sending sick patients to hospital, although that doesn’t mean it isn’t happening.

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,” Meadus said.

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

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