{"id":14117,"date":"2020-07-23T23:15:01","date_gmt":"2020-07-24T03:15:01","guid":{"rendered":"https:\/\/www.ontariohealthcoalition.ca\/?p=14117"},"modified":"2020-07-26T23:20:25","modified_gmt":"2020-07-27T03:20:25","slug":"analysis-why-were-covid-19-outbreaks-worse-in-older-toronto-nursing-homes","status":"publish","type":"post","link":"https:\/\/www.ontariohealthcoalition.ca\/index.php\/analysis-why-were-covid-19-outbreaks-worse-in-older-toronto-nursing-homes\/","title":{"rendered":"Analysis: Why were COVID-19 outbreaks worse in older Toronto nursing homes?"},"content":{"rendered":"<p>(July 22, 2020)<\/p>\n<p>By: Mike Adler, Toronto.com<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"\" src=\"https:\/\/dynamicmedia.zuza.com\/zz\/m\/original_\/d\/a\/dab12553-cdd5-4b0c-a093-a0ae606284d7\/NY%20Hawthorne%20Place%20Long%20term%20care_Super_Portrait.jpg\" alt=\"Hawthorne Place Long term care\" width=\"373\" height=\"187\" \/><\/p>\n<p><em>Hawthorne Place Care Centre is a long-term-care facility near Jane Street and Finch Avenue. &#8211; Dan Pearce\/Torstar<\/em><\/p>\n<p>Alessandra Lamanna-La Marca\u00a0remembers the slow, shuddering elevator to the third floor, its stifling heat in summer, and the urine smells outside her mother\u2019s four-bed room.<\/p>\n<p>That Hawthorne Place Care Centre room had one shared bathroom, where her mother\u2019s wheelchair wouldn\u2019t fit.<\/p>\n<p class=\"thirdPrg\">Three or four-bed \u201cward rooms\u201d are part of many aging nursing homes across North York, Scarborough and Etobicoke.<\/p>\n<p>Like Hawthorne, which opened in North York in 1973, these older homes were built to standards set for 1972, when many nursing home residents were younger and abler.<\/p>\n<div id=\"div14562\" class=\"asset-body-part1 act\">\n<div>\n<p>Known as \u201cC\u201d bed facilities, these homes are also where COVID-19 outbreaks were costliest in lives.<\/p>\n<p>Ward rooms can be crowded.\u00a0Lamanna-La Marca wrote last week her mother\u2019s personal space included a shared closet.<\/p>\n<p>\u201cThey often would lose my mother\u2019s clothes and I would find her with someone else\u2019s clothing,\u201d she recalled.<\/p>\n<p>Hawthorne\u00a0<span style=\"color: #3366ff;\"><a style=\"color: #3366ff;\" href=\"https:\/\/www.toronto.com\/news-story\/9998632-north-york-nursing-home-near-100-per-cent-contamination-rate-report\/\" target=\"_blank\" rel=\"noopener noreferrer\">lost 51 residents to COVID-19<\/a><\/span>, including Lamanna-La Marca\u2019s mother, while at Downsview Long Term Care Centre,\u00a0<span style=\"color: #3366ff;\"><a style=\"color: #3366ff;\" href=\"https:\/\/www.toronto.com\/news-story\/10013809-downsview-care-home-resident-cried-i-am-hungry-days-before-dying\/\">64 died<\/a><\/span>.<\/p>\n<p>In Scarborough, Altamont Care Community (53 resident deaths) is a \u201cC\u201d home, as is Extendicare Guildwood (48 deaths, seven others recorded as non-COVID-19) and\u00a0<span style=\"color: #3366ff;\"><a style=\"color: #3366ff;\" href=\"https:\/\/www.toronto.com\/news-story\/9923236-timeline-coronavirus-deaths-at-scarborough-s-seven-oaks-nursing-home\/\" target=\"_blank\" rel=\"noopener noreferrer\">Seven Oaks (41)<\/a><\/span>.<\/p>\n<p>Scarborough\u2019s Midland Gardens Care Community, a home with \u2018B\u201d beds \u2014 which \u201csubstantially exceed\u201d 1972 requirements but don\u2019t meet contemporary standards \u2014 had 42 deaths.<\/p>\n<\/div>\n<\/div>\n<div id=\"div14563\" class=\"asset-body-part2 act\">\n<div>\n<p>In Etobicoke, Eatonville Care Centre (42 deaths) and Humber Valley Terrace (36) are also \u201cC\u201d facilities.<\/p>\n<p>Facility age isn\u2019t the whole story. Newer or retrofitted nursing homes in Toronto\u2019s inner suburbs also had deadly outbreaks, and many \u201cC\u201d homes managed to stop outbreaks without loss of life.<\/p>\n<p class=\"thirdPrg\">Still, it is only homes built since 1998 which don\u2019t have rooms with three or four beds or other features which make isolating the virus more difficult.<\/p>\n<p>Extendicare Guildwood started as a motel and has few single rooms.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"\" src=\"http:\/\/media.zuza.com\/a\/8\/a8eaf822-3537-48fa-bebc-6ac1485bd5b2\/SC%20Guildwood%20Rally5.JPG\" width=\"414\" height=\"276\" \/><\/p>\n<p><em>Relatives of Extendicare Guildwood residents pause during a June 12 rally in front of the Scarborough nursing home to honour residents who died during an outbreak of COVID-19. &#8211; Torstar file photo<\/em><\/p>\n<p>Scarborough Health Network,\u00a0<span style=\"color: #3366ff;\"><a style=\"color: #3366ff;\" href=\"https:\/\/www.toronto.com\/news-story\/10078532-doctors-refused-to-visit-scarborough-nursing-home-health-officials-say\/\" target=\"_blank\" rel=\"noopener noreferrer\">now temporarily in charge<\/a><\/span>, reported the home is \u201cless than ideal to prevent the spread of infection between residents\u201d and its \u201ctight spaces\u201d make physical distancing difficult.<\/p>\n<p>Two people whose relatives were residents say its medical director, Dr. Eric Kaziuka, told them management knew it wouldn\u2019t be able to isolate COVID-positive residents properly.<\/p>\n<p>\u201cThe home just isn\u2019t set up for that,\u201d is what Jeanine Skretas remembers Kaziuka said to her and Michelle Wilson during a May 19 telephone conversation.<\/p>\n<p>Kaziuka couldn\u2019t be reached for comment through Extendicare or his Scarborough offices.<\/p>\n<p>Asked about Kaziuka&#8217;s alleged opinions about isolation in the home, Extendicare in a written statement did not comment on this, but said the &#8220;structure of the home&#8221; and loss of staff during the outbreak made the situation &#8220;exceptionally difficult to manage.&#8221;<\/p>\n<p>On July 22, Extendicare said it will limit occupancy in four-bed rooms to two residents in anticipation of a second wave, and that it had recently applied to rebuild all of its \u201cC\u201d bed homes.<\/p>\n<p>Skretas, whose father died on May 23, said Extendicare could have installed extra resources to make better isolation possible. Instead, she argued, management \u201cleft them to die.\u201d<\/p>\n<p>Researchers\u00a0based at Toronto\u2019s Mount Sinai Hospital looked at Ontario Long-Term Care (LTC) outbreaks between March 29 and May 20.<\/p>\n<p>Using simulations, the team, led by Dr. Nathan Stall, found converting all four-bed rooms to two-bed rooms\u00a0<span style=\"color: #3366ff;\"><a style=\"color: #3366ff;\" href=\"https:\/\/www.medrxiv.org\/content\/10.1101\/2020.06.23.20137729v1\" target=\"_blank\" rel=\"nofollow noopener noreferrer\">would have averted 19 per cent of COVID-19 infections and deaths<\/a><\/span>. \u201cReducing crowding in nursing homes could prevent future COVID-19 mortality,\u201d they advised.<\/p>\n<p>Ontario\u2019s government appeared to draw similar conclusions.<\/p>\n<p>It told homes not to place new residents into ward rooms. On July 15, it announced a \u201cmodernized funding model\u201d to rebuild older homes, including grants to cover municipal development charges.<\/p>\n<p>\u201cMurky,\u201d convoluted and lasting three to five years, the province\u2019s former capital renewal program for homes wasn\u2019t viable, and in Greater Toronto land costs were \u201cprohibitive,\u201d said Ontario Long Term Care Association CEO Donna Duncan, adding few facilities were rebuilt since 2007.<\/p>\n<p>The association represents most Ontario nursing homes, including for-profit and not-for-profit providers.<\/p>\n<p>Measures taken during flu seasons in older homes \u201creally were no match\u201d for the coronavirus. With homes at capacity there was little ability to move residents around, Duncan said.<\/p>\n<p>\u201cThere was no place left to move them to.\u201d<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"\" src=\"http:\/\/media.zuza.com\/2\/3\/23187133-21e3-4fef-b8ab-2e3b75fcfbad\/1SC%20HospitalMerger0220.JPG\" width=\"388\" height=\"268\" \/><\/p>\n<p><em>Natalie Mehra, executive director of the Ontario Health Coalition, speaks during a news conference in 2014.<\/em><em>\u00a0&#8211; Torstar file photo<\/em><\/p>\n<p>Natalie Mehra, executive director of the Ontario Health Coalition, a network of more than 400 grassroots community organizations, said for-profit companies, which own many older homes in Toronto, haven\u2019t brought homes up to standards, though governments offered them money over two decades.<\/p>\n<p>\u201cThey\u2019re running them as they are because they can,\u201d argued Mehra, who thinks the province should move such homes into public ownership.<\/p>\n<p>Remaking older homes is \u201cat the bottom of the priority list in many countries,\u201d partly because few people plan to live in such places, said Pat Armstrong, a York University sociology professor.<\/p>\n<p>Studying long-term care for a book, Armstrong met Norwegians shocked by four-bed rooms; theirs were all private, she said.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"\" src=\"http:\/\/media.zuza.com\/5\/0\/50fde302-c7aa-4bc7-852e-e90f6d84c65f\/3vNY%20PatArmstrong.JPG\" width=\"231\" height=\"323\" \/><\/p>\n<p><em>Pat Armstrong is a York University sociology professor and an expert on long-term care. &#8211; Paul Jones\/photo<\/em><\/p>\n<p>Rather than just \u201ctear it down,\u201d Armstrong said, Ontario needs multiple strategies to create flexibility in structures. A four-bed room, for instance, can become a double with a bathroom.<\/p>\n<p>Providing staff with spaces to eat or change clothes, so they aren\u2019t taking contamination in or out, is important, she said.<\/p>\n<p>Armstrong believes better LTC for seniors is a human right. Because we\u2019ll have to raise taxes to improve it, she\u2019s worried Ontarians will lose interest, thinking, \u201cWhat\u2019s the big deal?\u201d<\/p>\n<p><span style=\"color: #3366ff;\"><a style=\"color: #3366ff;\" href=\"https:\/\/www.toronto.com\/news-story\/10110509-analysis-why-were-covid-19-outbreaks-worse-in-older-toronto-nursing-homes-\/\">Link to original article<\/a><\/span><\/p>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>(July 22, 2020) By: Mike Adler, Toronto.com Hawthorne Place Care Centre is a long-term-care facility near Jane Street and Finch Avenue. &#8211; Dan Pearce\/Torstar Alessandra Lamanna-La Marca\u00a0remembers the slow, shuddering elevator to the third floor, its stifling heat in summer, and the urine smells outside her mother\u2019s four-bed room. That Hawthorne Place Care Centre room [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[21],"tags":[],"class_list":["post-14117","post","type-post","status-publish","format-standard","hentry","category-ohc-in-the-news"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Analysis: Why were COVID-19 outbreaks worse in older Toronto nursing homes? - Ontario Health Coalition<\/title>\n<meta name=\"description\" content=\"(July 22, 2020) By: Mike Adler, Toronto.com Hawthorne Place Care Centre is a long-term-care facility near Jane Street and Finch Avenue. - Dan\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" 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