As COVID-19 cuts a deadly swath through nursing and retirement homes across the country, CARP says Canadians who can care for loved ones at home should do it.

“Personally, if I had a family member in long-term care, I’d be taking them out,” said Marissa Lennox, policy officer for CARP, Canada’s largest organization for older Canadians.

She noted more than 80 per cent of deaths in Ontario have been in retirement or nursing homes, and more than 600 across the country have confirmed cases of COVID-19, pointing to outbreaks at nursing homes in B.C., Ontario and Alberta.

“That’s why CARP is saying that if you do have concerns and you know that your loved one is particularly vulnerable – and you have the capacity at home to meet their care needs – you have the option to take them out of long-term care.”

She stopped short of endorsing the alarming conclusion made by the Globe and Mail health columnist André Picard, after he interviewed Canadian geriatrician Dr. Samir Sinha: “Get them out while you still have a chance.”

 

Instead, Lennox said CARP is advising its members that they have the option, particularly “if you do have concerns and you have the capacity at home to meet their care needs.” It’s not an indictment of long-term care facilities but may be necessary given how easily the respiratory disease spreads in these environments and how deadly it is for frail seniors.

Ontario Health Minister Christine Elliot is aware some families want to remove their loved ones from nursing homes. While it may be an option for some people, “It’s just not a reality for most people,” she told a press conference on Friday.

But Dr. Isaac Bogoch, an infectious diseases scientist at the University of Toronto and clinician-investigator at Toronto General Hospital, cautioned it isn’t a simple “black-and-white” decision.

Families should be aware that a COVID-19 outbreak in a nursing home “will spread quickly, and the mortality rate will be high – up to 30 per cent,” he said in a telephone interview.

But he stopped short of offering blanket advice for anxious families who are wondering what to do. “There’s no one-size-fits-all solution to this devastating issue.” Rather, he advised families who are considering such a drastic move to ask themselves some serious questions: Can you ensure that the risk of infection will be lower at home than in a long-term care facility? And will you be able to provide your loved one with the standard of care they would receive in a nursing home?

Ultimately, Bogoch said, the decision comes down to a “value judgment” by families, who have to decide if it’s safer for their loved one to be at home or in a long-term care home.

Shortage of Personal Support Workers

A complicating factor is the critical shortage of staff at long-term care homes that have been decimated by the pandemic. There is now a massive shortage of Personal Support Workers (PSWs) – the people who provide the bulk of the care, including feeding, washing, exercising and companionship.

“They entered this crisis already short-staffed, and the pandemic has only amplified that,” said Ian DaSilva, human resources director for the Ontario Personal Support Workers Association (OPSWA), the professional body that oversees training and advocates for these front-line workers.

DaSilva says some of his PSWs have been infected by the virus and are at home in self-isolation. But the real problem is that many others simply can’t work, either because they have underlying health conditions of their own or because they are in their 50s or 60s, which is also a high-risk age group.

Because of these compounding factors, “The request for emergency PSWs is continuing to rise,” he said. Earlier this week, the organization’s website posted an urgent call to fill openings in smaller communities across Ontario.

Part-time staff, volunteers

As a result of the labour shortage in nursing homes, the government of Ontario has issued an emergency order that allows long-term care facilities to defer vacations for existing staff and hire extra part-time staff or volunteers to help cope with the pandemic. In Bruce County on the shores of Lake Huron, library and museum workers were being offered jobs at nursing homes serving food, cleaning bedpans and helping residents with activities.

DaSilva noted his organization “recognizes that there’s such a shortage on the front line right now” but stresses  “when the emergency order is over, those persons must leave.”

When asked about the emergency order, the Ontario Long Term Care Association (OLTCA), which represents the province’s home operators, it directed us to a statement on the website.

Because long-term care facilities could lose up to 50 per cent of their staff during the pandemic, the OLTCA is supporting any reasonable measures to help them fight COVID-19, “including recruiting interim non-clinical employees to allow scarce clinical professionals to focus on direct care and support, and to stabilize our homes.”

An OLTCA spokesperson clarified that emergency staff will not provide care but will help prepare patients for meals, tidy rooms and provide companionship – anything to free up PSWs so they can focus on care.

But some groups, including CARP, feel that families need assurances that nursing home residents are being properly looked after.

“While the emergency order is in effect, some families worry that their family members in nursing homes won’t receive the kind of care they need,” said Lennox, CARP’s advocacy officer. She recognizes the province needs to be “agile” on staffing in these desperate times but notes many members are “deeply concerned” that “unqualified staff who lack the expertise or credentials needed to work with seniors will cause further harm to one of our most vulnerable populations.”

Front-line heroes

It’s unfortunate that it took a pandemic to shine a light on the difficult job of PSWs, who are on the very front lines of the pandemic.

“Everyone is feeling tense and afraid of the uncertainty of the times,” says DaSilva. “And the PSWs are feeling that anxiety many times over.” He says the lack of protective equipment and confusion over the transmission of COVID-19 are uppermost in their minds, but the workload remains their No. 1 concern.

But he’s overwhelmed by how PSWs have responded to the crisis. “I’m amazed by the level of duty and heroic sense of service they’re displaying.”

Lennox is quick to praise the monumental contributions made by PSWs, who are some of the unsung essential workers on the pandemic’s front lines. “Unfortunately, it shouldn’t have taken a pandemic to trigger action from government in addressing the shortage of qualified personal support workers in Ontario,” she says.

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