To win the COVID-19 war, we need more home care for seniors

If home is the safest place to be these days, shouldn’t Ontario do more to keep seniors out of long-term-care facilities and enable them to live at home again?
By Steve Paikin - Published on Apr 11, 2020
Minister of Health Christine Elliott speaks at Queen's Park on April 10. (Nathan Denette/CP)



If you’re afraid of getting COVID-19, one of the worst places in Ontario you could be these days is in a long-term-care home.

We know that fatality rates skyrocket if you’re 80 or older, and it gets even worse if you have additional underlying health problems.

In fact, fully half of all deaths in Ontario due to COVID-19 have been among those who lived in long-term-care facilities.

The family of 91-year-old Robert Nixon, the four-time Ontario Liberal leader, was so concerned about these demographic realities that they took him out of his facility, a seniors' home in Brant County, and brought him back home. He was doing fine where he was — but no one wanted to take any chances.

Perhaps understandably, Ontario’s health ministry has been focusing its efforts primarily on beefing up hospital resources and ensuring the safety of front-line staff and patients. But, as we learned last week from a sombre Premier Doug Ford at one of his daily briefings, the demand for ICU beds could overwhelm our health-care system in the next couple of weeks if we’re not able to flatten the curve.

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All the more reason why the province ought to be making a major commitment to increasing home-care services right now. It was only last Friday that Health Minister Christine Elliott added staff and patients in long-term-care facilities to the list of those who merit priority COVID-19 tests. One of the reasons these homes have become a hotbed for the virus is that the elderly may contract it outside that setting, then, when they move into a long-term-care facility, rapidly spread it to others.

That unfortunate reality was thrown into sharp relief last Friday in Markham, when Participation House, a care home for adults with physical and mental disabilities — in other words, for among the most vulnerable people in the province — found itself in a state of emergency, after 10 patients and two staffers tested positive for the virus.

Most of the staff walked off the job, terrified that they, too, would become infected. That left 42 residents virtually abandoned. Forty of the people who live there need wheelchairs and are unable to feed themselves.

Management is promising full PPE for those who return, but the previous lack of such gear no doubt contributed to a sense of danger among the workers.

Participation House may be a dramatic example, but it’s just one of many: the Pinecrest Nursing Home in Bobcaygeon was described as a “war zone” by the home’s medical director after COVID-19 swept through the facility, killing 29 residents. Seven residents of the St. Clair O’Connor Community home in Toronto have also perished.

Shouldn’t the province be doing everything it can to improve home care so that residents who can go home or live with family members are able to do so?

“Home care has been a missing piece in this pandemic,” says Shirlee Sharkey, president and CEO of SE Health, one of the biggest home-care providers in the country.

“This is not entirely surprising, because it’s been a pretty significant gap in our health-care system for over 30 years.”

More testing may actually not be the answer here. Provincial health officials, who briefed the media on Friday, insisted that there was limited value in testing everyone in care homes. Patients without symptoms could test negative but then catch the virus the next day.

“To test the whole facility when there’s no cases would use up resources and reduce the availability of resources elsewhere,” an official said. “If you find nothing that day, it doesn’t mean anything.  And you can’t test every day forever.”

Having said that, officials acknowledged the need for residents who have been tested to get the results right away so that follow-up care can be administered before more damage is done. They added that there’s now a “home- and community-care table” of provincial health officials who are working with agencies to figure this out.

“This is one of our bigger, challenging areas,” the health-care official acknowledged — bureaucrat-speak for ‘This is a helluva problem that we haven’t got a handle on yet.’

In addition, there has been no specific relief funding or targeted investment in home care. “In fact, in Ontario, we’re actually reducing the availability of home-care services,” said a leading provider.

Furthermore, hospitals are discharging older patients into long-term-care homes or hotels, where they’re less safe, rather than to their own or their family’s homes, where, with some beefed-up care, they’d be in far less danger.

Ontario’s official opposition NDP has suggested aggressively recruiting more home-care workers, using incentives such as increased wages and the mandatory provision of PPE for every home visit (one provider told me visits are down 20 to 30 per cent because many seniors don’t want care workers coming into their homes if those workers don’t have PPE).

“PPE is an incredibly challenging environment,” said a provincial official at Friday’s health-care briefing, using that word again, suggesting that we’re too far behind where we need to be.

The head of another major home-care organization confirms that. “Bayshore has yet to receive a single piece of PPE from the government of Ontario,” says Stuart J. Cottrelle, president of Bayshore Health Care. “I believe all organizations are in the same situation.

“The COVID Pandemic solution is very simple,” he continues. “One patient per caregiver, and give that caregiver full-time hours. Other professional supports can be arranged virtually or, if necessary, in person.”

At the premier’s daily briefing on Friday, Elliott confirmed that 99 long-term-care homes have had residents test positive for COVID-19. And, despite the province concentrating resources on places where there are outbreaks, these homes will likely continue to be highly dangerous — until we can get our act together.

At every briefing, Ford and Elliott tell Ontarians to stay home because that’s the safest place for them to be. If that’s the case, isn’t it time to bring in some policies to help the elderly and frail stay safe as well?

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