A push to save lives as longstanding issues leave long-term care homes susceptible to COVID-19

Tight budgets, understaffing and limited infection prevention measures have plagued long-term and retirement homes for years, leaving them susceptible to the ravages of COVID-19, according to experts.

The novel coronavirus has torn through care homes across the country, infecting residents and staff and causing deaths.

"I think it's quite the tragedy," said Dr. Mustafa Hirji, acting medical officer of health for the Niagara Region.

"With this particularly more dangerous virus we are seeing even more acutely how bad some of the challenges they face are."

On Wednesday, as outbreaks were reported in 114 long-term care homes, Premier Doug Ford described the facilities as the new frontline in the fight against COVID-19.

There have been 145 deaths in long-term care homes related to COVID-19, and just over 40 per cent of cases are among patients aged 60 and older. 

"Today we're throwing everything we've got to our long-term care homes," said Ford while announcing a plan to contain the virus.

Homes in Hamilton and Niagara have not been spared and officials are also adding resources to the fight. Local outbreaks have prompted public health units to create special teams of infection inspectors and acknowledge steps they took before the virus broke out in homes didn't go far enough to protect residents who are especially at risk.

Six of Hamilton's seven institutional outbreaks of COVID-19 involve nursing homes. As of Friday morning:

• Heritage Green Nursing Home has 11 infected residents, three infected staff and three deaths.
• Cardinal Retirement Residence has 45 infected residents, 17 infected staff and four deaths.
• Chartwell Deerview Crossing Retirement Residence has one infected staff member.
• Kingsberry Place Seniors Residence has two infected residents.
• Clarion Nursing Home has an infected staff member.
• Wentworth Lodge has one infected staff member.

There were 306 cases of COVID-19 in Hamilton as of 9 a.m. Thursday. Nineteen per cent of which were long-term care  or retirement home residents, according to public health. Eleven people in the city have died of the virus so far.

Anson Place in Hagersville is among the hardest-hit homes in the province. Twenty-two residents have died as of Saturday and 70 of the home's 101 residents have tested positive for the virus. Thirty-one staff also have COVID-19.

There are also outbreaks at five homes in Niagara, including at Lundy Manor in Niagara Falls, which has led to 12 resident deaths. Twenty-two residents and five staff members have also tested positive for the virus, according to Oxford Living, which runs the home.

Hirji pointed to "longstanding challenges" in the industry, including tight budgets that limit infection prevention and control, unstable staffing that makes it hard to build expertise around managing outbreaks and low pay that can force employees to work at numerous facilities to make ends meet.

Dr. Henry Siu, an assistant professor in McMaster University's department of family medicine and attending physician at a Hamilton long-term care home agreed homes have been struggling.

He said complaints about workload and understaffing are frequent and the physical layout of many long-term care homes — multiple beds in a single room and shared common areas — create a major risk of virus spread.

In anticipation of COVID-19, Niagara Region Public Health upped its regular long-term care home inspections from quarterly to weekly and instructed inspectors to take a more detailed look at how homes were operating.

But, since the virus hit the area, Hirji said it's become clear that step "probably wasn't enough."

Now the unit has set up a special team of inspectors who head into facilities that are struggling to provide "on-site coaching" and observe how they're handling PPE, how frequently they're washing their hands and to see "not being done totally right," said Hirji.

Public health officials in Hamilton have also begun inspecting homes — issuing orders to 31 residential facilities that weren't doing enough to curb the spread of COVID-19 this week.

Staff in Niagara have also begun testing more people in case they have asymptomatic infections.

"We started doing that over the long weekend and we're actually seeing quite a few persons coming back with those infections," said Hirji.

A chance for a silver lining

The provincial strategy for long-term care and retirement homes includes more testing for residents and staff, including asymptomatic residents or staff who came in contact with someone with COVID-19. 

Provincial officials also pledged to provide PPE to any homes in need within 24 hours and will work toward "better isolation measures," said Dr. Merrilee Fullerton, Ontario's minister of long-term care.

"We will spare no expense to keep our most vulnerable residents safe," she added, promising the province will use emergency funding to hire more staff.

Siu described the government's plan as a "very good first step" and one he hopes will be followed through on to help people in years to come.

"I think this is a chance to make a real difference for our long-term care residents and a chance for a silver lining in a really bad situation," he said. "I hope all the changes that are being made aren't erased when the pandemic is declared over."