Fearful of 'nightmare,' special care homes ask for government help protecting vulnerable

The threat of COVID-19 getting past her front door is a constant worry, and Jan Seely's worst nightmare.

She is the operator of Seely Special Care Home in Saint John and president of the New Brunswick Special Care Home Association.

"Do I 100 per cent believe that we're ready to deal with a COVID case tomorrow at my care home? I do not," she said.

"Right now, I would say we are very 'paper prepared.' We have paper plans and we have paper memos and we have paper recommendations … and we are doing our very best to navigate our way through those mounds of paper." 

When it comes to COVID-19, New Brunswick's Achilles heel has been special care homes. There have been outbreaks at four homes and counting since the pandemic began, and at least three of the six COVID-related deaths in the province were special care home residents. 

Seely represents about 400 homes, which offer 7,000 licensed beds to those who need more support than they can get at home but don't need nursing home care.

Health-care workers who responded to the first outbreak of COVID-19 at a special care home in Atholville in late May and early June, described a troubling scene at Manoir de la Vallée.

When five of the staff members became infected, 10 others were forced to self-isolate and the rest of the staff refused to work in the infected Alzheimer's unit.

Health-care workers who volunteered to care for the residents in those early days of the outbreak said that by the time they got there, residents were malnourished, dehydrated and needed bathing.

• As COVID outbreak raged at Atholville home, volunteer workers felt abandoned by province

Seely is calling on the Higgs government to introduce a policy that would see any suspected or confirmed cases of COVID-19 at special care homes immediately transferred to hospital to ensure the virus doesn't spread to staff and other vulnerable residents who live in close, and often shared, spaces.

"You have people that wander out of their rooms, people that can't hear properly, people that think [COVID-19] is a bunch of baloney," Seely said of the challenges special care homes face.

"We're community-based homes that are run by people with [personal service worker] training, human service counsellor training. We're not infection-control specialists."

P.E.I. policy applauded

Jason Lee, who is the CEO of three special care homes in Prince Edward Island and two in New Brunswick, would like to see New Brunswick follow the Island's lead when it comes to COVID positive residents.

On the Island, Lee said, any suspected or confirmed case of COVID-19 can be immediately transferred out of the home.

"We have the option in Prince Edward Island of having them go to hospital, which is an option that my understanding is we do not have in New Brunswick. And I think that would be an area of policy that that government should be maybe taking a stronger look at."

Lee said the biggest challenge when COVID-19 gets into a special care home is "limiting the spread."

"These homes were designed to be comfortable places to live. They're not designed to be hospitals where you can really isolate people and easily stop the spread of a virus — that's just not how many of these homes are set up."

For Lee and his staff, knowing that hospitals, which have isolation rooms and trained staff, could step in to help special care homes would go a long way in easing everyone's worries.

"It's a huge peace of mind for everybody involved — for the residents and their families and for the staff to know that if we do have an outbreak in a P.E.I. home, that resident can and most likely will go to an acute care hospital," he said. 

"By having somebody who's positive with this virus not in the middle of a building filled with people who are very susceptible to getting the virus … is the safest move for everybody."

It's an idea that Guy Tremblay, president and CEO of the Lokia Group which owns Manoir de la Vallée, also supports.

During the COVID-19 outbreak at his special care home, Tremblay said, all 17 residents in the Alzheimer's and dementia unit contracted the virus. Two of them died. He agrees that moving residents to a hospital or to a separate COVID unit set up by the government would help.

"I said, right at the beginning, we should probably look for an outside COVID unit," Tremblay said. "Just to concentrate those COVID-positive persons."

Russell won't commit to transferring patients

When asked about introducing a policy that would allow special care homes to transfer residents with suspected or confirmed cases of COVID-19, Dr. Jennifer Russell said, "we really don't want to transport people unnecessarily."

For New Brunswick's chief medical officer of health, the preferred approach is to bring in whatever health-care support is necessary, including respiratory therapists and extramural nurses, to keep patients in their special care home.

"The goal is to have people be able to isolate in the right location," she said. "But obviously, again, every situation is different."

We have lists of people that we can send on a dime to any location in the province on very, very short notice. So that also proved to be very successful in the Moncton outbreak recently.- Dr. Jennifer Russell

"The ultimate goal, again, is to reduce the number of people infected within the facility, including staff, and then keep the numbers low and make sure that it's not transmitted to the community at large."

Although Russell believes the biggest challenge has been, and continues to be, a shortage of staff, she would not commit to moving residents out of special care homes if they are COVID positive. 

Russell said there was a shortage of health-care workers in hospitals and adult residential facilities before the pandemic, and it continues to be a problem.

"We were already behind the eight ball before COVID started," she said. "It differs from geographic location to geographic location within the province. So there are some areas that, prior to COVID, were even more challenging in terms of having those human resources available."

Russell admitted it took time to "mobilize" health-care workers to respond to the first outbreak at the Manoir de la Vallée in Atholville in June, but she said teams are now in place and ready to respond.

"We have lists of people that we can send on a dime to any location in the province on very, very short notice. So that also proved to be very successful in the Moncton outbreak recently."

Without support, staff will leave

Seely doesn't believe that bringing health-care workers into homes is the best solution, arguing it won't prevent the spread of the virus to other special care home residents.

Beyond that, she is also requesting the New Brunswick government hold "mock drills" at special care homes.

"Let's do it," she said of putting everyone through the paces of an outbreak. 

Seely said staff are living with "a tremendous amount of stress," and she is watching people leave the field every day. If government offered more support, she argues, workers could be convinced to stay on the job.

They didn't walk out because they're uncaring. They walked out because of fear. They walked out because they felt they weren't supported in their role. They walked out because they didn't have proper PPE.- Jan Seely

"The only way we can do that is to 100 per cent guarantee to them that they have the support that they need, they have the tools they need.

"And things like sending COVID residents to hospital or to a designated wing that the province provides goes a long way to helping us to provide that peace of mind."

For a sector that already struggled to recruit and retain care workers who are paid $14 to $16 per hour, staffing challenges have only been exacerbated by the pandemic.

Caregivers, cooks and cleaners all walked off the job during the first COVID outbreak at Manoir de la Vallée, and urgent calls for help also went out during the more recent outbreak at Manoir Notre-Dame in Moncton. Seely warns it will continue happening unless government steps up.

"They didn't walk out because they're uncaring. They walked out because of fear. They walked out because they felt they weren't supported in their role. They walked out because they didn't have proper PPE."

Russell said an assessment of adult residential facilities has been completed, and WorkSafeNB staff are now taking next steps with special care home owners.

"WorkSafe is going in to review the operational plans and be as helpful as they can with them — helping them follow all the measures that are included in those plans," she said. 

Uncertainty, angst among workers

Ken McGeorge, a retired hospital CEO and now consultant working with the New Brunswick Special Care Home Association, believes the "uncertainty and the angst" that exists among caregivers in the sector could be lifted with some simple steps.

Number one is for government to put an end to what he calls "the nonsense" of pretending that special care homes are prepared to isolate COVID positive residents.

"A lot of the homes can't possibly do that. Train them all you like, provide as many nurse consultants as you like but the physical arrangements just are not there."

Secondly, is for employees to continue to receive any government top-ups or bonuses intended for essential workers  during the pandemic.

It's something he said the association had to fight for, and McGeorge worries it has left people feeling bitter.

"At the very last minute, just before the election was called, that came through," he said. "But you know what? The anger and the tears that were shed in trying to get to that was totally unnecessary."

Finally McGeorge again points to Prince Edward Island, where special care homes were given an additional $7 per day for each resident when the pandemic hit to help with extra costs of PPE and cleaning.

"That would be a great step forward," he said. "Take off an awful lot of angst, anger, heat, pressure, the whole bit."

The New Brunswick Special Care Home Association has hired consultants to create a  comprehensive operational pandemic plan that all of its homes can use and tailor to their own environments.