What it will take to keep nursing home residents safe from COVID-19
Why leadership makes a difference in the safety of long-term care homes during COVID-19's second wave
To counter some of the drivers of coronavirus transmission among essential workers, governments across Canada should prioritize safety, say experts who've looked closely at avoiding outbreaks among the most vulnerable.
Canada's worst outbreaks continue to hit residents of long-term care homes, where short staffing can make it difficult to care for vulnerable people sick with COVID-19. To keep them safe will require addressing long-standing staffing shortages on top of stockpiling personal protective equipment and changing how the long-term care sector is led.
Farinaz Havaei, an assistant professor in the school of nursing at the University of British Columbia, says she found a combination of good planning, strong leadership and a focus on safety contributed to how a large B.C. long-term care facility successfully kept COVID-19 at bay at the start of the pandemic.
"Their [leadership] decisions were essentially driven by prioritization of safety rather than being driven by budget and finances, which was really important," Havaei said. She and her team analyzed surveys, reviewed administrative data and interviewed leaders, workers and family members for the research.
In contrast to the horrors reported by the military at some devastated long-term care facilities in Quebec and Ontario in the spring, Havaei said staff at the B.C. facility went above and beyond in caring for residents.
The workers spent quality time with those under their care, reading them books, painting their nails and facilitating virtual connections with family members.
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Havaei is now planning a provincewide study of B.C.'s single-site employment policy for long-term care workers, which requires staff to work in only one high-risk site.
To Havaei, more flexible paid sick leave policies and ensuring adequate 24/7 staffing in long-term care homes go hand-in-hand with keeping residents safe.
"My personal opinion is that staffing is the cause, or is probably one of the root causes, of this whole situation," of having to call in the military to deal with outbreaks in long-term care homes during the first wave, she said.
She says several factors exacerbate the challenges staff face in long-term care homes:
- Crowding of residents.
- Residents may lack the cognitive ability needed to follow handwashing and other infection prevention measures.
- On top of their regular workload, staff became the eyes and ears of family members who weren't allowed to visit or provide care.
Havaei points to a body of research, including her own, that's established a link between burnout of nurses and higher likelihood of adverse events for patients or residents.
"They are more likely to make some sort of a patient-adverse event, like making a medication error, having their patient fall, violating infection prevention control guidelines that potentially result in urinary tract infection and so on," she said.
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During the second, worsening wave of COVID-19 across much of Canada, nurses and personal support workers at long-term care homes face those everyday challenges on top of the coronavirus. About 40 per cent of all long-term care homes in Ontario alone are dealing with an active COVID-19 outbreak.
Havaei wonders whether stretching staff too thin in such a high-risk environment contributes to lapses in infection control that can allow the virus to take hold.
In B.C., health-care workers top the list of workers' compensation claims followed by long-term care, a much smaller industry proportionately.
Work both improves health and can sicken
Victoria Arrandale, an assistant professor at the Dalla Lana School of Public Health at the University of Toronto, studies how to reduce exposure to hazards in the workplace, including COVID-19. It's a field she was drawn to after suffering an ankle injury at a pulp mill in her home province of British Columbia, plunging her into the world of filing a workers' compensation claim.
"I just got hooked on thinking about how work does impact people's health," Arrandale recalled. "It improves people's health because it provides stable income, hopefully, but it can also make people sick."
Arrandale said paid sick leave is an important policy because it can help prevent the introduction of the coronavirus into the workplace.
From a population-level perspective, Arrandale would like to see more detailed collection of workplace data during contact tracing, as in Ontario's Peel Region and Hamilton, and as Toronto is moving toward.
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"We've got good information on health care, but having it for every [sector] would allow us to better understand where the workplace burden of COVID is arising," Arrandale said. "There may be groups of people who we're not recognizing that could be more precariously employed or racialized groups, women."
Having a more complete picture could improve understanding of where and why workplace outbreaks occur to better target prevention measures, such as staggering shifts and breaks, providing alternative lunch spaces or splitting up people who are all working in a row while still achieving workplace goals, she said.