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COVID-19's impact on long-term care today and as impetus for future change

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At St. Michael's Long Term Care Centre in Edmonton, COVID-19 has meant a renewed focus on safety precautions, while still tending to resident's social and emotional needs. Photo: supplied.

Almost one third of Canadians 85 and over live in long-term care homes. Senior advocates in Alberta say the COVID-19 pandemic is shining a light on problems inside Alberta's (and all of Canada's) nursing homes — problems that have long needed to be addressed. And with COVID-19's deadly consequences and numbers of seniors requiring long-term care expected to quadruple within 20 years, crisis within longterm care is an issue that can't be put off any longer.

Eldercare advocate and researcher Carol Wodak said factors including low pay for workers (which can force workers to work in two or three homes to make ends meet) staffing shortages and privatization have left care homes ill-prepared to deal with crises.

"We knew this was going to happen 20 years ago," said Wodak — with the Edmonton-based advocacy group Seniors Action and Liaison Team (SALT) — whose own mother experienced a range of continuing care options after suffering a series of strokes from 1995 to 2006. "By 2020 and when COVID-19 hit, there was zero capacity for the system to absorb stress. It was set up to fail."

In Canada to date (around 80,000 confirmed cases and over 6,000 deaths), some 80 per cent of deaths are in long-term care facilities. Alberta is slightly lower than rates in Quebec and Ontario, but outbreaks and deaths continue to mount, nearing 7,000 cases across the province. As of mid-May, a staggering 85 of a total 118 COVID-19 deaths in Alberta have been residents of continuing care facilities.

The Alberta government recently announced a further $170 million for designated supportive living and long-term care facilities in the province. The money is for enhanced staffing, extra cleaning supplies and to bump up lost revenue from beds that remain empty due to COVID-19.

The funding is a help, according to Isabella Roth, CEO of Christenson Communities, which operates 1,500 independent living, designated supportive living and designated supportive living with dementia suites across Alberta. Roth said her company was one of first to adopt a single-site, single-employee policy, but that has created challenges in dealing with the crisis.

"We've hired COVID-specific recreation coordinators and increased screening staff because other staff have to stay home with their own young children since daycares and schools have been closed," said Roth. We enacted restrictions early, so we've seen no COVID cases here, but there are constant hurdles. Families understandably want to visit, and mental health is a continuing issue among residents and staff. For the safety of this vulnerable population, we had to be the first ones in and will be the last ones out around lifting restrictions."

Re-evaluating definition of essential work

Toronto Sociologist Pat Armstrong said that in the long run, improved care means more staff, higher wages and better working conditions. Government and public perceptions have to change around the value of the essential work carried out in long-term care homes too, she said.

Long seen as unskilled labour, aides provide 80 per cent of the care in nursing homes, and these workers are usually women (and often immigrants, or from marginalized racial groups).

COVID-related changes have also been a challenge for St. Michael's Health Group, an Edmonton-based not-for-profit care provider that has one 153-bed long-term care facility in the city, and supportive living sites in Vegreville, Spruce Grove and Edmonton.

"At St. Michael's, we are facing a battle that has changed the way we provide care and the way we live," said John Kopeck, president and CEO of St. Michael's Health Group. "We've added staff and increased PPE supplies to operate safely and effectively, and we work within our means to offer the highest level of care possible. If any good comes from the COVID-19 crisis, it's that the entire long-term care system has to be re-evaluated. Everything should focus on quality care for residents."

"I'm optimistic that the system will become stronger. Every conversation we have is about putting resident's safety and well-being first. Does that mean keeping family and volunteers out? We have a strong volunteer pool at St. Michael's that contribute to all we do, helping staff and residents, so it's a connection we want to sustain," he said.

St. Michael's, like so many long-term care facilities, has worked hard to keep staff and residents safe, while maintaining connections through Zoom meetings and Facetime or window-side chats. A recent May Day parade of honking cars, signs and balloons was organized by family to thank staff and tell residents they haven't been forgotten.

Armstrong said any post-COVID-19 analysis must examine the effect of isolation on staff and care home residents.

"Did we look at the balance of safety risk for staff and residents versus the negative outcomes of isolation and loneliness? What makes a life worth living? It's not solely about safety. What are the alternatives to lockdown? Do we have to keep families and volunteers out?" Armstrong asked."The reaction to COVID-19 within care homes actually took away about a third of the care and comfort residents were getting. We may have to rethink our approach."

Wodak also wants the province to set up a group of independent experts to conduct unannounced inspections during the pandemic and afterwards.

"Any facility that is looking after a vulnerable clientele should have [to show] that they have interventions in place to protect not only the clients but the workers and caregivers that are looking after them," she said. "This should have happened even before there was an outbreak."

Proactive inspections

Alberta's Chief Medical Officer of Health, Dr. Deena Hinshaw, said a team of Alberta Health auditors is designing a plan to conduct inspections at continuing care facilities, to ensure operators are following the orders she's put in place, "starting with those facilities that do have outbreaks and then moving into the facilities that do not.

"And we'll do proactive inspections to make sure that all of the measures laid out in the continuing care orders are being implemented and that everything that can be done to protect residents and staff is in place," said Hinshaw.

Whether through the Canada Health Act or by creating a parallel piece of legislation that addresses elder care, Wodak added that guidelines including a long-term care inspector program (conducted by an independent agency) is a critical piece going forward.

"An independent agency can collect data and deal with problems outside of government and care home owners. That kind of consumer protection is essential," she said. "We can't think of the cost of such programs and changes to long-term care as an expense. Rather, it's an investment in our vulnerable population and our own future."





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