(March 30, 2021) A new report from the Canadian Institute for Health Information (CIHI) found that a shocking 69% of Canadian fatalities due to COVID-19 occurred in Canada’s long term care facilities. The international average of fatalities in long term care was 41%. ‘
Canada’s long term care facilities are run by a mishmash of organizations. Forty-six per cent are publicly owned and 54 per cent are privately owned either by nonprofit organizations or for-profit companies. There are 2,039 long term care facilities in Canada.
New protocols implemented during the first wave to limit the spread of COVID-19 resulted in unintended consequences for residents in long-term care (LTC) homes, says the CIHI. The first wave is defined as being from March 1 and August 31. During that time residents received less medical care and fewer visits from family and friends, and more residents died during this period compared with previous years.
Residents had fewer physician visits and hospital transfers in the first wave. They also had less contact with friends and family, including caregivers who provided help with personal care activities like bathing, eating and dressing.
And despite changes to care and learnings from the first wave, the CIHI says more LTC residents died from COVID-19 and a greater number were infected with the virus in the second wave from September 1, 2020, to February 15, 2021.
“COVID-19 has had a devastating impact on long-term care and retirement home residents, staff and their families,” Tracy Johnson, Director, Health System Analysis and Emerging Issues, Canadian Institute for Health said in a statement. “Recent provincial and national inquiries have highlighted the challenges that homes face and echoed recommendations from past inquiries that point to broader structural issues like staffing levels and infection control and prevention. CIHI’s report shows that a complex situation did not improve overall, as some provinces that fared relatively well in the first wave are now grappling with more cases in the second wave.”
A new book by Globe and Mail health policy reporter, Andre Picard Neglected No More: The Urgent Need to Improve the Lives of Canada's Elders in the Wake of a Pandemic is about the urgent need to improve the lives of Canada’s elders in the wake of the pandemic.
“He makes a heartfelt plea to stop dehumanizing elders, to reimagine long-term care and to fix a broken system,” wrote Roger Ali in his review of the book for The Charity Report. “Sadly, it took a coronavirus pandemic to open our eyes to the deplorable state in long-term care homes.”
Reports coming out of the long term care facilities at the time were shocking.
The Canadian Armed Forces who were asked to assist in caring for residents in long term care facilities wrote a report to Minister of Public Services Bill Blair that detailed a number of serious care deficiencies including inadequate palliative care standards, such as inadequate dosing intervals for some medications. Much of the ward stock of medication was expired. Residents who suffered incontinence and who routinely soiled their beds were not permitted to have an extra soaker pad or towel in bed to help protect sheets and blankets from soiling. The letter to the Minister Blair also reported gross in-adherence to some recurring orders, such as regular vital signs or patient turning. Force and aggressive transfers were observed by CAF personnel as was forceful feeding by staff causing audible choking/aspiration and forceful hydration causing audible choking/aspiration.
In terms of controlling infection, the CAF reported poor training and adherence to infection prevention protocols, deterioration of cleanliness standards throughout the facilities, insect infestation, delayed changing of soiled resident leading to skin breakdown and inadequate equipment.
The letter to the Minister Blair details the shocking treatment of patients in long term care facilities, much less any effort to control infections, and it wouldn’t be too much of a stretch to conclude people died unnecessarily from the poor care they received.
“Recommendations from recent provincial and national inquiries on COVID-19 are similar and speak to long-standing concerns and structural challenges in the sector,” said CIHI in a statement.
“There are significant impacts on a resident’s health and well-being when they aren’t allowed to see family members or friends, or when access to care decreases in their LTC home. It’s clear from the data that we must do better to protect our most vulnerable people from COVID-19,” says Dr. Samir Sinha, Director of Health Policy Research and Co-Chair, National Institute on Ageing. “There are many ways we can both improve care and limit the spread of COVID-19 in LTC homes, including enhanced staffing and family presence, improvements to infection control and prevention strategies, and mandating de-crowding policies.”
It remains a matter a significant public concern whether provinces, who control long term care, can make enough changes in the way they operate to regain the trust of people who might use their services.
As Roger Ali points out in his review of André Picard’s book, Picard best summarizes Eldercare in Canada as “so disorganized and so poorly regulated, the staffing so inadequate, the infrastructure so outdated, the accountability so non-existent and ageism so rampant, there seems to be no limit to what care homes can get away with.”