What experts say needs to change in long-term care in COVID-19

·4 min read

It’s no secret that long-term-care homes have shouldered the brunt of the pandemic.

In late January, a group of experts who provide scientific evidence on COVID-19 to the government released a brief with recommendations to control the virus in long-term care. The Ontario COVID-19 Science Advisory Table called for less reliance on temporary staff, reducing crowding in resident rooms, and reducing the risk of COVID-19 transmission among staff.

“The situation is absolutely, constantly evolving,” said McMaster University professor Andrew Costa soon after the brief was published. “We’re still nowhere near perfect.”

Costa, an expert in clinical epidemiology and aging who sits on the advisory table that focuses on long-term care, spoke in detail about what the recommendations mean.

Improve staffing

One of the biggest pieces of advice is to ramp up staffing and improve working conditions inside the homes.

Costa said paid sick leave could help “bolster and sustain” staff levels by reducing the number of staff a home loses to “low morale,” for example.

He said better wages overall would help stop the number of workers leaving for better-paid jobs in an industry where it was hard to recruit staff even before the pandemic. And sick pay would prevent sick workers from having to choose between isolating and supporting their families.

Advocates and experts have called on the province to improve staffing in long-term care throughout the pandemic. It’s a costly investment in an already underfunded system, Costa says, but worthwhile. He notes the province has promised to increase care to four hours a day per resident by 2024-25, but “that’s a long time.”

Costa says the province should step it up.

“Of all the policy considerations on improving quality in long-term care, the most obvious and evidence-based is simply to improve staffing,” he said.

Fewer residents per room

The number of residents a long-term-care home has in a single room has been an ongoing concern in the pandemic.

Homes with three or four residents per room are “a tinder box for COVID.”

“Things spread really fast,” said Costa.

In December, the province introduced a rule that any incoming residents should not be placed in a room with more than one other person in a long-term-care facility.

Reduce community spread

We often hear public health and others say to reduce COVID-19 spread in long-term care, we have to reduce it in the community.

Costa says data shows community transmission is a big predictor of long-term-care infections and deaths. He said when community spread reaches a certain point, “it’s inevitable” a proportion of long-term-care residents will be infected, and a certain number will die.

Costa says the only way the virus enters a home is through a person who comes into the building from outside.

Increase testing

The tricky part about detecting COVID-19 early on is that people can carry it without having symptoms. That’s why Costa says testing is essential.

In particular, Costa supports surveillance testing — which occurs before someone shows symptoms, to stop COVID-19 in its tracks. He says even that is not “foolproof,” but it will help.

“If it’s raining more outside, the more likely someone’s going to come in with raindrops on their jacket,” he said. “An umbrella reduces the risk if it’s spitting, but if it’s a torrential rainstorm, the umbrella still reduces the risk, but you’re going to get wet.”

What about essential visitors?

Multiple homes in outbreak have stopped allowing essential visitors. But experts and advocates have pointed to the important role family caregivers play in supporting resident mental health and well-being.

The brief says visitor restrictions have led to many residents facing “severe and potentially irreversible physical, cognitive, psychological, and functional declines.”

“There has also been an increase in the prescribing of psychoactive drugs to Ontario LTC residents,” it says.

Balancing visitors with infection control remains an ongoing struggle.

“There’s no easy answer,” Costa said, noting it takes staff to co-ordinate visits and it also creates more room for transmission. He errs on the side of letting in family, and says they should have better access to COVID-19 tests.

“In long-term care, the life expectancy is somewhere around 18 months,” he said. “For most residents, if they could choose ... they don’t want to spend the last months of their lives in a situation where they can’t be close to loved ones.”

Maria Iqbal, Local Journalism Initiative Reporter, The Hamilton Spectator