Long-term care home proposes larger role for family members during COVID staff shortages

New Brunswick's largest long-term care home is working on a proposal that could see family members help take care of their loved ones as well as other residents in the event of a staffing shortage during a COVID-19 outbreak.

Under the province's current COVID-19 rules, family members are not allowed into a long-term care facility when there is even one confirmed case, which constitutes an outbreak.

But the York Care Centre in Fredericton contends family members who are part of its designated caregiver program and have been trained in COVID-preventive measures could "bring a lot of value to the response rather than being locked out," said president and CEO Tony Weeks.

"We obviously don't have any approvals to actually implement something like that because we're committed to following Public Health directions like everybody else," he said.

"And so what we want to do is be able to influence government thinking to allow that to happen."

York Care Centre and its research company, the Centre for Innovation and Research in Aging, are preparing a report for the provincial government on a low-staff simulation exercise conducted at the home in December to demonstrate the role designated caregivers could play.

Weeks expects to submit the report within the next month.

He thinks the centre's program could serve as a model for long-term care homes across the province and across the country, not just during a COVID staffing shortage but in any emergency or evacuation.

The Department of Social Development did not respond Friday to a request for comment.

Started in the summer

The designated caregiver program at York Care Centre started last summer. It links residents with a family member who can assist with care on a set schedule, said Lori McDonald, vice-president of care and research services.

Unlike regular visitors, who are accountable only for "being safe when they're here and having that needed togetherness with their loved one," designated caregivers commit to interaction that improves their loved one's health, she said.

The type of interaction is different for everyone, said McDonald.

"One person might be helping to feed their mother. Another person might be helping walk their father, or someone else might be in just for social engagement because they're at risk for depression."

The designated caregivers also receive training in infection control, proper hand washing, the use of personal protective equipment, and safe practices to reduce the risk of bringing any virus into the facility, said McDonald.

"So it's quite a robust education program," she said, but a voluntary one.

100 trained so far

"We're not approaching them and asking them if they want to be part of this program. They're approaching us, saying, 'We want to be in your facility to care for our loved one, just like we always did [before the pandemic], but in a safe way.'"

Of the centre's 218 residents, 100 now have a trained designated caregiver.

General visitors are barred from the centre when the Fredericton region is at the more restrictive orange or red levels of COVID-19 recovery, as it is now, but designated caregivers are allowed in no matter the level — as long as there's no outbreak.

To date, York Care Centre has not had any positive cases of COVID-19.

In the event of an outbreak, "it's a very real possibility that we'll have staff who are sick or maybe scared to come to work," said McDonald.

During earlier outbreaks at other long-term care homes, some staff left or didn't show up for work, and the government had to seek volunteers from other parts of the province.

McDonald said family members "bring quite a bit to the residents' lives … And they've told us they want to be here."

Residents, meanwhile, have said they "feel lonely and they feel isolated when their families are not here," she said.

"So we're looking to bridge that gap … by using our [designated] caregivers."

Some of the designated caregivers might also be willing to assist with the social support or quality-of-life issues of residents they're not related to, said McDonald, noting many develop friendships after years of visiting.

"There's absolutely no pressure," she added, and the consent of all parties would be required.

This was not the program's original "initial target," but is now a "byproduct," said McDonald. "It's something we're looking at."

Simulation 'held back' staff

In December, the centre ran a simulation to see how it could respond to an emergency that resulted in a significant reduction of its 350 full-time equivalent staff, and determine what role the designated caregivers could play now that they're familiar with the organization and trained, said Weeks.

"We couldn't actually run with short staff [and risk compromising care], so all we could do is hold back," he said, adding residents and families were advised in advance of the two-day simulation being conducted by two teams of staff on a couple of different units.

"Team A was basically doing all of the functions in a short-staffed scenario, and then they let out some of the B team folks to support it when things got in a pinch.

"So similar to if it was a real scenario, resources would become available as we're able to get them. And so that was the examination, to see what impact would that have on the care that we provide.

"What impact would it have on the stress on the employees? How would it impact the residents? And again, as a byproduct, what role could designated caregivers play?"

One of the scenarios being assessed was, if multiple residents were pressing their call bell at the same time, what was the centre's ability to respond to those call bells in a safe manner, said Weeks.

Another example was if a resident required some extra attention that tied up a nurse while something else happened, what impact would it have if the nurse couldn't respond.

In addition, the simulation looked at how many of the functions taking place might be considered non-urgent but still quality-of-life issues, such as social interaction or getting people to activities, which designated caregivers might be able to help with, said Weeks.

He acknowledged there may be some people who would argue they pay for the care their loved ones are supposed to receive, and they shouldn't have to volunteer.

But he said none of the York Care Centre families have made any such comments.

"When we told them about this initiative, they were all quite excited to know that it's going on because they understand it provides another level of safety," he said.

"Remember, we're talking about people that even before the pandemic, they were coming in here on their own because they have strong connections with their loved ones, and they want to be part of their lives."