With most long-term care residents vaccinated, restoring their quality of life is urgent, experts say

When Maureen McDermott and her mom, Elsie, got their second COVID-19 shots about a month ago, she felt positive.

"I was hopeful that we would move from the mode we're in right now, which is barely existing, into a mode of actually living out her golden years," McDermott said.

Elsie McDermott, 93, lives in River Glen Haven, a long-term care home in Sutton, Ont., about 70 kilometres north of Toronto, and suffers from dementia. The isolation of the past year in COVID lockdown has sent her into "very serious decline," her daughter said.

"There's many, many times my mum has said to me, 'This is not living. And I don't want to do it anymore,'" McDermott said.

"I would much rather my mom had passed a year ago [as] opposed to having her live that year, and me outside looking through a dirty window at the most confused, beautiful face and [her] begging for me to come in. Or now that I'm allowed in, she just begs me to come home."

As an essential caregiver, McDermott is allowed to visit her mother, but is supposed to stay in her room. Like many family members, she's wondering why — if she and her mother have both been vaccinated and regular COVID testing is in place — she can't take her mom outside on warmer days to "let her see the sky" or take her home for a visit.

"We're doing all these things to make sure they're okay. When are we going to free the reins of these people so they can start interacting with family members again? And having a sense of life," she said.

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Providing guidance to long-term care homes on how to safely give residents that quality of life is "critically important," said Dr. Allison McGeer, an infectious disease specialist and a member of Ontario's COVID-19 Science Advisory Table.

"This year has been devastating for everybody who lives ... [and] works in long-term care homes," McGeer said. "And there's two pieces of that devastation —- one of them is COVID and the second is the consequences of trying to prevent COVID."

The emergence of COVID variants of concern is a big worry when it comes to easing restrictions in long-term care, she said, but at the moment there appears to be a window of opportunity to free residents from lockdown.

That's because even in nursing homes that recently had COVID-19 outbreaks despite most residents being vaccinated — including in B.C. and in Quebec — the people infected were either asymptomatic or had only mild symptoms, suggesting the vaccine is doing its job in preventing serious illness, McGeer said.

In addition, COVID-19 vaccination appears to be protecting residents against the most common variant of concern — B117, first discovered in the U.K.

It's still possible that one of of other variants of concern could take hold in the coming months and pose a threat to long-term care residents, McGeer cautioned, so long-term care homes must be prepared to reinstate restrictions if necessary.

But for now, it appears there's "time until the next variant comes," she said.

"I think we need, over the next couple of weeks, to talk about, you know, how we do this gradually. Let's not throw ourselves into it, but you know, we just need to stop keeping people imprisoned in their rooms."

Right now, there's no clear guidance in Ontario and long-term care homes are making their own decisions about whether or not they can reinstate any group activities within their own facility, said Donna Duncan, CEO of the Ontario Long Term Care Association.

One of the biggest challenges to restoring normalcy is that although most long-term care residents have been vaccinated, many staff members have not, she said.

That's due both to vaccine supply issues and vaccine hesitancy, Duncan said.

"We do need to get the staffing [vaccination] rates up higher and that will help us enormously."

The fact that different long-term care homes have achieved different levels of vaccination among residents, staff and family caregivers means "targeted guidance" is important, said Dr. Samir Sinha, director of geriatrics at Mount Sinai and University Health Network hospitals in Toronto.

Homes that have achieved high levels of vaccination might be able to reinstate group recreational activities — such as crafts, bingo, and exercise — or communal dining in a controlled way, such as a floor-by-floor model similar to the cohort model used in schools, Sinha said.

"When you actually think about people who really have been denied a lot of those activities that are really helpful, not only for their physical wellbeing but for their mental health as well, I think it reminds us how important it is to allow us to resume those activities whenever possible."

Rules on what's allowed could also be targeted even more specifically to individual residents and family caregivers who have both been vaccinated, Sinha said, to give them more visiting freedom, such as the ability to hold hands or hug.

Clear directives, such as vaccination thresholds long-term care homes need to meet before relaxing restrictions on group activities or visiting, don't appear to be on the horizon in Ontario, Sinha said.

That's why he and fellow geriatrics specialist Dr. Nathan Stall are planning a guidance document to be issued through the National Institute on Ageing in the next few weeks.

In an email response to CBC News on the question of easing restrictions for residents, Ontario's ministry of long-term care said, "as we near completing offering both vaccine doses to all long-term care residents, and as we continue to vaccinate staff, essential care givers, and other vulnerable groups, we remain hopeful that life will slowly begin to return to normal.

Until more people have the opportunity to receive the vaccine, we must continue to be vigilant in following public health guidance."

The emailed statement also said the ministry would "continue to consult with, and act on, the advice of the Chief Medical Officer of Health and other health experts."