Public health issues orders to 31 residential facilities to take action on COVID-19 infection risk

Hamilton Public Health has ordered 31 residential care facilities to make changes to improve infection controls or face consequences after inspections showed they weren't doing enough to stop the spread of COVID-19.

Staff have developed an infection control checklist and have been assessing homes for the past week or so, said Dr. Elizabeth Richardson, the city's medical officer of health.

But despite those efforts, 31 of the facilities charged with caring for some of Hamilton's most-vulnerable didn't get the message.

"We said at that point: 'We've tested, we've assessed, we've educated, we've looked for ways to help you, but at this point you have to get on with it or you'll be ordered' and that's the stage we're at," said Richardson.

Residential care facilities — sometimes referred to as second-level lodging homes — feature shared dining and common areas and 24-hour on-site support for residents, including those with cognitive or mental health struggles. Some also have an attached retirement home.

Public health is responsible for routine inspections of the facilities, but those assessments ramped up in advance of COVID-19, according to Richardson.

The city has also started to inspect long-term care homes and retirement homes in order to try to reduce the chances of further outbreaks, despite the fact those checkups are typically carried out by the provincial government and a separate regulatory body.

While COVID-19 will be just a bad cold for many, Richardson said it's those who are struggling with chronic illness, lacking income or living in cramped conditions, such as a residential facility, who are most at risk.

"That's where we're really concerned about outbreaks," she said. "We're really concerned about the consequences ... so we're taking steps to help these places follow really good infection-control practices."

Orders concern PPE, physical distancing

Each of the facilities were issued one order under the Health Promotion and Protection Act (HPPA), which empowers a medical officer of health to take further steps to ensure compliance if education alone isn't working.

"There's really not a lot of limits in terms what we can be ordered," said Richardson.

"We have to have reasonable grounds that we think there's an issue around communicable diseases. In the setting of COVID-19 that's fairly easily met."

Some of the orders issued Wednesday are around improving supply of personal protective equipment such as masks, gowns and sanitizer — something Richardson acknowledged has been a struggle.

Other orders require the homes to find ways to follow physical distancing such as partitions between beds in double rooms or serving meals in shifts.

Staffing is another struggle, so Richardson said the city's housing staff is looking at ways to help.

At this point none of the orders have resulted in fines or closures, said the doctor. 

"These people are housing some of our most-vulnerable, so closure's not usually something we would use in this setting unless there was some really egregious issues," she explained.

"Most people, when you ask them to do something, will do it. Some of these will need a bit more of an incentive to move forward and rarely do we find it has to be escalated to something like fines or further orders."

Ultimately the goal is to support these facilities in figuring out what they need ... to get full compliance."