Resident isolation, staffing remain significant concerns in Ontario long-term care centres

For Joni Asboth's 99-year-old father, living in a Toronto-based long term care centre has become a series of isolating lockdowns, where just one positive COVID-19 test of a staff member can mean confinement for some residents.

Indeed, she said her father John, whose room has been in and out of lockdown, hasn't been outside since September.

"What we're doing to the elderly at this time is incarcerating them. There's no other word for it," Asboth said.

On Friday, Ontario's Long-Term Care COVID-19 Commission — which investigated how and why the virus ravaged nursing homes, and what steps were taken to prevent its spread — is set to hand over its report to the government. It will be up to the Ministry of Long-Term Care to release it.

But ahead of the report, family members of residents and advocates are already calling on the government to take specific action, to retain certain policies put in place during the pandemic, and relax others.

"There's been a lot of commitments made, a lot of great comments, but very, very little action," said Sharleen Stewart, president of SEIU Health Care, a healthcare union representing more than 60,000 frontline workers.

The toll of isolation

The province's auditor general has already released a damning report earlier this week which found Ontario's long-term care sector and the ministry that oversees it were not "prepared or equipped" to handle the litany of issues brought on by the COVID-19 pandemic.

Among its findings:

• Residents were living in rooms with three or four occupants.
• Long-term care homes had insufficient staff and staff training to provide appropriate care.
• Restricting families from visiting homes took an emotional and physical toll on residents and their families.

Asboth said the government still needs to change its rules that isolate residents deemed a close contact in the event of an outbreak, which is now defined as two positive cases linked to a home.

She said isolation lasts almost two weeks, until health officials get a negative result from everyone on that floor. While she's quite happy with the care her father receives at Harmony Hills Care Community, she's very concerned about what these government-imposed restrictions are doing to his physical and mental health. 

In an email to CBC News, Aslan Hart, a spokesperson for the Ministry of Long-Term Care, said that residents who are not under isolation requirements can leave the home to take a walk in the immediate area, including during an outbreak.

The problem for some residents like John Asboth, however, is that since the fall, they have been repeatedly required to isolate, even though they are now vaccinated, according to his daughter Joni.

"By the time that lockdown happens or is lifted, they may have had another positive case," she said.

Those restrictions, she said, need to be "lifted immediately" and allow the residents, who are all vaccinated, to mingle with others outside of their rooms.

In an email to CBC News, Nadia Daniell-Colarossi, a spokesperson for Sienna Senior Living, which owns Harmony Hills Care Community, said their staff members are "very sensitive to how difficult this can be for residents."

She said they "continue to go above and beyond to adapt daily routines and special occasions to provide them with compassion, and connection to their loved ones."

Meanwhile, around 75 per cent of the staff at Harmony Hills have received their first vaccine dose, while 95 per cent of residents have received both doses, she said.

Dr. Samir Sinha Director of geriatrics at Sinai Health and University Health Network, said those restrictions, which included limiting visits from family members, had profound mental health effects on residents, and included the worsening of loneliness, social isolation, depression and dementia.

Now, with almost every resident vaccinated, and the risks of outbreaks significantly declined,  Sinha said the burden of the restrictions are probably doing more harm than good.

"And I think a lot of people are losing hope because we're not re-opening homes in the way we should."

He said the province should reopen the homes, because, ironically, during this third wave, they "are the safest place to be in Ontario."

Staffing key to change

Pat Armstrong, a professor of sociology at York University and an expert in long-term care, said as for the factors that lead to the high death rates: "I don't think that there have been very many changes whatsoever."

The Ontario government has promised in four years to implement new guidelines that would include a minimum of four hours of direct nursing care per resident per day.

"Four years is a very long time," she said.

 Armstrong expressed concerns about the government's announcement last weekend that it was removing restrictions that forced personal support workers at long-term care facilities to work in one facility at a time. 

Without those restrictions, many with part-time work are pushed into working in more than one place, and carrying infections with them, she said. 

"So the measures that we saw as really important to preventing infections and increasing the quality of care are not permanently in place," Armstrong said.

"There's no question the biggest change has to be in staffing, in their numbers, their pay, their benefits."

But Armstrong believes it will be difficult to recruit staff to Ontario long-term care homes.

"We've heard such horror stories. I think it'll be difficult to get people to go into them, to live in them. I think it will be difficult to get people to work in them."

Sharleen Stewart, the SEIU Health Care president, said, since the pandemic began, there has been no sense of urgency on behalf of the government to deal with a staffing crisis in long term care.

"That is the number one issue when you see how fast this pandemic was able to spread through these homes."

With the government allowing long-term care staff to work in more than one place, instead of giving them full time jobs, "you wonder what has been learned over the last 13 months," Stewart said.

Government investments

But Hart, the Ministry of Long-Term Care spokesperson, said the government is investing nearly $5 billion in staffing, which totals more than 27,000 new positions, in order to provide four hours of daily direct resident care. 

She said the government has invested $321 million in temporary pandemic pay for staff in long-term care homes which will continue until June 30, 2021, "when the government will review the enhancement to inform next steps."

As well, through pandemic pay alone, Ontario's long-term care homes hired over 8,600 staff between April 24, 2020 and August 13, 2020, Hart said.

Some long-term care homes still have three to four people rooms, a concern in terms of containing the spread of a virus. But Hart said when beds in those rooms become vacant, new admissions will not be placed into there, and those wards are being phased out and redeveloped to modern design standards.