Ontario requires masking for long-term care home staff amid rise in COVID-19 outbreaks

Masking is now required for staff in long term care homes across Ontario amid a recent rise in COVID-19 outbreaks, cases and resident hospitalizations, the provincial government says.

A Nov. 2 memo from the Ministry of Long-Term Care to LTC licensees says the requirement is based on advice from Dr. Kieran Moore, chief medical officer of health. Homes were expected to implement the requirement no later than Nov. 7, it says.

The masking requirement also applies to students, support workers and volunteers when they are in resident areas indoors. The ministry further strongly recommends that visitors and caregivers wear a mask in resident areas indoors except when they are with residents in their rooms or when eating with residents in communal spaces.

"Recent trends have shown a moderate to high level of community transmission of COVID-19 and an increase in COVID-19 outbreaks in LTCHs, with an increased risk of hospitalization amongst residents," Kelly McAslan, assistant deputy minister, long-term care operations division, said in the memo.

McAslan adds that the virus is projected to possibly peak in the next few weeks — around the same time that the flu and respiratory syncytial virus (RSV) are expected to increase.

There have been 5,459 COVID-19 cases among long-term care residents, with 181 people hospitalized from Aug. 27, 2023 to Oct. 28, Public Health Ontario says in a Nov. 7 surveillance report.  A total of 106 people have died.

In the same time period, there have been 1,698 COVID-19 cases among staff, but no staff hospitalizations or deaths due to the virus. 

Public Health Ontario says there have been 394 COVID-19, five influenza and four RSV outbreaks in long-term care homes and 302 COVID-19 outbreaks in retirement homes during the same time period, but no flu or RSV outbreaks.

Masking appropriate given outbreaks, deaths: doctor

Dr. Samir Sinha, director of geriatrics at Sinai Health System in Toronto, said the masking requirement is appropriate given the number of outbreaks, cases and deaths. 

"Right now, we have had a significant COVID wave that started this summer, and it certainly has kind of ripped through our long term care homes. Luckily, with a lot of previous vaccinations and infections, we're not seeing anywhere near the rates of deaths that we've seen before or hospitalizations," Sinha said.

Sinha said in the early days in the pandemic, about 30 per cent of long-term care home residents with COVID-19, or close to one in three, died. Now, the case fatality rate is 3.6 per cent.

"While still every death is something that we should try and prevent, we're seeing far lower rates of fatalities. But we have to remember that many of these deaths remain preventable if we maintain masking during high rates of spread but also make sure that people are up-to-date with their vaccinations," he said.

Sinha said homes need to encourage all vaccinations, especially because residents could be hit with COVID-19, flu and RSV all at the same time. He said there have not yet been major waves of influenza and RSV in the city so far, but they could still come later this year.

Kerri Thompson, whose mother is long-term care resident at Southlake Residential Care Village in Newmarket, says masking among staff there could be taken more seriously.

She said the home had a COVID-19 outbreak in the last six weeks and that half the residents in her mother's unit, or about 30 residents, tested positive for the virus. Her mother fortunately didn't get COVID-19, she said. But she said what is frightening is the number of people who got sick.

"I just think there's just a bit of fatigue with COVID, but the reality is, in long term care, it's just as serious as it ever was," she said.

Staff not always complying, family member says

While masks are mandatory for LTC staff across the province, Thompson said she has seen staff not complying or wearing masks below their noses. 

"Staff are pulling down the mask to talk to each other and to talk to residents. Like, hello, COVID is still here. We wear the mask properly," she said. 

Southlake Residential Care Village disputes that allegation, saying in an email on Friday that it is "consistently" auditing staff on masking and providing feedback where needed.

"Staff were not reluctant to wear a mask as they also understand that masking is to protect themselves, their coworkers, and the residents that we care for," the home said in the email.

The home said it has a full-time designated manager — an infection prevention and control lead — that focuses on such matters as masking, hand hygiene and personal protective equipment audits.

For Thompson, while the home may be doing its best, "In my humble opinion, it's not good enough.

"And I don't believe it's the best they can. I've seen the best before and it was way higher compliance than what it is now."