The Town continues to reach out to long-term care home facilities to ensure they have what they need, as they remain free of the coronavirus, and work diligently to stay that way.
Lord Mayor Betty Disero says one of the homes has said it needs gloves. It’s not out of gloves, but doesn’t have the stockpile that would make staff feel comfortable, so the Town is searching for a source to get them more.
Asking whether they need anything, and how the staff is doing, Disero says, is the limit of their conversation, but so far, they seem to be in good shape.
We know that as of Tuesday Niagara-on-
the-Lake’s residences have remained free of COVID-19, because the Region announces those with outbreaks. Of the three facilities in town, Niagara Long Term Care is privately owned, with 124 beds; Pleasant Manor is not-for-profit and can accommodate up to 29 individuals; and Upper Canada Lodge, run by the Region, has about 80 residents.
Across Niagara, the story has not been as good, with more than 80 per cent of the deaths from the virus occurring from outbreaks in long-term care and retirement homes.
“Niagara has done well at limiting the number of cases of COVID in the wider community,” says Dr. Mustafa Hirji, the acting medical officer of health for Niagara Region.
However, within long-term care homes, there has been a struggle with infectious control practices, he says.
Once COVID-19 takes hold in one of the facilities, “it spreads widely, and once it spreads, staff become infected and are not able to work.”
With fewer staff looking after residents, and the virus creating more work for the remaining staff, it becomes “a vicious cycle,” says Hirji, and spreads out of control.
As Hirji explains, because retirement homes typically have seniors who don’t require as much care as long-term care homes, the staff ratios are lower, and comprised mostly of personal support workers (PSWs), with one nurse.
The average ratio of front-line staff to residents in Ontario homes is one to 10. Recently, with the alarming number of cases and deaths across the province in long-term care and retirement homes, there has been a call for those numbers to be mandated.
Currently, the Ministry of Health dictates one registered nurse on staff at all times, and enough staff to properly meet the needs of residents. It doesn’t set out a ratio for front-line health care workers to residents.
“We need to find a staff solution, and a way to bring in more staff to help in those situations (when there is an outbreak),” says Hirji.
“We’ve learned a lot from the three homes with serious outbreaks.”
The worst outbreak in Niagara, at Lundy Manor, a retirement home, has resulted in a $20-million class-action lawsuit against the home, alleging management failed to protect its residents — charges not proven in court.
The other two Hirj refers to are Seasons Retirement Community and Royal Rose Place in Welland, a long-term care home.
There can be no conclusions drawn about retirement homes, with less staff, and long-term care homes, with a higher ratio — there are some of both that do have outbreaks, “and lots of each that don’t,” Hirji says.
Before the pandemic, an inspection of a residence would have taken two to two and a half hours, he says, but the inspection process regarding infectious disease control practices has been enhanced, and now takes about four hours for inspectors to watch how things are done, and ensure approriate processes, according to provincial standards, are being followed.
By ensuring similar practices are being done in homes that don’t have outbreaks, he says, “it seems more likely we can prevent them.”
While there might have been some “subtleties” of infectious control practices that were missed early in the pandemic, and other homes might have been doing more, “luck might have been a big factor,” he says.
If a staff person or visitor didn’t carry the virus into a facility at the beginning, before enhanced infectious control practices were instituted at all homes, the fact that everyone was then using best practices has likely helped to keep it out, he says.
The percentage of deaths to the number of cases in Niagara is high, because of the number of cases in long-term homes, and a small percentage of cases from community contact, Hirji points out.
Up until the end of March, shortage of testing equipment was a problem, says Hirji, but since then, “the number of tests is going well. Since late March, we’re testing anyone with symptoms.”
Kim Widdicombe is executive director of the Niagara Long Term Care Home, formerly Chartwell. It is considered medium-sized by provincial standards, but is the largest in NOTL at 124 beds.
“We have been diligent in following all public health directives,” she says.
“We are thrilled to remain COVID-19 outbreak-free, but we recognize that could change at anytime. No one is immune to this virus, and its seemingly ever-changing symptoms. Our deepest condolences are extended to the families and friends who have lost loved ones during the COVID-19 pandemic.”
Widdicombe adds, “the only way to protect our residents against COVID-19 is to keep it out of our home. Once the virus has entered many facilities, big or small, whether it be long-term care, retirement home, factories, etc., it has taken hold quickly, and often without much warning.”
As with all long-term care homes, she says, “we have policies and procedures in place every day that address how we care for our residents, cleaning standards, infection protocols, and even pandemic plans, the latter we hope we don’t ever have to use. But we are prepared in any event.”
In the case of COVID-19, in addition to existing procedures, Widdicombe says public health mandates they are following include not allowing non-essential visitors; enhanced hand hygiene; active screening twice a day for residents and staff; isolation of residents who display any COVID-19-like symptoms; enhanced cleaning and sanitation; one site employment for staff; and universal masking.
Prior to the Province restricting workers to one home, Widdicombe says, they had a few staff who also worked at other locations, “however, we were very pleased that most chose to stay with us.”
The staff to resident ratio is dictated by the Ministry of Long-Term Care, says Widdicombe, “and does not differ from other long-term care operators, unless there is a sickness or other reason staff cannot come to work.”
The home has 129 employees, she says, but was unable to say how many of them directly care for residents.
Widdicombe adds, “we are very fortunate here at Niagara Long Term Care to have an awesome team, who are hard working and committed. They are truly passionate about the work they do and the residents they serve.”
Peter Criscione, communications consultant with the Region, says from the beginning of March, Upper Canada Lodge, a regional long-term care residence, was no longer using agency staff in the home. By March 14, all visiting by families and friends was suspended, with the exception of end-of life visiting, first passing active screening, and wearing personal protective equipment. The home has also had “excellent support” from medical director Dr. Tim Bastedo, and doctors from the Niagara North Family Health NOTL team. Doctors are using telephone consults with residents, facilitated by nurses at the home. “We also were doing everything possible to avoid emergency department transfers by reaching out to the nurse practitioner to provide services instead of sending residents out,” he says.
By early April, “we no longer had staff working in multiple locations.”
Active screening of residents and staff continues to be done twice a day. All staff are encouraged to call in sick if they are unwell, and symptomatic employees are referred to public health for direction on whether they should be tested and if they should be in self-isolation, he says.
Regional homes are following PPE guidelines to ensure the protection of residents and staff, “while using our PPE wisely.”
Training is ongoing with safety talks, which include respiratory infection refresher training, hand hygiene, PPE donning and doffing, refresher training, point-of-care risk assessment, and say COVID-19 spot check reports.
With adult day programs shut down, “we were able to redeploy activity staff to allow for resident engagement while social distancing. This included connecting residents with their families through FaceTime or by phone.”
Criscione says staff have been increased in some departments, including nursing, housekeeping and recreation, ensuring resident needs are met and cleaning practices are increased. If staff are off, “we are not working short,” he says.
Staff at Pleasant Manor, the not-for-profit long-term care home in NOTL, did not respond to a request for similar information.