Like many Canadians with loved ones in long-term care, being denied the ability to visit during the COVID-19 pandemic has been very difficult for Margaret Calver, 81, who used to volunteer daily at her husband’s residence, Markhaven Home for Seniors.
But for the facility north of Toronto, keeping visitors out has not stopped the coronavirus from getting in. And now families are concerned about how staff will manage to protect other residents and themselves.
“I’m very worried,” Calver said. “I don’t know how the staff is going to cope with all of this.”
Markhaven is one of at least 20 long-term care homes in Canada that have seen residents contract COVID-19.
A resident there was diagnosed with the illness on March 20, and since then, two personal support workers have also tested positive.
COVID-19 is particularly dangerous for the elderly, with a death rate that is significantly higher for those over 60. At least 20 seniors’ home residents in Canada have died of the illness — more than half of the country’s total death toll.
Eleven of those who died were residents of a single long-term care home in North Vancouver.
Given the serious health issues of residents and the already high demands on staff, seniors’ homes across the country are facing extremely difficult challenges during the pandemic.
At Markhaven, for example, all 96 residents, including the patient with COVID-19, are being quarantined in their rooms to help prevent the spread.
But that provides little comfort for Calver.
“The staff are overworked, terribly overworked at the best of times,” she said.
A Marketplace investigation last year revealed that long before the coronavirus pandemic, staff at Markhaven struggled to keep up with care needs. Staff admitted to skipping lunch breaks to get all their work done, and residents in wheelchairs were seen waiting up to an hour to use the restroom.
The dining room often had family members and volunteers helping to feed several residents at a time.
Ontario’s chief medical officer of health issued a memo to the long-term care sector on March 14, strongly recommending that homes only allow essential visitors to enter due to the threat of COVID-19.
Calver worries about how Markhaven will get everyone fed without volunteers there to help.
“They’ll have to be fed in their rooms … even residents who eat independently have to be monitored every time they’re eating,” she said. “There are three meals a day, plus three refreshments, nourishment times as well, then there’s all the personal care that has to be done.
“It’s an impossible situation.”
Calver’s husband, Wayne, an 84-year-old retired military lieutenant with dementia, lives at Markhaven in a locked wing for residents who tend to wander.
“The residents wander in and out of each other’s rooms,” she said. “So I’m not sure how they’re going to keep the residents in their rooms.”
‘Everyone should have been isolated immediately’
In an email to CBC, Markhaven executive director Mike Bakewell said he has been working with several health authorities since the start of the outbreak. He said York Region Public Health has been implementing staff training at Markhaven this week, and ordered the isolation of all 96 residents on Sunday.
Calver said she thinks that plan should have been in place on Friday, when the resident was first diagnosed.
“I said I wanted him left in his room and fed in his room,” she said of her husband. “At that time, I was told that he could not be fed in the room, that the residents all still had to go to the community dining room…. I think everyone should have been isolated immediately.”
Marjolyn Pritchard, director of York Region Public Health’s infectious diseases control division, told Marketplace in an email that a resident showed symptoms of respiratory illness on March 15, and “standard outbreak control measures” were implemented after they declared a respiratory outbreak on March 17, including the cancellation of group activities and isolation of residents who were ill.
Pritchard said the decision to fully isolate all residents was made based on consultation and advice received from Public Health Ontario and the Ministry of Health.
“Given this is [one] of the first COVID-19 outbreaks in an institutional setting in York Region and one of the first in the province, the guidance is evolving and York Region Public Health was acting on emerging evidence as it was received,” she said. “Heightened control measures were implemented as soon as possible on the advice of these provincial public health authorities.”
She said they have since shared this guidance with the other long-term care homes in York Region.
Quarantine has its own risks
Miranda Ferrier, president of the Ontario Personal Support Workers Association, said quarantining everyone in a care home poses unique challenges that these facilities have never seen before.
“You can’t lock somebody in their rooms, especially when they have dementia,” she said. “They need more staff on those wards in order to quarantine them properly.”
In long-term care facilities, she said, any sort of virus or sickness “spreads like wildfire.” And even if you could manage to keep everyone confined to their rooms, keeping them immobile for extended periods poses other health risks, she said.
“What you’re going to see are dementia patients may be slipping into comatose states … there will be massive skin breakdowns, there will be depression and there will be loneliness,” she said.
“You’re going to see massive burnout on the front line.”
To support those on the front line, the Ontario government stepped in Tuesday to implement measures that will allow long-term care homes to temporarily bypass some collective agreement restrictions on scheduling and shift assignments, and to train staff to perform tasks they normally wouldn’t do.
The Ministry of Health is also trying to mitigate employee burnout by calling on any trained professionals who have left health care or retired to come back to the industry to help ease the burden on staff.
This comes after an announcement on March 17 that saw the province invest $50 million in emergency funding for the sector.
Ferrier says it is difficult to predict exactly how effective these measures will be, but says she’s impressed that people are willing to come back to the industry to help out despite the risks.
“We’re hearing from them 24 hours a day — there is fear, they are scared,” she said. “But one thing that we’ve seen that’s come out of this is the amazing ability of these personal support workers to put the care first.”
Ontario’s Ministry of Health told Marketplace more than 5,000 individuals have signed up to return to health care through their program, and that they are currently validating their statuses with regulatory colleges.
“They are picking up their scrub pants and their scrub shirts, putting them on, and they’re heading into work,” said Ferrier. “They truly are heroes.”