Outbreaks of COVID-19 in Ontario long-term care homes are very much in the news this week.
At his daily press conference, Premier Doug Ford became emotional talking about his personal situation. His mother-in-law in long-term care has tested positive and he acknowledged that Ontario's long-term care home system "is broken," but said that can't be done until after the pandemic.
"We're going to fix the system but right now the No. 1 crisis is making sure we take care of these most vulnerable people," Ford said.
Also today, the Ontario Health Coalition released a report aggregating how serious the situation is in Ontario's long-term care homes. To date, the coalition found, there have been more than 400 deaths in LTCs, accounting for more than half of Ontario's total number of COVID-19 fatalities. Nearly 4,000 staff and residents have been infected. There are outbreaks in at least 80 LTCs.
Northern Ontario has so far escaped the brunt of the COVID-19 pandemic and there has been an outbreak declared at only one LTC so far. This week it was announced that one staff member and one resident of St. Joseph's Villa had tested positive.
On April 23, Sudbury.com spoke with Aaron Archibald, the director of Pioneer Manor in Greater Sudbury. The Manor is the largest LTC in Greater Sudbury and one of the largest long-term care homes in Northern Ontario with 433 residents, more than 500 employees and some 160 volunteers, as well as four attending physicians.
Originally, this conversation was to be livestreamed to YouTube as Sudbury.com has been doing weekly since the pandemic began. Unfortunately, today we experienced some technical issues and were unable to livestream. We did record the conversation so you can watch, but be aware there were issues with the quality of the audio. You can watch the video below.
While the situation in LTCs has been very much in the news for the past week or two, Archibald said long-term care facilities have been fighting the fight against COVID-19 for more than two months, adding the outbreak numbers released this week show just how serious the situation is.
"The numbers really illustrate the measures we have taken and put in place. Since early February, actually late January, we have been meeting on our COVID-19 response," he said. "In February, the province started releasing their initial documents and screening protocols, and at that time we implemented our pandemic plan, and since then we have continued to implement additional measures to safeguard our residents.
"Our No. 1 priority ... is the safety of our residents, staff (and) families."
That pandemic plan is comprehensive and includes cleaning and disinfecting protocols, as well as monitoring residents and staff for signs and symptoms.
"We continue to aggressively use surveillance measures and testing on anyone who shows symptoms," Archibald said. "We've been aggressively testing all residents that have been showing any symptoms of COVID-19 for more than a month, and we have been working with Ontario Health and Public Health, and we are testing, as we speak, everybody."
The Manor is city-owned and operated, and while there continue to be calls from some circles, including some elected officials, for Greater Sudbury to sell the facility, Archibald said, in this pandemic, the LTC has benefited from the co-ordinated city-wide response to COVID-19, as it has had access to resources, data and personnel, that might not otherwise have been available.
So what happens when a resident or staff member does show symptoms? Archibald said viral or bacteriological outbreaks aren't uncommon in LTCs; it's a closed, close environment with hundreds of people interacting at any given time.
COVID-19 might be new, but LTCs are used to managing outbreaks of one kind or another, so there are protocols already in place to manage those situations.
Residents who show suspected symptoms are isolated from others "with appropriate protocols, processes and protective equipment" to prevent spread, whether COVID-19 or not.
"With COVID-19 we're taking it a step further where we're doing aggressive surveillance monitoring and testing," Archibald said.
As part of its pandemic response, the Manor has slowed or stopped admission of new residents. This both protects current residents, and also allows the LTC to build capacity into itself in the event there is an outbreak.
Pioneer Manor now has nine empty rooms, seven of which are private, that will be used for COVID-19 positive residents, should that be required.
"Our pandemic plan is scalable, meaning we have a plan if we have just one resident, we have a plan if we have two residents, and we have a plan that will encompass multiple residents," he said. "Our plan will be to isolate an unwell resident from the well residents."
Under this scenario, staff will also be dedicated to caring only for a COVID-19 positive resident or residents, so staff themselves aren't a vector for transmission.
"By having surge capacity ... we have the ability to ensure we will move any of our positive residents into one area and offer specific services to them there, so we can limit any type of transmission throughout the home," he said.
When it comes to treatment, residents are treated in hospital when necessary (though this hasn't happened at Pioneer Manor during this pandemic so far) and the facility has a direct line for its physicians to call into the emergency department at the Health Sciences North so hospital staff are ready and prepared should an LTC resident have to be transported to HSN for treatment.
Now, if you have a loved one in LTC and are considering removing your relative from the home during the pandemic for their safety, you should be aware of one fact: While you're within your rights to do so, realize that under the emergency orders in place in Ontario, the resident must be discharged from the LTC to make this happen — the resident will lose their bed and would have to reapply to be admitted.
Archibald said he has been fielding those types of questions from families. The province, he explained, has put a stop on all non-essential visitation to LTCs, which also means residents can't leave for non-essential reasons.
Residents of long-term care homes live in LTCs because "they have exhausted all community supports" and have complex needs to fulfil to keep them healthy and safe.
"Understandably people are afraid," he said. "But families can't come and pick a loved one up and take them home for a couple of days. They would be discharged home and if they wanted to come back into a long-term care home, they would have to re-apply and go through that process."
He said families are fully informed of this fact when they inquire, so they can make an "evidence-based decision" regarding their loved one's care.
If you are concerned about the state of Pioneer Manor's stores of personal protective equipment, Archibald said they are ample. He said the province has set up supply arms specifically for LTCs, so if a facility's normal supply lines have an issue, they will not have to go without.
He said staff and residents are naturally concerned at this time, but he said everyone is doing their best to remain upbeat, to laugh and to cope with the situation, while ensuring everyone stays safe and healthy.
If you are a family member or decision-maker for a resident of Pioneer Manor, you can email questions or concerns directly to firstname.lastname@example.org. As well, click here to read the latest letter updating Pioneer Manor families on the COVID-19 situation.