More than 90 long-term care homes in Ontario are suffering an outbreak of COVID-19.
Professor John Hirdes, an expert in geriatric care, explains why long-term care is a hotbed of COVID-19 and what governments can do to stop it from having an even more devastating effect on the country’s elderly population.
Why
are
long-term
care
homes
seeing
so
many
cases
of
COVID-19?
We
don’t
really
have
a
good
count
of
how
many
people
in
long-term
care
homes
have
COVID-19.
The
current
evidence
shows
that
many
people
in
long-term
care
with
COVID-19
are
asymptomatic.
Without
systematic
testing,
this
means
that
we
don’t
really
know
who
does
and
does
not
have
COVID-19.
That
said,
it
is
probably
the
case
that
when
COVID-19
does
get
into
a
home,
there
will
be
many
people
who
become
seriously
ill
and
death
rates
will
be
high.
Another
problem
we
have
is
that
there
doesn’t
seem
to
be
a
systematic
resource
for
tracking
which
homes
have
COVID-19
cases.
The
main
source
for
this
information
is
the
media,
who
are
calling
homes
to
find
out
if
there
is
a
problem.
We
need
to
do
better
than
that.
There
should
be
a
single
authoritative
source
we
can
all
go
to
so
that
we
know
how
many
homes
have
outbreaks,
when
the
outbreak
began,
how
many
cases
are
positive
for
COVID-19,
how
many
residents
went
to
hospital,
and
how
many
died
at
the
home
or
hospital.
Why
do
COVID-19
cases
in
long-term
care
homes
end
in
fatality
so
much
more
often
than
cases
in
the
general
population?
There
are
many
different
reasons
that
could
be
at
play,
but
the
chief
among
them
is
the
complexity
of
the
population
in
long-term
care.
Based
on
age
and
underlying
health
conditions
alone,
our
research
shows
that
40
per
cent
of
home-care
clients
are
at
the
highest
level
of
risk
based
on
WHO
criteria.
That
rises
to
almost
60
per
cent
of
people
in
retirement
homes
and
nursing
homes.
When
COVID-19
enters
a
facility,
the
virus
connects
with
a
densely
grouped
population
of
people
at
maximum
risk
of
adverse
outcomes.
The
second
most
important
reason
is
resources.
Long-term
care
homes
have
been
chronically
underfunded
and
they
simply
do
not
have
enough
staff
with
clinical
expertise
to
manage
the
complex
challenge
of
a
COVID-19
outbreak
when
it
happens.
However, we also have to remember the potential impact of conditions other than COVID-19 during the pandemic. Nursing home residents and staff are under tremendous stress, which can cause acute problems with cognitive function. Also, when staff focus only on the prevention of COVID-19 symptoms, there may be inadequate attention to other major problems like heart failure, resulting in deaths for other reasons.
What
can
be
done
now
to
stop
COVID-19
from
spreading
any
further
among
vulnerable
older
populations?
There
are
several
things
that
can
and
should
be
done:
- We need to continue efforts to keep COVID-19 outside of long-term care homes. That means continuing to restrict access to essential staff only;
- Staff members need to be screened at EVERY shift before they enter the home to be sure they have not developed COVID-19 symptoms;
- We need to be testing all staff and all residents in long-term care for COVID-19. We can’t just focus on symptomatic residents, because research has shown that many who have COVID-19 are asymptomatic;
- Staff members need to be restricted to working only for one home for the duration of the outbreak. However, we also need to support staff to be sure that the income they lose from that restriction is compensated;
- Staff in long-term care need to be wearing PPE to protect the residents from potential exposure;
- We need to mobilize more clinical resources to the home to bring in the expertise needed to help the staff manage the complex clinical problems caused by COVID-19 outbreaks, as well as preventing the negative secondary problems that can come from the lockdown;
- Family members need to continue to be involved in the lives of long-term care home residents to counteract loneliness, depression and hopelessness. This could include using video and telephone technologies to connect residents with their family members. Family members could also send pictures and letters for residents to see.