The School of Public Health and Health Systems is a division of the Faculty of Applied Health Sciences
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.