September 14, 2023, Kitchener, Ontario
Posted by: Robert Deutschmann, Personal Injury Lawyer
The COVID-19 pandemic has laid bare systemic issues within the long-term care (LTC) sector, demanding immediate attention and reform from policymakers. In Ontario, where over 70,000 residents reside in 626 LTC homes, the pandemic has disproportionately affected this vulnerable population, particularly residents with dementia and women. Shockingly, LTC home residents accounted for over 60% of all COVID-19-related deaths in the province, despite comprising less than 1% of the older population. In response, numerous inquiries and reports have been generated, offering a range of recommendations to address these critical issues.
This blog post delves into five key lessons learned from the COVID-19 pandemic's impact on LTC homes, drawing from a comprehensive analysis of federal and provincial reports. These lessons include enhancing staffing, reducing crowding, ensuring connections among residents, incorporating palliative care, and optimizing infection prevention and control (IPAC) measures. The information comes from this article by the Science Table and you can read the entire published article here.
Lesson 1: Enhancing Staffing
The shortage of staff in LTC homes has long been a concern, exacerbated by issues such as high turnover, part-time employment, low wages, and inadequate training. Despite numerous reports highlighting these issues, little progress has been made. Comprehensive and accurate data on staffing levels, working conditions, and turnover are vital for addressing these problems. A key recommendation is to establish a minimum of four hours of combined direct care by 2025, but this requires transparent and verifiable data on staffing hours.
Data collection should also encompass all staff members, including maintenance, kitchen, and housekeeping workers, who play a critical role in infection prevention. Comprehensive data should extend beyond staffing numbers to factors contributing to labor shortages, like turnover rates and scheduling. The U.S. Affordable Care Legislation serves as a model for efficient data collection and transparency in staffing levels, ensuring quality care.
Lesson 2: Reducing Crowding
Crowding within LTC homes significantly contributes to the transmission of respiratory viruses, including COVID-19. While some reports recognize this issue, it remains under-acknowledged. Addressing crowding requires eliminating three and four-bed ward rooms and increasing the availability of private rooms with dedicated bathrooms. This structural improvement will enhance residents' well-being and reduce infection risks.
Moreover, LTC home design should consider high-quality heating, ventilation, and air conditioning (HVAC) systems in common areas. Increasing the size of shared spaces can also help minimize transmission risks. Addressing crowding should include permanent caps on occupancy in ward rooms and a focus on private rooms for new LTC home builds.
Lesson 3: Ensuring Connections
Family members and essential caregivers play a vital role in the health and well-being of LTC home residents. The pandemic's restrictions on visitation have had severe consequences, affecting residents' mental health and mortality rates. Studies show that residents without personal contact experienced significantly higher mortality rates.
Therefore, LTC homes must maintain in-person access for essential caregivers and family members while seeking innovative ways to facilitate connections when in-person visits are not possible. Prioritizing residents' well-being includes balancing the risk of COVID-19 with the need for social connections.
Lesson 4: Incorporating Palliative Care
Many LTC home residents have serious or life-limiting illnesses, making palliative care essential. However, only a few reports mention this critical aspect of care. Variation in access to palliative care across LTC homes necessitates improvements. LTC homes should strive to provide palliative care in-house, avoiding unnecessary transfers to hospitals.
Training for personal support workers and health care aides in palliative care is crucial. Ensuring access to essential medications for end-of-life symptoms should also be a priority. High-quality palliative care improves residents' quality of life and ensures a balanced approach to care, considering both quality and length of life.
Lesson 5: Strengthening Infection Prevention and Control (IPAC)
All reports emphasize the need to enhance IPAC measures in LTC homes. Establishing dedicated IPAC practitioners within each home is recommended, along with stronger partnerships with external IPAC experts and local public health resources. IPAC measures are closely tied to staffing, crowding, and visitor education.
By improving staffing, reducing crowding, and educating visitors and essential caregivers on safe practices, LTC homes can enhance IPAC. Ongoing collection of high-quality and current data is essential to adapt IPAC strategies to changing circumstances, as seen in the varying waves of the COVID-19 pandemic.
The COVID-19 pandemic has exposed critical weaknesses in LTC homes, but it has also provided an opportunity for transformation. These five lessons—enhancing staffing, reducing crowding, ensuring connections, incorporating palliative care, and strengthening IPAC—serve as guiding principles for meaningful change. To improve the quality of care and protect LTC home residents, policymakers must prioritize these lessons, backed by transparent data collection and ongoing measurement of progress. Reforming LTC homes to be more resident-centered and focused on quality of life is not only necessary but also a moral imperative.