What it takes to keep LTC residents safe during the sixth wave

It’s too dangerous to meet Jacquie Cheng where she lives. Long-term-care homes are tinderboxes, each visitor a potential spark.

Instead, Cheng, 80, joins the Star in a boardroom, four floors below where she lays her head at night, to discuss her life, cloistered from society for her protection.

Sitting in an office chair, her face obscured by a mask, Cheng fills the six-foot distance between her and her interviewer with stories of what long-term care was like before COVID-19 froze residents in place. There were trips to restaurants, blackjack games with neighbours, singers and dancers brought to her door. Cheng is still happy, she said, but longs for those freer times.

“Every time I look forward to something, again another lockdown,” she said.

In Ontario, life is closer to pre-pandemic normality than it’s been in the last 26 months with virtually all COVID restrictions having evaporated into suggestions.

This doesn’t apply to the tens of thousands of Ontarians in long-term care. They still live under siege, heavily restricted in where they can go and who they can see.

Several told the Star in recent interviews they want nothing more than to rejoin the world with everyone else, to spend weekends with family, to try the restaurants they’ve overheard nursing home staff gush about these last two years. But it’s still too risky.

The ongoing sixth wave of the pandemic is almost certainly infecting more people daily than any previous wave. This unprecedented community spread is mirrored in long-term care, where daily COVID infections saw near constant increases since early March. In the past 30 days, daily cases have increased by 97 per cent, from 610 to 1,204, with an average of 2.1 residents dying from COVID each day, according to data from the province.

It’s a volatile situation, so much so that Ontario reversed its decision to remove the mask mandate in long-term-care homes and hospitals last month, instead extending it to June 11. On Thursday, 161 of the province’s 626 long-term-care homes were in outbreak, defined as two or more confirmed COVID cases in residents, staff or other visitors within a two-week period, where at least one infection is likely to have occurred in the home.

Cheng has lived at the Yee Hong Centre Scarborough Finch long-term-care home for four years. Staff there have kept her safe through meticulous screening, testing, masking, ventilation, vaccination and isolation policies. Every layer of protection is crucial. In an airborne pandemic, even a whisper can kill.

“We’re not horrified by the pandemic, because we are well-protected here, head to toe,” said Cheng.

Cheng’s home is notable for being one of very few Toronto long-term-care homes to have had zero COVID deaths all pandemic.

Success on this front comes with a cost. Cheng and her neighbours can’t gather much, have a difficult time going out into the community because of isolation requirements upon return and cannot visit other floors in the building. This was particularly difficult for Cheng, whose mother lived a floor above her. They couldn’t spend time with each other in the months preceding her mother’s recent death.

“(My mother) kept on asking the nurses when she could see me,” said Cheng. “But we had to stick to the restriction given by the Ministry of Health. Lockdown is lockdown.”

Airtight lockdowns come and go, but even in this most laissez-faire period in the pandemic, life in long-term care is still “not as free as before,” Cheng said. Mahjong tiles and playing cards sit idle. Singers and dancers no longer make regular visits to entertain. Even the virtual reality program, which let residents explore Google Earth in VR, had to be paused because sanitizing headsets became too demanding.

“Our activation manager cried once, because she really wants to provide activities, but we are so limited now,” said Lloyd DelRosario, the home’s executive director. “It’s heartbreaking for me as well. We want to go back to normal. We don’t want to stop providing the quality of life for our residents. We want them to enjoy this moment, even under the pandemic.”

It takes creativity and care to accomplish that. Residents miss going out to eat, so staff prepare restaurant-style meals for them in a live cooking show format with audience participation. Tablets have replaced board and card games. Holiday decorations are more elaborate than ever to offset families not being able to come in to celebrate.

All this is done by staff who, like all long-term-care workers, have been run ragged by the pandemic.

“What’s really hard for Yee Hong and every other organization is severe staffing shortages,” said Yee Hong Centre CEO San Ng. “We really need government support. It’s not fair that our staff have to work overtime or miss vacations. They’re really burnt out. I don’t worry about outbreaks, because our team is great, but I worry about the team.”

Dr. Amit Arya, palliative care lead at Kensington Health, which operates a long-term-care home in Toronto, called staffing a “chronic problem” in the sector, which has only gotten worse throughout the pandemic.

“Many people are not aware of the ongoing humanitarian crisis in long-term care,” he said. “We have maybe one nurse looking after 25 or 30 people or even more on a regular basis in the day. And that number drops to one in 50 to one in 60 at night.”

Arya said the government’s response has been to promise to build more long-term-care homes — necessary as there are around 30,000 people on wait lists in the province — but the corresponding call to increase staffing is insufficient, long-term-care advocates argue. Without staff, a long-term-care home is just another building.

The Ministry of Long-term Care has pledged to create 27,000 new positions for personal support workers, registered nurses and registered practical nurses by March 2025, including “up to” 10,000 positions this year, a spokesperson told the Star.

Ontario nurses have also been offered $5,000 by the government to keep working — half before the June 2 election and half after — in a bid to “help retain and stabilize the nursing workforce,” the ministry said.

But, said Arya, “that doesn’t compensate for the day-to-day challenges of working as a nurse and working with such low staffing levels on the front lines of long-term care facilities, of being so fatigued and exhausted, of being disproportionately impacted by this virus in some way or another over two years.”

Daily active COVID cases among long-term-care staff have jumped nearly 70 per cent in the past 30 days, from 369 mid-April to a high of 624 this week. Homes across Ontario have seen about one in 20 of the residents they take care of die in the last two years from COVID. On Thursday, the pandemic death toll in long-term care was 4,375 residents and 13 staff.

There is now strong demand from Ontarians in the upcoming provincial election for better long-term care. The province has seen thousands of deaths in nursing homes throughout the pandemic and reports of horrific treatment of residents in some homes uncovered by the military in 2020. Major parties have pledged to either increasing long-term-care staff wages, build more beds or buy back for-profit homes, which had higher COVID death rates.

In April, Ontario’s COVID-19 Science Table published an assessment of the pandemic’s impact on long-term care, writing that residents have experienced “disproportionate deaths, prolonged isolation from family and essential caregivers and reduced quality of life.”

“We’ve very worried because the number of outbreaks is still going up,” said Arya. “But I’m more worried about what (autumn) will bring. Pretty much all public health measures have been dropped and we’re at high risk for new variants.”

To combat respiratory virus resurgence, Chester Village, a Scarborough long-term-care home with zero COVID deaths, will mandate masking every flu season in perpetuity, even if they aren’t required to by public health.

Non-COVID outbreaks are little thought of now, but any infection or infestation can be dangerous in long-term care.

“There used to be a lot of cold and flu outbreaks, and those are really hard to get out of,” said Chester Village CEO Cynthia Marinelli. “Every time someone comes down with symptoms, it would go like wildfire through a home.”

Debbie Marston’s mother lives in long-term care in Oshawa. Because of COVID and scabies outbreaks, Marston’s mother and her neighbours are often isolated.

“It seems like every time I turn around, they’re locked in the room,” she said. “My mom is cognitively aware, so for her to be stuck in her room with just the TV, three meals a day, alone all day for seven to 10 days, that makes her just go wacky.”

Still, there is hope, as residents and staff continue on the long, uncertain journey into the post-COVID era.

Yee Hong Scarborough Finch activation manager Sophie Ma is already planning a party to celebrate the end of the pandemic, whenever it may be.

“We’ll have food, because the residents love food. Singing. The residents really love singing. Dancing performances. My type of party is not just a one-day party. It’s an entire week.”

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