The problem is the absolute patchwork of oversight when it comes to long-term care facilities. That problem should be solved with a national strategy. One of the after-effects of the pandemic will be a genuine interest in working collectively to upgrade the level of seniors’ care across the country.
By Sheila Copps
First published in The Hill Times on May 25, 2020.
OTTAWA—The latest post-mortem theory on Canada’s COVID deaths is that beefing up hospital resources fuelled the death rate in nursing homes.
That appeared to be the dubious conclusion in a front-page story last week in The Globe and Mail.
An elderly patient was transferred from an Oshawa hospital into a long-term care home, where she died three weeks later.
The inference in the article is that the transfer caused her death.
But the context reflected a superficial, and misguided critique, of the current triage system in Canadian hospitals.
For the past 40 years, critics have been pointing out that up to one-third of acute care hospital beds are being taken up by long-term patients who would be better served in a retirement facility setting.
The COVID crisis prompted a long-overdue transfer of patients from hospitals to nursing homes to free up acute care beds to treat patients in acute, current distress.
It appears more likely the reason this unfortunate death happened was entirely because the long-term care home to which she was transferred to was a COVID-19 hotbed, with 77 deaths.
But the journalists fail to ask the key question. Why do some retirement homes have zero infections while others are rampant?
The issue is not patients’ transfer, but rather the level of hygiene and best practices in nursing homes.
In a good home, infection isolation strategies were in place long before the pandemic struck. In a retirement home, if a flu bug is not properly managed by isolation and hygiene practices, it can and will spread like wildfire.
Proper medical practices, employed by medical staff and personal care workers, prevent the virus affecting a patient in one room from spreading to the rest of the facility.
Appropriate lockdown strategies, early in the game, while difficult for families, have also kept the virus out of some facilities.
So, the problem is not caused by moving chronic patients out of acute care hospitals. The problem is caused by lack of oversight of the chronic-care facilities that house our seniors.
The Globe report said that most patients have a preferred list of long-term care homes. Families aren’t stupid and when it comes to checking the quality of care in a retirement facility, you only have to look at the waiting list.
The longer the wait-list, the better the care.
The best long-term care facilities have not been hotbeds of infection.
The Globe goes on to reveal another shocking headline that “nobody is tracking deaths inside seniors’ facilities at a national level.”
That should surprise no one because health data is collected and managed by provincial governments.
Each province tracks its seniors’ facilities deaths.
But the real questions were not asked by the reporters.
Why are there some facilities with vulnerable patients who have managed to completely avoid COVID-19 infections while others are hotbeds?
What is the infection correlation between publicly run facilities versus privately provided care homes?
What impact did the reduction in inspections of Ontario nursing homes have on the infection rates?
What is the influence of differing labour laws in different jurisdictions?
British Columbia moved immediately to restrict health-care workers from working in more than one facility. Quebec waited until mid-cycle to do the same thing.
What is the correlation between salary scales in individual facilities and infection rates? Some of the largest companies in the private elder care business had zero national strategy to secure sufficient personal protective equipment for their patients and employees.
They left the decisions on equipping homes and health-care staff up to each retirement facility. Some obviously did not do a very good job.
Contrary to The Globe claim, the move of chronic care patients out of hospital is actually key to saving and supporting health care.
The problem is the absolute patchwork of oversight when it comes to long-term care facilities.
That problem should be solved with a national strategy. One of the after-effects of the pandemic will be a genuine interest in working collectively to upgrade the level of seniors’ care across the country.
Let’s not just throw money at the problem. We need to ensure proper accreditation and real consequences when homes fail to meet the basic statutory requirements. When was the last time a home was shut down because of improper eldercare, bedsores, and infection spread, all signs of a poorly managed facility?
Let’s tackle the real problem. We need an end to the patchwork of oversight currently governing Canadian nursing homes.
Sheila Copps is a former Jean Chrétien-era cabinet minister and a former deputy prime minister. Follow her on Twitter at @Sheila_Copps.