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COVID-19 and the urgent need to prioritize Canadian long-term care

The coronavirus pandemic has revealed critical flaws in Canada's long-term care system, leaving seniors unguarded in the face of a global emergency.

A Canadian soldier helps a resident at a long-term care facility in Montreal. Genevieve Beaulieu/Canadian Armed Forces/AFP via Getty Images

Given the measures that have quickly been put in place to mitigate the spread of COVID-19, one would anticipate that the highest levels of precautions would be found in the buildings that house one of Canada's most vulnerable populations - our seniors. The sad reality, however, is quite the contrary. Nursing homes have become the epicenters of the COVID-19 crisis in Canada, with reports suggesting that anywhere from 62% to 82% of all virus-related deaths have occurred in these facilities. Rather than unavoidable consequences of the virus, these numbers point to critical flaws in Canada’s long-term care system which has allowed for Canadian seniors to be left unguarded in the face of a global emergency.

The nature of an assisted living residence raises additional difficulties amid an infectious pandemic. For one, many residents may not be capable of communicating the onset of their symptoms or any changes thereafter. Second, many components of these facilities require staff to act as an integral and intimate extension of the residents, whether that be for mobility, washing or eating. The latter highlights a crucial need for proper disinfection and protective protocols to be in place for the sake of both the residents and those working in the facilities. Yet, in light of recent controversies surrounding the quality of care in assisted living facilities, the emergence of a number of class action lawsuits against nursing homes in Quebec and Ontario, citing their failure to implement appropriate COVID-19 protocols was not surprising. On top of improper personal protective equipment (PPE) use, allegations include a failure to isolate sick residents, symptomatic employees forced to work, continuity of communal meals and no restrictions or screening of visitors.

It takes great compassion and strength to provide support and care to this vulnerable population, many of whom have mobility, cognitive or physical ailments. I witnessed this first-hand, as a volunteer in an assisted living facility. Here, I obtained a glimpse of the challenges faced when it comes to feeding and caring for those who have dementia. From this experience, I know that the personal reward of such work is high. Yet, many of these employees are often overworked, underpaid, and working in less than optimal conditions. In light of the pandemic, provincial governments have implemented pay raises for assisted living center employees, with up to $1000 monthly bonuses for Quebec staff and $4 increases in hourly pay for essential Ontario workers. This was a much needed change, but is this enough to raise the quality of healthcare in these facilities?

While appropriate compensation to our essential workers is important, the gross failing of the nursing homes to protect our Canadian seniors is not simply an issue of salary. A gut-wrenching report by the Globe and Mail exposes a haunting picture of the state of long-term care facilities even before the pandemic began. In a recent press conference, Quebec Premier Francois Legault estimated that even prior to the pandemic, the addition of 10,000 more assisted living personnel was required before optimal staff ratios would have been achieved in these facilities. With such significant gaps in staff already present, in a time of pandemic how do you further stretch this into separate groups of caregivers for those infected and those not yet sick, so as not to potentially propagate the transmission of the virus? Legault has recently proposed to pay for people to train and enter the field of assisted living care to combat the severe staffing gap. This incentive is promising, as it finally shows a recognition by the Quebec government that they must actively prioritize and support this area of care.

Hiring more workers will not only result in arguably better and more personalized care for the residents, but will also provide the necessary relief to those already working. This, in turn, aids in preventing staff burnout and complacency. Nevertheless, staff can only provide the level of care the system allows. Even if maximum personnel were present at the time of the pandemic, I anticipate similar events would have unfolded. Along with the widespread shortage of PPE across healthcare facilities, an overall lack of funding and overcrowding in long-term care facilities often results in multiple residents housed in one room and main spaces at maximum capacity. This only makes it easier for the virus to spread among residents. We have all been urged to maintain a distance of at least 6 feet when in public or to simply stay inside to protect ourselves from getting sick, yet we fail to even provide this safe distance for seniors in their own homes.

The Ontario government has announced they will assemble an independent commission to investigate what led to the COVID-19 crisis in long-term care facilities. This is an important first step, as a full overhaul of care facilities is required. Yet, this can only be achieved if the review is transparent, and if the geriatric community is prioritized by government and society. The repercussions of the COVID-19 pandemic add to an ever growing list of reasons a senior ought to be entitled to a private and safe space that is uniquely theirs.

People are quick to state they will do anything for their child, but what then for their parents? As the population continues to age, more and more will utilize assisted living resources. Sadly, the COVID-19 pandemic has exposed the waning stability of our geriatric care infrastructure. Now, more than ever, the need to implement changes to better promote the safety and well-being of seniors is clear.

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