Nursing home workers are moving between multiple facilities. That’s a big problem.

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There are now 98 confirmed cases of COVID-19 among residents and employees at eight long-term care homes in Nova Scotia. At least two of the four deaths to date were former residents of nursing homes.

The largest case clusters are at The Admiral in Dartmouth (13) and Northwood in Halifax (68).

Update, 8:20 Saturday morning: sometime overnight, Northwood has updated its figures. As of Friday morning, the facility has 84 cases (51 residents and 33 staff).

As the number of COVID-19 infections rises in nursing homes, so, too, does the number of employees forced to leave work and stay home because of their contact with clients. The province has not stated how many employees are in this category, but we do know that nursing homes are even more short-staffed than usual.

“The Nova Scotia Health Authority put out a call for volunteers for deployment to long-term care facilities in Central Zone. We generated a list of staff who wished to help, and that list was shared with the facilities. Staff are then being called directly by individual long-term care facilities,” emailed Carla Adams, a senior communications advisor with the NSHA.

Some homes have also recruited help from the Victorian Order of Nurses and private healthcare providers. But the most telling signs of how short-staffed our 132 continuing care homes remain are reflected in the public policies Nova Scotia has adopted.

Nova Scotia has not followed the example of British Columbia (and Ontario, as of next week) which have taken measures to prevent people from working in more than one long-term care facility. The government of Ontario has acknowledged some deadly outbreaks in its facilities were the result of staff who had worked in two or three homes, inadvertently spreading the virus among patients and staff.

“Clearly, the more we can keep staff working in one facility, the better,” said Nova Scotia’s Chief Medical Officer Dr. Robert Strang. “That’s one of our objectives. But we are not in a position to be completely directive on that like some other provinces. We actually need people to be in the facilities to provide care.”

Homes in Nova Scotia which have experienced outbreaks of the virus resulting in staff leaving to self-isolate — thus creating a staff shortage — are still allowed to employ people who are also working at other locations.

Continuing care homes received that permission in an updated COVID-19 policy directive a week ago, at the same time the Province began supplying surgical masks to be worn by all staff interacting with residents. Under the heading ‘Outbreak Control’ the April 11 policy directive reads:

In general:

Staff from outbreak facilities must not work in non-outbreak facilities.

However, in the event of critical staff shortages and under the direction of Public Health, staff from non-outbreak facilities may work in outbreak facilities. They may continue to work in their home facilities. This exception will not apply to those who have been identified as a close contact by Public Health.

Workers must get their temperature taken twice a day to confirm they don’t have fever or symptoms. If they don’t, they’re good to go.

Louise Riley is a Continuing Care Assistant (CCA) who heads up CUPE NS’s Long-Term Care Committee. She says it is “common” for CCAs to have more than one employer. “There’s lots of people that work in other facilities. They might be full-time at one facility and working casual at another because they need the income, right? There’s lots of CCAs who work in one home part-time and they work in home-care part-time or do shifts at the hospital.”

So what would happen if Public Health restricted nursing homes from hiring CCAs or LPNs who worked at more than one location?

“It makes sense from stopping the spread, but there wouldn’t be enough people to staff the nursing homes,” replied Riley firmly.

That was the same conclusion Dr. Robert Strang appeared to reach when questioned at this past Monday’s briefing. He was asked why nursing home workers who had been exposed to someone who tested positive were then being recalled before their 14-day isolation period ended. Strang admitted that was the case if the worker then tested negative before the 14 days was over. (Since then, scientists have noted some later cases have emerged, suggesting the incubation period for the virus might be closer to 20 days.)

“We’re balancing challenges for sure,” replied Strang. “In an ideal situation where staffing was not an issue and we had adequate staff to provide essential care for residents, we would have all workers in a long-term care facility who were exposed off for 14 days. We don’t have that luxury.”

Strang went on to say that protocols have been put in place to protect returning workers, such as mandatory masks and temperature checks.

“The alternative is bringing in staff from other long-term care facilities and homecare agencies. The risk, which I believe is a greater risk, is now they are going to go back to work in their other facility or homecare setting. Now we have created a risk of transmitting the virus from a place where we know we have it into another setting.”

Well, according to CUPE, that riskier “alternative” is also playing out at long-term care facilities where COVID-19 has struck. The current situation can’t help but make a person wonder whether the “outbreaks” today would have been better controlled if nursing homes had the money to hire more permanent staff. This spring’s provincial budget increased funding by just $5 million.

A public awareness campaign launched this past February by CUPE Nova Scotia’s Long-term Care Committee stated, “Fully 74% of CUPE members in long-term care report they are working short on a regular basis and 36% are working short each and every day.” The campaign was asking for public support to lobby the province to provide more funding to hire more staff.

The same message was delivered to the premier two days ago by an eldercare advocacy group called ACE (Advocates for the Care of Elderly). “We hope your government will agree to providing supplemental income to long-term care staff as being proposed by the federal government. Low rates of pay and benefits has long been an issue of concern in the long-term care sector,” writes chair Gary MacLeod. “The COVID-19 crisis has laid bare and made this unacceptable situation much worse.”

Prime Minister Trudeau promised earlier this week that the federal government would provide funding to top up the wages earned by essential workers in nursing homes who earn less than $2,500 a month. But long-term care is a provincial responsibility, and the PM said the top-up would be dependent on cooperation from that level of government to make that happen.

In the meantime, those doing the work of caring for our elderly and severely handicapped citizens in nursing homes and group homes appear to be shouldering the high-risk brunt of this pandemic.

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