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A Halifax researcher is hoping the tragic toll COVID-19 has taken on long-term care residents provides an opportunity to address and fix long standing “fault lines” in the system.
“I’m just beside myself. I think the tragedy in my mind is that this pandemic in Canada, it’s all on the shoulders of our most vulnerable people, the people that are in fact the highest proportion of people who died,” Janice Keefe, director of the Nova Scotia Centre on Aging and a gerontology professor at Mount Saint Vincent University, said in an interview.
“We spent so much time planning for acute care and not planning and not recognizing what could happen in long-term care that it’s just a tragedy. I’ve been working in this field for 20 years, and I never in my wildest dreams would have imagined that this would have happened. It’s heartbreaking.”
According to a May 3 paper published by the International Long Term Care Policy Network, Canada has the highest proportion of deaths in long term care settings among 14 countries.
As of May 2, there were 3,566 deaths linked to COVID-19 in Canada. Of those deaths, 2,227 (62%) were care home residents. Ireland has the second highest proportion of long term care deaths related to the virus at 60%.
Here in Nova Scotia, that statistic is even more bleak. Of the 41 COVID-19 related deaths to date, 35 occurred at the Northwood long term care facility in Halifax (85.4% of all deaths) and two at Harbourstone Enhanced Care in Sydney.
That means thus far, 90.2% of deaths from the novel coronavirus in this province have occurred in long term care settings.
Asked if the number of deaths at Northwood could have been prevented, Keefe said she believes evolving information about treating the disease and its asymptomatic presentation in some people made it a challenge from the beginning.
“They (Northwood) are a very, very good long-term care facility. They’re well managed, they have very dedicated staff, and they’re always innovating, and so in my mind they were probably one of the best prepared. At the same time, they are an older facility, they have a lot of residents that are two residents per room, and that’s a big issue for this kind of thing,” Keefe said.
“Could it have been prevented? I can’t answer that because it would seem you are blaming someone and I don’t think there is anyone to blame. It sounds crazy to say because they have the most (deaths), but it’s easy to contain it if you don’t have any. That’s a big issue. When you have it and didn’t know you have it, therein lies the issue.”
In 2018-19, Keefe served as chairperson on the Minister’s Expert Advisory Panel on Long Term Care. Among their five recommendations and 22 action items on how to improve the quality of long term care (as outlined in a Dec. 21, 2018 paper), the first was the need for the province to address quality of care and staffing.
“Quality of care of residents in LTC (long term care) facilities is affected by the quality of work life for staff. Sufficient and appropriate staffing is necessary to meet the increasing care needs of residents,” the panel noted.
“We heard over and over from residents and their families that staff do not have the time to provide appropriate care because they are “working short.” Shortages increase staff responsibilities, with more residents to provide care for, resulting in overstressed staff, high rates of injury and sickness, and many unfilled vacancies across the sector.”
Regarding the COVID-19 related deaths at Northwood, Keefe said it’s impossible to say whether more staff would have prevented any of those deaths.
“But I will say that having this stable workforce is really important. I’m working with a group in Alberta and there are 25% of their staff, their frontline workers, actually working at more than one facility…and there’s another 10 to 15% that are working at other places like hospitals or Tim Hortons,” she said.
“Why is that? It’s because they can’t get a decent wage or they can’t get sufficient hours. They’re women. Out West, 57% don’t speak English as a first language. So you’ve got a cascading effect of a workforce that’s badly in need of support.”
In his April 23 daily briefing, Prime Minister Justin Trudeau addressed the numbers of COVID-19 related fatalities in long-term care facilities, saying “We need to do better because we are failing our parents, our grandparents, our elders – the greatest generation who built this country. We need to care for them properly.”
When we do finally emerge from this pandemic, Keefe said we absolutely must do better by taking action. That starts by prioritizing care for older people who need assistance both in home care and long-term care settings.
While she doesn’t anticipate the current crisis will in any way eliminate what she calls the fundamental ageism that occurs in our society, Keefe said we’d be taking a huge step forward if we started valuing the work of those who care for our older population.
Paying decent wages and providing full-time jobs are just two concrete measures Keefe believes would help.
“There were some actual fault lines in the system already. We have to think about it in the context of the pandemic because that’s what demonstrated that these things are really important. And unfortunately, we hadn’t addressed them before and because of this situation, they blew up,” she said.
“Those fault lines certainly include the attention to the workers. I think that long-term care is often seen as the poor cousin or Cinderella to the broader health system, acute care, so that’s a really important factor.”
According to 2018 data provided by the Canadian Medical Association, that year there were 304 physicians practicing geriatric medicine in Canada, versus 2,613 practicing pediatricians.
“There is no priority in medical schools, in any of our universities, in our fellowships, in all of that there’s not the long term care specialty that it needs to have. They’re very complex cases. These folks have multiple comorbidities, they’ve got dementia,” Keefe said.
“But you know what? They’re still people.”
Keefe said she believes we need to turn this tragedy into an opportunity to create a better system for our aging population.
“That’s where I am wanting to come from, from all these bad things that have happened. What can we do to redesign a system which actually pays attention to the dignity of the people,” she said.
“We have a moral obligation as researchers in this area to contribute, and I hope all governments will look at the evidence, that they’ll engage all the stakeholders in this so that we get to redesign a better system.”
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Yes, I agree in general with her comments. They are similar to many other recents statements made by concerned experts and researchers. Of course, we need to continue to support and applaud the hard work of those working in the long term care system, flawed as it is. But … shouldn’t we also be asking more questions about our fundamental assumptions and practices around long term care that pre-date the pandemic, for example, why does society accept that older folks should continue to be warehoused in large impersonal dwellings? That personal dignity, decision-making powers and autonomy should be contravened in the name of risk or safety? That large scale congregate-living institutions are a fitting place for folks with memory loss or confusion? That community or family members are never involved during licensing inspections and rarely invited to comment on the methods or approaches to care? Most importantly, shouldn’t we be asking why the provincial government has reneged completely on its previous commitment to revise and update the provincial continuing care strategy (that includes long term care)? The strategy currently in place dates back to 2005.
No one should need to hold down more than one job to keep a household above water. If we want to kickstart the economy after the pandemic we need to adopt the “trickle up” theory of income distribution. It’s simple: you mandate big wage increases for people at the bottom of the scale, they will spend all that new money because they have urgent needs, and the profits will trickle up to the high income groups. We’ve lived with trickle down for half a century. That’s long enough for an obviously failed policy idea.
I agree with Dr Keefe, blame doesn’t belong to Northwood, however it can be attributed to the politicians, bureaucrats and Heath policy and system leaders for ageism and sexism over the past 5 or 6 decades. Long term care has been ignored and the work of women devalued ( most LTC providers are women) for far too long and this is the result. Also the blame goes to society for not screaming loud enough so politicians needed to pay attention. Would this have happened if the focus of care was children and not the elderly? Think about that!