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The legislature’s Health Committee met yesterday for the first time in six months to talk about the government’s response to the pandemic and future preparedness.
“All in all, we have fared well,” said Chief Medical Officer of Health Dr. Robert Strang, pointing to just a handful of active cases and the current low rate of transmission in the community. “We have low numbers today because Nova Scotians took the risk of COVID-19 seriously and continued to follow the rules and encouraged others to do the same.”
Yes. But. The glaring exception being the 53 residents who died in long-term care at Northwood and several more at other nursing homes, accounting for more than 86% of the 65 deaths in the province.
Susan Leblanc, the NDP’s elected representative from Dartmouth North, asked both Strang and Dr. Kevin Orrel, the deputy Health Minister, what measures are being taken now to prevent more deaths in the event of another outbreak at nursing homes.
“Long-term care in Canada — the standard of care — is such that without a pandemic, we probably would have got by for hundreds of years as it was… But the pandemic showed us these are very vulnerable people,” said Orrell, an orthopedic surgeon who assumed the job of deputy Health Minister on April 1. “They are older people with co-morbidities; they cohabit; they share bathrooms. So now that we have witnessed how drastic this has become, we have to do better… We are going to use the experience, as sad as it is, to improve our ability to look after these vulnerable people.”
This was not the answer Dartmouth North MLA Susan Leblanc expected.
“I have to say I’m a little surprised by your comments,” she said, “that without a pandemic, we could have continued with long-term care as it is for hundreds of years! I think that is somewhat short-sighted, especially since we have many, many reports written long before this pandemic talking about the terrible state of long-term care in Nova Scotia… One could argue the issues we have seen at Northwood and at other nursing homes in Canada have something to do with the fact we haven’t been looking after our long-term care facilities for many years.”
Leblanc noted that the Nursing Homes of Nova Scotia Association has recently urged the McNeil government to develop a multi-year infrastructure plan to ensure every resident in long-term care will one day have their own room. Leblanc pressed Orrell. What specific changes, she wanted to know, are the Department of Health prepared to make prior to a second outbreak of COVID?
“We know the (double and triple) occupancy itself may not be the issue,” said Orrell. “It’s more to do with the sharing of bathrooms. There is some way to manage that, perhaps with people who are mobile and using the bathroom who could be room-mated with someone who is not as mobile and would be occupying the bathroom. We look at the staffing — the staff models. Cleaners are a very important aspect in long-term care. We need to see if we can keep them in separate sections so they aren’t travelling through the whole building.”
Orrell said the administration will act based on two separate reports they will receive next week — on Sept.15, from an internal group examining Infection Prevention and Control procedures at all nursing homes, as well as a two-person external panel appointed by the McNeil government to review the circumstances at Northwood and make recommendations. Those recommendations will eventually be shared with citizens — but, crucially, not the contents of the report itself, because the province opted to conduct a review under the Quality Improvement Information Protection Act instead of some form of public inquiry.
Orrell also referenced something said earlier in a public forum by Dr. Shelley McNeil, a professor at Dalhousie Medical School and one of only five infectious disease specialists in this province. “We need more people trained and qualified in infection control and situated in nursing homes and residential care facilities to help us when we get an outbreak. The changes that are necessary for long-term care will take place over a very long period of time. It’s very complicated the way continuing care has evolved…Regrettably, it’s expensive but I think if planned well and initiated over many years, I think we can do the right things.”
Cold comfort for advocates who have been trying for decades to improve living conditions for people dependent on others at the end of their lives.
Houston’s turn at bat
“If there had been fewer shared rooms, would that have made a difference at Northwood (where 53 residents died)?,” asked Tim Houston, the Progressive Conservative leader. Houston and Leblanc both reminded the government officials Northwood had for three previous years requested money to expand its facility so it could spread out residents and reduce the risk of infection by reducing the number of people living in small rooms built 50 years ago.
“I don’t think you can pin it on any one specific factor,” hedged Strang. “It was the combination of a number of things. COVID has highlighted long-term care as an issue.”
Orrell said the panel reviewing the circumstances last spring at Northwood has specifically been asked to address that question posed by the PC leader. On a personal note, Orrell said his mother had enjoyed having a roommate while in long-term care and a blanket conversion to single rooms may actually increase loneliness and isolation among some seniors.
On another front, Houston also wanted to know when the Department of Health plans to resume sending out at-home screening kits to residents who can check themselves for symptoms of colorectal cancer. Houston suggested based on numbers from the past few years, as many as 30 cases of colon cancer may have gone undetected since March when the program stopped.
“A wait of a few months may not be that significant,” replied Orrell, who became deputy after working for decades as an orthopedic surgeon in Cape Breton. “It’s a diagnosis that needs to be made so that treatment can get started but the disease has already existed a great deal longer than three months.”
Orrell did not provide a timeframe for when the screening program for colorectal cancer might resume.
Mammograms to check for breast cancer are being offered again across the province.
Coincidentally, the province chose the same day as the Health Committee met to announce some easing of restrictions at nursing homes that had prevented family members from assisting residents with feeding and providing some care and comfort. Up to two family members may now interact with a resident and more than one visit a week can be scheduled, provided the individual nursing home has enough staff in the building to help make that happen.
Michele Lowe, the managing director for the Nursing Homes of Nova Scotia Association, says staffing remains an ongoing concern for many of the homes.
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