"Those lives lost unnecessarily had value. Those older adults deserved a good closing phase of their lives and a good death. We failed them." "[Causes of the failure are complex, but rooted in] systemic and deeply institutionalized implicit attitudes about age and gender." "[Those unregulated workers] receive the lowest wages in the health-care sector, are given variable and minimal formal training in [long-term care], and are rarely part of decision-making about care for residents." "We have a duty to care and to fix this -- not just to fix the current communicable disease crisis, but to fix the sector that enable that crisis to wreak such avoidable and tragic havoc." "[Provinces must] immediately implement appropriate pay and benefits, including sick leave, for the large and critical unregulated workforce of direct-care aides and personal support workers [and offer them ongoing training and mental health support]." Royal Society of Canada report
The report chaired by University of Alberta 's Dr.Carole Estabrooks representing the working group created by the Royal Society COVID-19 task force, comprised of scientists and researchers, concluded that the causes of the failure to protect Canada's most vulnerable, the elderly and health-compromised housed in long-term care institutions, is a damning one, both for the disinterest of the federal government to institute badly needed national guidelines and for the provincial oversight bodies that failed their due diligence in ensuring that best practices reigned at these homes for the elderly.
The pandemic, they emphasize, represented a "shock wave" that had the effect of exposing long-standing deficits in the system, causing high levels of "physical, mental and emotional suffering" for seniors who were highly dependent and whose plight failed to provoke the interest of authorities until it was too late. An astonishing 81 percent of COVID-19-responsible deaths in Canada occurred in long-term care homes. A rate far in excess of those occurring elsewhere in comparable countries.
In the United States, with its much-higher overall case load and death rate, a much-reduced 31 percent figure relating to deaths in long-term care homes places Canada's figure in stark perspective. Australia suffered a 28 percent death rate in their homes, while Spain, one of the countries of Europe hardest hit by the SARS-CoV-2 virus had a 66 percent rate. Canadian homes, pointed out the report's authors, permitted staff-to-patient ratios to drop, shifting work and responsibility increasingly to an unregulated workplace.
Patients, the report points out, are living longer with diseases requiring increasingly complex care, particularly those patients suffering from dementia. Many of these overworked staff members suffering from high rates of burnout, cope as best they can in the absence of an appropriate representation of registered nurses, where many residents lack access to comprehensive care; medical, health and social services along with therapies to match the needs of patients.
The complaints and wishes of long-term care residents are ignored by authorities, as well as the needs of those who are tasked with their care. In most instances, both groups are represented overwhelmingly by women. Along with the fact that when family members are called upon increasingly to fill gaps in the system, it is women who respond. Conditions in many of the long-term care homes were such that already-ill patients living in crowded conditions, sharing bedrooms and bathrooms, left them more susceptible to the novel coronavirus.
Canadian long-term care homes tend to be of an older vintage, badly in need of upgrading, with an emphasis on separating residents from close proximity both to protect their health and their dignity. the fact that basic infection controls and personal protective equipment were in short supply and many home workers found employment in multiple facilities to make up a living wage, increased opportunities of virus contagion.
Recommendations for improvement include that the federal government collect data on resident quality of life, the standard of care and worker satisfaction, ensuring such data be analyzed to effect change where needed. Disparities caused by ethnicity, gender, poverty and associated vulnerabilities should all be taken into account. Full-time employment should be offered to unregulated staff and policies preventing employees from multiple home employment must be put in place.
Sick leave, along with appropriate pay rates and benefits must be overseen by provinces on behalf of the unregulated workers and direct-care aides along with personal support workers, offering them opportunities for ongoing training and mental health support. It's long past time for both the federal and provincial governments to commit themselves to ensuring that long-term care residents and those who care for them live and work in conditions favouring overall experiences of quality care and security.
A resident and a worker watch as 150 nursing union members show support
at rchard Villa Long-Term Care in Pickering, Ontario on Monday June 1,
2020. (THE CANADIAN PRESS/Frank Gunn)
COVID-19 Cutting Its Deadly Path in Canada Through Long-Term Care Facilities Housing the Elderly and Health-Impaired
"All
the provinces and territories are trying to do the best they can to
strengthen the response in that area [long-term care facilities
country-wide]." "Because that is driving the severe outcomes in Canada. That is absolutely a key feature of this epidemic." Dr.Theresa Tam, Chief Public Health Officer, Canada
"Providing
consistent guidance for long-term care homes across the country will
save lives. But it will take much more than these guidelines to keep our
seniors and vulnerable Canadians safe." "It would be impossible to keep them safe without individual Canadians practising social distancing." Seniors Minister Deb Schulte, Ottawa
"We have to look after the most vulnerable. We have a duty to look after those who cannot look after themselves." "I know it's difficult, but this virus is ruthless and it's deadly." Ontario Premier Doug Ford
Funeral
home workers remove a body from the Centre d'hébergement
Sainte-Dorothée, on April 13, 2020, in Laval, Que. There have been 26
deaths related to the novel coronavirus at the Sainte-Dorothée centre. Ryan Remiorz/The Canadian Press
The grim situation of rising case statistics in Canada and consequent
deaths among those hardest hit by COVID-19, has been enormously
exacerbated by the revelation of the carnage done to elderly,
incapacitated individuals being cared for in long-term care facilities,
most of which are not equipped to deal with a raging epidemic, are
understaffed and under-managed. The recently revealed outbreaks in a
number of long-term care homes have underlined their role in pushing up
overall numbers of deaths in Canada.
A projection by the government of Canada released on April 9th
conjectured between 400 to 700 deaths by April 16, caused by COVID-19,
but by April 12 it was clear that the death total stood at 717, handily
passing the presented worst-case scenario. It took another day for the
total death number to rise to 734, and it is the impact of the outbreaks
in those long-term care facilities countrywide that has expanded those
death numbers.
In a facility in Bobcaygeon, Ontario alone 29 elderly residents died of
the effects of COVID-19. There were 21 reported deaths earlier in the
month in such facilities in Vancouver. And while the impact of the dread
novel coronavirus on such elder-care, health-impaired facilities may
vary from province to province, the end result is that this most
vulnerable demographic has become a target of the deadly pathogen.
Not only are these frail elderly people dying, the end effect is that
the virus has spread from the facilities to the greater public.
So that even while officially the country's confirmed COVID-19 cases are
tracking in a positive direction, it is the fatality rate among the
elderly frail that is increasing with continuing outbreaks in the
facilities housing them and caring for them. In Dorval, Quebec last
month 31 residents of a private seniors' residence died. Many in the
residence were neglected, people found dead in their beds, others unfed
and unwashed, some lying on floors where they fell.
Residence
Herron, Dorval, Quebec, April 13, 2020.REUTERS/Christinne Muschi
Untrained staff had been unable to cope, were frightened for their
personal well-being, and had simply abandoned their charges, leaving
only four attendants to try to cope with 60 patients in yet another
long-term for-profit care home in Quebec. In the Dorval facility there
were 150 residents 'abandoned' by the staff, leaving the elderly lying
in soiled beds, requiring immediate assistance to be fed, leading to the
tragic outcome.
Infection prevention and control were entirely missing in the
facilities. Some were crowded with multiple residents in one room,
sharing common spaces, making it impossible to impose social distancing.
Attendants in many of the residences did not wear masks for the
duration of their shifts. Added to the dangers inherent in crowded
facilities with overworked attendants improperly trained to rise to the
occasion of an epidemic, that many health-care providers and other staff
work at multiple facilities.
Vital recommendations have been reached that include visitor restriction
to admit only those essential for medical or compassionate care. All
staff to be screened along with visitors to ensure that anyone entering
the premises, including staff with questionable symptoms be forbidden
from entrance, sent home to self-isolate to recovery. Training on
infection-control measures, routine cleaning of trafficked areas and
limiting employees to work in a single facility are critical guidelines
to be implemented.
Former federal cabinet minister Jane Philpott, a medical doctor herself
and formerly Canadian Minister of Health, has volunteered to work at a
facility in Markham, Ontario housing residents with developmental and
physical disabilities. The facility, Participation House, is caught in a
staff crisis, struggling to cope with the pandemic, reflecting what is
happening all over the country.
Anson Place in
Hagersville, Ontario, where 55 residents and 30 staff members have
tested positive for COVID-19, seen here on April 2, 2020. (Dan Lauckner / CTV Kitchener)
"One of the things that jumped off the page for us is the high resident-to-staff ratios at these homes." "One of our hopes is that there will be a recommendation along those lines." "Another area where we think investments need to be made is with respect to improving and modernizing medication management for both the handling of insulin but also opioids." Alex Van Kralingen, lawyer "The best-case scenario is that the government, whoever is making the decision, actually listens and actually does something about the long-term care situation." "The report is just a bunch of pieces of paper with a bunch of words on it." "What matters is the people making the decisions and what they do with it." Andrea Silcox, Woodstock, Ontario
Elizabeth Wettlaufer pleaded guilty to eight counts of first-degree
murder for killing nursing home patients. Police now believe she
committed additional attacks. (Dave Chidley/The Canadian Press)
Andrea Silcox's father James Silcox was the first to die. Murdered at a a long-term care facility for the elderly and the frail, in August 2007 at Caressant Care, in Woodstock, Ontario, a facility overseen by the provincial government. His long-term care nurse, Elizabeth Wettlaufer now known as the worst serial killer that Canadian health care has ever reeled under, was never suspected of having killed a vulnerable, helpless old man. That gave her the green light to just go on killing, until seven more elderly people in her care were dead before their time.
Through it all, she was never a suspect. She herself revealed the crimes, when she sought treatment at the Centre for Addiction and Mental Health in Toronto in 2015. She informed health workers at the Centre that she had taken the lives of eight elderly people -- through the process of interviews presumably to lead to a therapeutic protocol she sought for herself. The interviewer immediately contacted police. And the news became a frenzied public revelation of institutional incompetence.
Her confession to the eight murders augmented by a descriptive admission of yet another attempt to kill another four in her care and assaulting two others, made up the grim story of her murderous spree and the disinterest of authorities at any level to investigate how and why it was that vulnerable, elderly people suddenly expired inexplicably. She injected them with a deadly amount of insulin, and then awaited the results.
There were warning signs. She had been fired from a northern Ontario hospital only months after her hiring because of suspicions of drug abuse and of theft. She had been fired much later by the Woodstock, Ontario long-term care home where seven people were murdered by her. And then went on to another placement at yet another long-term facility in London, Ontario, where her final victim met his untimely end.
In her seven years of employment at Carressant Care and then Meadow Park in London, the deadly toll she took was quite simply unnoticed. Without her self-incriminating admission after the death of eight people she could quite simply have continue her killing agenda with no one, apparently, any the wiser. A two-year investigation followed by public hearings ensued. Elizabeth Wettlaufer pleaded guilty to eight first-degree murders, four of attempted murder and two of aggravated assault.
The Province of Ontario oversees more than 600 homes holding about 78,000 residents, the largest and most complex long-term care system in the country. Their oversight so lax that one nurse succeeded in carrying out a years'-long deadly crime spree with the use of lethal insulin injections. She was sentenced to prison, with no chance of parole for 25 years.
This represents a general opinion site for its author. It also offers a space for the author to record her experiences and perceptions,both personal and public. This is rendered obvious by the content contained in the blog, but the space is here inviting me to write. And so I do.
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