B.C. opens way to social closeness at LTC homes while other provinces review isolation policies

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B.C. is relaxing its rules for nursing and retirement homes to allow more than 30,000 people living in these facilities to hug their family and friends inside their units or go on outings to socialize in public – an abundance of privileges for a population that has been extremely isolated throughout the pandemic.

Other provinces will likely follow suit and further open their COVID-19 protocols for more of these activities in the long-term care sector once almost all residents and staff are vaccinated, one of the country’s leading experts on aging says.

Bonnie Henry, B.C.’s Provincial Health Officer, announced the new rules Thursday. Beginning April 1, they will replace the current policy of a single designated visitor with a new system allowing up to two adults and one child at a time to book visits with elders while masked. Residents will be able to take trips outside their nursing homes without having to isolate inside their rooms after returning.

Inside these facilities, residents will also resume eating meals together in their communal dining rooms and won’t have to stay two metres apart from one another, Dr. Henry said. She added that the loosening of these rules will likely lead to more outbreaks, but said the province is prepared.

“We’re at a point where the benefits of having those social connections and interactions outweigh the risks, and we know that we can manage those risks with the vast majority of residents and staff now being protected with immunization,” she said.

In many provinces the majority of seniors in long-term care have had at least one dose of a COVID-19 vaccine, but are still living lives of isolation with heavy restrictions on who can visit. With no clear guidance forthcoming from Ottawa or its panel of pandemic experts, public-health authorities and provincial politicians across the country are still debating whether to revise their guidelines to open up nursing homes as variants of concern continue spreading in the community.

Meanwhile, the owners and operators of hundreds of Canadian care homes are reluctant to drop restrictions too early and risk outbreaks at their properties.

B.C. has only three active outbreaks in these facilities, which have housed more than half of all the people killed by the virus in the province. A continuing outbreak in Kelowna infected eight people, despite them having at least one dose of the vaccine, but none of those infected has died or been hospitalized so far.

B.C.’s new rules are the most liberal in the country, according to Samir Sinha, director of health policy research at Ryerson University’s National Institute on Ageing. They go much further than other provinces by allowing residents unsupervised visits in the community – where they might mingle with those who have the virus – and then allowing them to return without isolating in their rooms for a set period, Dr. Sinha said. These outings have virtually been banned across the country, he said.

B.C. has taken this calculated risk, he said, in part because more than 90 per cent of people working in these facilities in the province have also had at least one dose of vaccine. That is more than the 75 per cent of this work force in Ontario with one dose and much higher than the roughly 40 per cent of staff in Quebec, he said, citing the latest data available to him.

“Some people may find [the new rules] a bit cavalier,” said Dr. Sinha, who is the director of geriatrics at the University Health Network and Sinai Health System in Toronto. “But with the devastating effects of 13 months of lockdown, this is the most appropriate thing to do and it will create a sea change.”

At a pandemic briefing a half hour before B.C.’s announcement, Barbara Yaffe, Ontario’s Associate Chief Medical Officer of Health, said her province is looking to modify the definition of an outbreak in long-term care and retirement homes to align it with other settings, while at the same time maintaining “vigilance.” She said vaccination rates among residents are close to 100 per cent and also high for essential caregivers, but “unfortunately not as high for staff, which is an issue,” pegging the number at 60 to 70 per cent on average.

“I think we do need to look at what measures are necessary, how do we balance it with the quality of life. As somebody said the other day, how do we put the ‘home’ back in long-term care home,” she said. “I’ve certainly heard many complaints, many concerns expressed: ‘We’ve been vaccinated, what can we do now that’s different?’ And I think they’re right and we are working on how we modify it.”

Still, Krystle Caputo, spokesperson for Ontario Minister of Long-Term Care Merrilee Fullerton, said the province will study B.C.’s new rules but will be taking a cautious approach to loosening any restrictions.

Quebec’s Health Department stated last week that the further easing of restrictions would depend on criteria including epidemiology, vaccination rates and variant spread.

Isobel Mackenzie, B.C.’s independent Seniors Advocate, said these changes are long overdue, especially given the troubling effects isolation has had on residents. Of note, she said, is an 8-per-cent increase in the use of anti-psychotic drugs – or tranquillizers – among residents, roughly a third of whom are using these drugs.

“When we look back over this we will have to do some collective soul searching,” she said.

Emidio Galea had no problem spending two weeks isolated in his room with his wife during two previous COVID-19 outbreaks at their North Toronto care home. But, the 80-year-old Maltese immigrant is brimming with anger halfway through a third such lockdown because there is a crucial difference this time: Both he and Maria Carmen received their second dose of the Moderna vaccine more than a month ago.

The couple and residents of 10 other units have been confined to their rooms for the past week after a staff member was confirmed to have had the novel coronavirus. They have both tested negative during this span – Ms. Galea twice and Mr. Galea once (he refused a second test) – and neither has any symptoms of the virus.

“When I complain, you know what they tell me?” he said. “They tell me, ‘Mr. Galea, you are right, but we are operating under the protocols.’ ”

With a report from Laura Stone in Toronto and The Canadian Press

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