David Musyj, chief executive officer of Windsor Regional Hospital, is monitoring a COVID-19 outbreak at a nursing home in his region hour by hour.
Eighteen residents of Iler Lodge have tested positive for the virus since an outbreak was declared on Oct. 30. If the virus continues to spread, Mr. Musyj said, he is ready to reopen a 100-bed field hospital Windsor Regional has set up in an athletic facility.
Iler Lodge in the town of Essex is one of 21 long-term care homes Windsor Regional is helping through the second wave of the pandemic. During the first wave, Windsor Regional transferred 50 residents of Heron Terrace to the makeshift hospital.
“We worked with them nonstop for weeks to get them out of outbreak,” Mr. Musyj said.
A growing chorus of voices is calling for transferring residents who test positive for COVID-19 to alternative settings, including hospitals. The group representing not-for-profit homes and the commission examining long-term care in Ontario argue older facilities with multibed wards lack the capacity to properly isolate those made ill with the virus from the healthy.
Mr. Musyj alone will not decide whether to transfer residents of Iler Lodge. The home’s owner, for-profit chain operator Revera Inc., will be part of what Rhonda Collins, its chief medical officer, says is a “really challenging” question.
“One of the things we know about people with dementia is that changes in environment are not good for them,” Dr. Collins said. “They need constancy.”
Other health care experts argue against transferring the frail elderly out of their nursing home to hospitals. Kevin Smith, chief executive officer of University Health Network, which encompasses three hospitals in Toronto, said quality of life often declines for these individuals in a hospital.
“The worst place for an acutely ill frail patient who doesn’t need to be in a hospital is a hospital,” Dr. Smith said.
The debate over where residents who test positive should go is taking on new urgency as more people in nursing homes succumb to the virus. In Ontario, 182 people in long-term care died in the first three weeks of November, a more than four-fold increase compared with the first three weeks of October. In Winnipeg, a city with a dangerously high level of community spread, just over five dozen residents have died at the two hardest-hit homes. The virus is also finding its way into several homes in Western Canada.
Homes in some provinces are better equipped than others to keep the virus in check. In British Columbia, 88 per cent of the rooms are single occupancy. Fewer than 1 per cent of the beds in Alberta and Newfoundland and Labrador are in wards.
In Ontario, by contrast, almost 40 per cent of the homes have multibed wards. A previous Globe and Mail analysis found 36 homes where residents sleep in the same room and share a bathroom with two or three other people accounted for 55 per cent of the province’s long-term care deaths during the spring.
Lisa Levin, chief executive officer of AdvantAge Ontario, which represents municipal and not-for-profit homes, has urged the provincial government to require residents in older homes who test positive for COVD-19 to be immediately transferred to alternative settings.
“We fear many older homes will simply not have the capacity to properly isolate and care for COVID-positive residents and that the outbreaks and deaths in LTC [long-term care] homes could be even worse during Wave 2,” Ms. Levin says in a letter to Long-Term Care Minister Merrilee Fullerton, a copy of which was obtained by The Globe.
The province’s independent commission on long-term care has also recommended that COVID-positive residents in older homes be given the option to transfer to alternate settings to avoid further transmission of the virus and to help them recover.
“Given that many [long-term care] homes cannot effectively cohort and isolate because of physical infrastructure limitations,” the commission says in its five-page letter released last month, they should “quickly decant” residents to other facilities.
A Hamilton, Ont., company that makes shipping containers has also weighed into the debate. FERO International Inc. says it can convert its containers into mobile medical units for nursing home residents.
Each room would have its own heating and ventilation system and cost between $100,000 to $200,000 to set up, said FERO chief executive officer Sabrina Fiorellino. “We are hoping the provincial and federal governments pull the trigger on funding,” she said.
Nursing homes, meanwhile, continue to struggle. York Region’s Medical Officer of Health, Karim Kurji, issued an order on Friday against Langstaff Square Care Community in Richmond Hill for inadequate staffing levels and infection control measures during an outbreak of the virus.
Seven residents and seven staff have tested positive at Langstaff, which is in its second outbreak. The home’s owner, for-profit chain operator Sienna Senior Living Inc., is subject to a daily fine of up to $5,000 for every day the offence occurs. A Sienna spokeswoman said the company is working with public health to address the issues.
Ontario Health, the agency that oversees the delivery of health care in the province, has launched a pilot project that provides temporary staffing help to homes with outbreaks, said spokeswoman Jennifer Schiffer.
This month, the agency deployed a mobile team of nearly a dozen registered practical nurses and personal support workers to Lakeside Long Term Care Centre, a 128-bed nursing home in Toronto owned by University Health Network. Six residents have died of COVID-19 since an outbreak was declared on Oct. 3.
Katerina Cizek’s father, Jiri Cizek, lives at Lakeside. She said the extra staff has been a big help but she thinks residents who test positive for COVID-19 should be transferred elsewhere.
“When this is all said and done, we are going to look back and say why did we trap hundreds of residents with known positives,” Ms. Cizek said in an interview. “What were we protecting?”
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