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A nurse wearing personal protective equipment works in the Tendercare Living Centre, a Scarborough long-term care home on Dec. 23, 2020.

Carlos Osorio/The Globe and Mail

Doctors have issued an urgent plea for help at a Scarborough nursing home with not enough workers to care for residents who are ill and dying of COVID-19. The call comes just as hospitals reach the limits of their capacity to support these facilities.

The situation at Tendercare Living Centre is a physician’s “worst nightmare,” said Silvy Mathew, a family doctor who worked a shift on Sunday at the private, for-profit home in suburban east Toronto, where 145 residents have tested positive for COVID-19, including 26 who have died.

Most of the 16 infected residents Dr. Mathew cared for on Sunday were weak from illness and a lack of food and water. Not enough staff were available to sit with sick patients to help them eat and drink, she said. Six had to have fluids delivered under the skin to keep them hydrated.

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“They were severely dehydrated. It’s not to say that the rest of them didn’t need [fluids.] It’s triaging,” Dr. Mathew said. “I haven’t personally had to do any sort of triage like that, ever.”

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The provincial government responded on Wednesday by bringing in North York General Hospital to temporarily manage the home. Scarborough Health Network and its three hospitals would have been the logical choice to take over management of a home in its neighbourhood. It has been helping Tendercare with the outbreak – but the hospitals are stretched thin caring for COVID-19 patients in one of the hardest-hit regions of the province.

“This pandemic is accelerating,” said Anthony Dale, president of the Ontario Hospital Association (OHA). “The situation is precarious. This is an example of what overwhelming conditions look like.”

The Tendercare Living Centre in Scarborough, Ont., on Dec. 23, 2020.

Carlos Osorio/The Globe and Mail

Tendercare is far from the only nursing home in Ontario with a major outbreak. But the fact that the provincial government has to go farther afield to find hospitals able to help underscores how severe the shortage of health care staff has become in coronavirus hot zones. Last week, the province called in Markham Stouffville Hospital, north of Toronto, to temporarily manage Faith Manor Nursing Home in virus-battered Brampton, west of Toronto. Twenty people have died of COVID-19 at Faith Manor.

Ontario hospitals are currently managing a total of 16 long-term care homes in outbreak. The virus has killed 2,555 nursing home residents in the province to date.

The province also announced on Wednesday that the federal government will fund teams from the Canadian Red Cross to help with infection control and resident care in 20 long-term care and retirement homes in the province, which have not been identified. The Red Cross has already been deployed to seven long-term care homes in Ontario.

As the number of COVID-19 cases continues to surge, said Nathan Stall, a geriatrician at Mount Sinai hospital in downtown Toronto, a breaking point is coming when hospitals won’t have enough staff to support long-term care homes or take acute-care patients from other sites.

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Dr. Stall himself frequently gets patients from Scarborough and as far away as Brampton. “This is just reflective of the fact that the system is in crisis,” he said. “We keep borrowing resources from areas that aren’t as hard-hit.”

Laura Tamblyn Watts, chief executive officer of CanAge, a national seniors’ advocacy organization, said a broader system is needed for helping homes beyond the local hospital to prevent massive outbreaks, including a rapid-response team that can go in immediately.

“This sector has been abandoned by the government of Ontario,” Ms. Tamblyn Watts said.

COVID-19-related long-term care deaths in Ontario during the second wave

From Sept. 14 to Dec. 22, shown by

public-health unit

LTC deaths as percentage of all COVID-19 deaths

20

40

60

80%

No COVID-19 deaths have

been recorded

No COVID-19 deaths in LTC homes

LTC homes with 10 or more COVID-19

deaths during the second wave

 

 

In Thunder Bay District Health Unit, all of the 14 deaths were in a LTC home

With a total of 243 deaths in the hardest-hit homes, Toronto has the highest number of fatalities in LTC during the second wave. This makes up 46 per cent of all COVID-19 deaths in the health unit in that time frame

murat yükselir and karen howlett, the globe and mail, source: The Ontario Ministry of Long-Term Care; public health ontario

COVID-19-related long-term care deaths in Ontario during the second wave

From Sept. 14 to Dec. 22, shown by public-health unit

 

LTC deaths as percentage of all COVID-19 deaths

20

40

60

80%

No COVID-19 deaths have been recorded

No COVID-19 deaths in LTC homes

LTC homes with 10 or more COVID-19 deaths

during the second wave

 

 

In Thunder Bay District Health Unit, all of the 14 deaths were in a LTC home

With a total of 243 deaths in the hardest-hit homes, Toronto has the highest number of fatalities in LTC during the second wave. This makes up 46 per cent of all COVID-19 deaths in the health unit in that time frame

murat yükselir and karen howlett, the globe and mail, source: The Ontario Ministry of Long-Term Care; public health ontario

COVID-19-related long-term care deaths in Ontario during the second wave

From Sept. 14 to Dec. 22, shown by public-health unit

 

In Thunder Bay District Health Unit, all of the 14 deaths were in a LTC home

LTC deaths as percentage of all COVID-19 deaths

20

40

60

80%

No COVID-19 deaths have been recorded

No COVID-19 deaths in LTC homes

LTC homes with 10 or more COVID-19 deaths during the second wave

 

 

With a total of 243 deaths in the hardest-hit homes, Toronto has the highest number of fatalities in LTC during the second wave. This makes up 46 per cent of all COVID-19 deaths in the health unit in that time frame

murat yükselir and karen howlett, the globe and mail, source: The Ontario Ministry of Long-Term Care; public health ontario

The OHA’s Mr. Dale said the “true sense of horror” of what’s happening at Tendercare is reminiscent of the devastation in the hardest-hit nursing homes during the spring. “The residents at Tendercare are incredibly vulnerable,” he said, “not only because of the pandemic itself, but because of the system’s inability to protect them.”

The Ontario Medical Association issued an “urgent request” on Monday evening for physicians to pick up shifts at Tendercare.

Reed Zhao has not been able to talk to his 96-year-old grandmother since Saturday, when Tendercare moved her to a COVID-19 ward on the home’s third floor. He said she tested positive for the virus last Friday.

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His grandmother, Ping Qiu, moved to Canada 10 years ago from her home in China to be with her children. “She’s a tough lady,” Mr. Zhao said. “She’s been through the Communist regime and nothing took her down.”

Mr. Zhao said the room where his grandmother is in isolation with other residents who have tested positive has no land line or internet access. He has left several phone messages at the home seeking more information about the outbreak, but no one has called him back.

A body is removed from Tendercare Living Centre, on Dec. 23, 2020.

Carlos Osorio/The Globe and Mail

Jessica Wong’s 82-year-old grandmother, Jean Wan Cheung, has lived at Tendercare for 13 years. Ms. Wong said she learned about the outbreak at the home after another resident contacted her last week.

Ms. Wong said she went to the home on Saturday to check on her grandmother – who she learned had tested negative – but wasn’t allowed past the front door. Now, she and her parents are planning to remove her grandmother from the home until the outbreak is under control.

“From what I see, they do not have it under control, and it’s very clear, they don’t have the answers. They don’t have the staff. I know they are trying to do everything they can, but unfortunately, that’s not good enough,” she said.

Family members raised concerns during a virtual town hall on Tuesday night about a shortage of staff in the home. Donna Lee, manager of risk and quality for Extendicare Inc., the home’s manager, said she has reached out to agencies to hire additional staff.

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Ms. Lee said 145 of the home’s 188 residents had tested positive for the virus since Dec. 9, and 26 had died.

Dr. Mathew said she worked alongside an “excellent” registered practical nurse and two personal support workers during her shift at Tendercare last Sunday, but all three were new to the home and none spoke Chinese, the mother tongue of most Tendercare residents. With so many sick patients to treat, the new staff didn’t have time to get to know residents or sit with them for long periods, coaxing them to eat or drink.

“I think maybe a couple of [residents] were in pain, but they could have been agitated, and that’s why knowing them really helps,” Dr. Mathew said, “but most of them were just so dehydrated and they were so weak.” One patient died during her shift, and another had to be transferred to hospital for additional care, Dr. Mathew added.

Long Term Care workers received some of the first set of COVID-19 vaccines developed by Pfizer-BioNTech as the Unity Health Toronto vaccine program opened on December 22nd.

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