Hospitals in Ontario have discharged more than a thousand elderly patients in recent days to free up beds and staff, just as the third wave of the pandemic threatens to overwhelm their resources.
Many of the patients, who still require medical aid, have been dispatched to nursing homes. While the initiative allows doctors and nurses to treat surging numbers of critically ill COVID-19 patients, it comes at the expense of the long-term care sector, medical experts warn.
Homes have plenty of empty beds but not enough staff to handle a sudden influx of new residents. Many homes that have struggled with staffing shortages for years were hit with an exodus of workers during the pandemic.
“COVID-19 is a crisis within a crisis,” said Amit Arya, a palliative care physician who works in long-term care homes in the Greater Toronto Area. “Although we have vaccinated the vast majority of residents and the deaths and the suffering from COVID-19 have pretty much ended, we have not fixed the system.”
The Ontario government recently called on the province’s nursing home operators to open their doors to a minimum of 1,500 patients who no longer need the acute care services of a traditional hospital but are unable to live independently.
“Our health care system is facing unprecedented challenges that could put our fellow community members at risk unless immediate, collective action is taken,” Ontario Health chief executive officer Matthew Anderson and deputy long-term care minister Richard Steele say in a memo dated April 11.
More Ontarians are being treated for COVID-19 in intensive-care units than at any time during the pandemic. On Thursday alone, 67 new patients were admitted to ICU, bringing the tally to 800, according to Critical Care Services Ontario.
In response to the government’s “call to action,” hospitals discharged 1,100 of the 5,900 patients no longer in need of acute care between April 11 and April 18, according to the Ontario Hospital Association. Until now, the number of these patients, known as alternate-level-of-care, or ALC, had remained “stubbornly high” throughout the pandemic, said Anthony Dale, president of the association. “We really do need all the help we can get,” he said.
Just less than 300 of the patients have ended up in long-term care homes, the OHA says.
Hospitals also moved patients en masse to long-term care homes last spring as they braced for a deluge of COVID-19 cases. Instead of overwhelming hospitals, the virus tore through long-term care homes because of poor infection-control practices, staffing shortages and lack of protective equipment for workers.
Outbreaks of COVID-19 are largely under control in the sector now that 94 per cent of residents are fully vaccinated. But many homes are struggling with a shortage of nursing staff and personal support workers, making it difficult, if not impossible, for them to meet the physical and mental needs of additional vulnerable seniors.
A survey done last summer by SEIU Healthcare, a union that represents personal support workers in long-term care, showed that 35 per cent of its members left the sector after the first wave. Many who remain are working double shifts and are “burnt out,” SEIU president Sharleen Stewart said.
Nathan Stall, a geriatrician at Sinai Health System in Toronto, criticized Premier Doug Ford’s government for asking nursing homes to help hospitals on short notice.
“They are not going to be able to hire staff in two weeks to take on extra residents,” he said. “Doug Ford’s lack of planning should not be the long-term care sector’s emergency.”
Roughly 11,000 of the 78,000 long-term care beds in Ontario are sitting empty, according to the Ministry of Health and Long-Term Care – a grim reminder that 3,755 residents succumbed to the virus.
Multibed wards already occupied by two people are off limits to new admissions. Vaccination is not a condition of admission, which worries Lisa Levin, CEO of AdvantAge Ontario, a group that represents municipal and not-for-profit long-term care homes. “The last thing we need is for people to come into the homes and start having seniors get sick and die,” she said.
One nursing home devastated by the virus will temporarily house 55 ALC patients, as part of a partnership between the Ottawa Hospital and for-profit chain operator Extendicare. Cameron Love, CEO of the hospital, said Extendicare is setting up a new transitional unit in its West End Villa home for the patients, who will continue to receive clinical care from hospital staff.
The hospital, which currently has 170 ALC patients, plans to start moving some of them to the Extendicare home on May 3. “This will make a massive difference for us,” Mr. Love said in an interview. The hospital needs to free up beds for transfers of COVID-19 patients from hospitals in the GTA. So far, 22 patients from Toronto’s Scarborough area have been transferred to the three hospitals in Ottawa, he said.
The Ottawa Hospital helped West End Villa deal with an outbreak of COVID-19 in the fall. The outbreak killed 18 residents.
“We stand ready to assist our hospital partners across the province in their time of need, just as they supported us in earlier waves of this pandemic,” Matthew Morgan, Extendicare’s chief medical officer, said in a statement.
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