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In Quebec – a resident seen here on April 15, 2020 outside the Residence Floralies Lasalle in Montreal – the shortage of staff in facilities for seniors remains a contentious issue.

Ryan Remiorz/The Canadian Press

Ontario will temporarily ban employees from working in more than one long-term care facility, but concerns are being raised about loopholes that could cause COVID-19 to continue to spread among seniors.

Details of the province’s new emergency order to limit workers to one seniors’ home were released Wednesday as part of Premier Doug Ford’s “action plan" intended to limit the transmission of the novel coronavirus in long-term care facilities.

Mr. Ford said the province is also putting together COVID-19 “SWAT teams” with staff from hospitals, home-care and public-health units to help homes handle outbreaks.

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“This is an enhancement of what we have already done, and we’ve done quite a bit," the Premier said.

As of Wednesday, almost 19 per cent of long-term care homes in Ontario have declared an outbreak, which happens when there is at least one case, according to government officials. In all, 144 residents have died and another 834 have tested positive for the disease.

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In Quebec, the shortage of staff in facilities for seniors remains a contentious issue, with Premier François Legault admonishing physicians for what he alleged is the reluctance from some to pitch in and help make up for the estimated 2,000 staffers out of 43,500 now missing from long-term care centres because many nurses and orderlies are sick, quarantined or concerned for their health.

The Premier said that, with surgeries being postponed and family doctors doing consultations online, there must be physicians who are available to feed and care for elderly people.

“We’re not asking them to clean floors but to help nurses so those nurses can help the orderlies,” Mr. Legault said.

Ontario’s new emergency order gives employees until April 22 to comply, allowing staff to take a leave of absence from some positions if they are working multiple jobs. The order expires on April 28, but can be renewed for another 14 days.

However, it will not apply to temp agency workers or other “critical contract" staff, “in order to ensure a steady supply of staff available to work on an emergency basis in long-term care homes,” said Adam Cotter, a spokesman for Minister of Long-Term Care, Merrilee Fullerton.

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Dr. Fullerton said the province is in talks with the federal government to address wage increases for staff.

The move was praised by the Ontario Long Term Care Association, which represents 70 per cent of the province’s 626 long-term care providers.

But NDP Leader Andrea Horwath said the government should have put in tighter restrictions weeks ago.

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“We cannot waste a second now, and we cannot allow this government to leave huge loopholes open. The government has to fix the problem years of underfunding and neglect in long-term care has created: Pay workers decently, give them full-time hours and ban them from working at a second facility, no exceptions,” she said.

Vicki McKenna, president of the Ontario Nurses’ Association, has been urging the government to put a stop to health-care staff working in more than one long-term care home.

“I’m glad it’s finally happened,” she said in an interview.

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The pandemic has highlighted a chronic, underfunding problem in Ontario’s health-care system, Ms. McKenna said. “People are working three part-time jobs because they can’t get full-time work."

Sharleen Stewart, president of Services Employees International Union Healthcare, said about half of the union’s 25,000 members are working multiple jobs, including as personal support workers and housekeepers in seniors’ facilities.

She said she wants a guarantee from the province that workers will be compensated for full-time hours.

“If you put the money through the employers, it is not going to end up with the front line, I guarantee you," she said.

Ontario’s Chief Medical Officer of Health, Dr. David Williams, recommended in March that wherever possible, staff should be limited to working in one home. On Wednesday, he said that making such a measure mandatory is complex – even though the province has been aware of the issue since the SARS outbreak in 2003.

“From the beginning, we had concerns about employees who work at multiple sites. ... We knew this was a continuing problem,” he said, adding that there is no “evidence” lives could have been saved had the order been issued earlier.

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The lesson learned from the SARS crisis in 2003, when 44 people died in an outbreak of the disease across Canada, is that having health care workers moving around to various institutions is not good practice, said David Walker, a professor of emergency and family medicine at Queen’s University and chair of Ontario’s expert panel on SARS. Among the panel’s many recommendations, it said 70 per cent of health care workers should be employed on a full-time basis at one institution.

“The reasoning behind it is pretty obvious,” Dr. Walker said in an interview. “When you have a highly infectious agent – and COVID-19 is more infectious than SARS – and you have health care workers moving from institution to institution to institution, clearly they can become vectors.”

Staff in long-term care homes can be infectious and spread the disease to elderly residents under their care without even knowing they have the disease, Dr. Walker said. “These folks are very vulnerable,” he said. “We are not suddenly going to see people stop getting sick in long-term care.”

Premier Doug Ford is opening the door to systemic changes to the long-term care system in Ontario, as more than 140 residents have died in COVID-19 outbreaks. The Canadian Press

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