When public health officials across Canada banned visitors from nursing homes to protect residents from COVID-19, they cut off an essential support system and inadvertently created a feeding crisis.
Two-and-a-half months after restrictions were put in place, family members and seniors advocates say there have been preventable deaths from dehydration and other residents are wasting away without the help of relatives and private caregivers they relied on at mealtimes. The loss of extra assistance comes as many facilities struggle with severe staffing shortages.
“People, we’re hearing, are really not eating. Not everyone, but there’s a real concern,” said Laura Tamblyn Watts, chief executive officer of CanAge, a national seniors advocacy organization. “It’s incredibly dire.”
Vinh-Kim Nguyen, a physician at the Jewish General Hospital in Montreal who helped at two long-term care homes last month, said barring family caregivers from facilities at the same time staffing levels dropped resulted in residents with COVID-19 dying from dehydration. While homes initially didn’t send sick residents to hospital, doctors were able to successfully treat some with intravenous fluids and oxygen, which aren’t typically available in nursing homes.
“Things sort of spiraled out of control, and very clearly, many of these patients did not have to die because they would have been fine if they were hydrated and fed,” said Dr. Nguyen, who said his experience in the seniors homes was more difficult than caring for Ebola patients in the Democratic Republic of Congo.
A small French study found that “confinement disease” is likely more detrimental than COVID-19 itself. The April paper concluded that more than 24 deaths at a long-term care facility that staff believed were due to the virus were mainly from hypovolemic shock, a life-threatening condition caused by a rapid loss of blood or fluids. The victims had been confined to their rooms for days with no assistance eating or drinking due to low staff numbers and a lack of personal protective equipment.
A military report last week on conditions in five Ontario seniors homes detailed a litany of failings, including that residents at one facility didn’t receive three meals a day and aides at another residence weren’t helping people eat.
Families and seniors organizations are calling on Ontario and other provinces to relax restrictions on visits to long-term care homes, saying residents’ physical and mental health are at risk. Quebec and British Columbia now allow visitors to help with essential care.
More than a month after Shoshana Padro’s Toronto nursing home closed to visitors, her daughter Lenore got news that she was barely eating or drinking and was on the verge of death.
Lenore Padro had been worried about how her mother would manage without extra help at mealtimes. The 79-year-old, who had dementia and needed to be spoon-fed, always ate more when her daughter or private caregiver visited and had time to coax her to take another bite.
The elder Ms. Padro, who twice tested negative for the coronavirus, died on April 28. Her health had previously been stable, and her daughter believes she died of dehydration or starvation.
“Once I kind of got my head around it, I was like, how did we even get here?” Lenore Padro said. “I’d never think in a million years that this woman was going to pass away in a few weeks. How did this happen?”
Ontario’s patient ombudsman launched an investigation on Tuesday into the experience of residents and caregivers at long-term care homes with COVID-19 outbreaks after receiving more than 150 complaints since March.
Miranda Ferrier, president of the Ontario Personal Support Workers Association, said overworked care aides have admitted to her that they have forgotten to feed people.
“It’s not an easy situation,” she said. “I don’t judge the PSWs because they have been literally given an impossible task.”
Jane Meadus, a lawyer at the Advocacy Centre for the Elderly, said long-term care facilities that are unable to adequately feed their residents are breaking the law by failing to provide the necessities of life.
“Homes can’t say, ‘Well, there was COVID and we couldn’t staff, so oh well,’” she said. “They have that responsibility and they have to provide that care and it’s their job to do it.”
Canadian nursing homes have been hit hard by outbreaks of the novel coronavirus. About 82 per cent of the country’s COVID-19 deaths have been linked to long-term care facilities.
People with dementia, who make up about two-thirds of the long-term care population, are particularly vulnerable. Many need partial or full feeding assistance, which takes time that staff don’t always have. Changes in routine, such as being confined to their rooms because of an outbreak, often cause confusion and worsen symptoms.
Heather Keller, who researches nutrition and aging at the University of Waterloo, said long-term care residents who eat in their rooms don’t consume as much, especially those with cognitive impairments, who lose out on the important social cues they would otherwise get in the dining room.
“That’s a big part of this, is the lack of that social connectedness at meal times that stimulates food intake for older adults,” Prof. Keller said.
For many families, not being able to set foot in care homes means constant anxiety. Some have installed tablets in loved ones’ rooms to monitor mealtimes, even keeping video chats open so they can tell aides who drop off trays that they need to physically help residents eat and drink. Others keep watch during window visits for signs of weight loss.
Ralf Leswal is haunted by worries that his wife, Karen, who had Huntington’s disease, wasn’t properly cared for in her final weeks. He used to spend hours every day caring for her at Orchard Villa, her nursing home in Pickering, Ont., including slowly feeding her so that she wouldn’t aspirate her food. Ms. Leswal contracted COVID-19 and died on April 30.
“I wonder, did my wife actually die of COVID or did she die of neglect?” he said.
Jason Gay, the home’s executive director, did not comment on Mr. Leswal’s allegations, but said Ms. Leswal is “deeply missed.” Orchard Villa, which is owned by Southbridge Care Homes, had severe staff shortages, and trays of food were found stacked inside a resident’s bedside table, according to the military’s report. The coroner is investigating the death of a resident who apparently choked while being fed lying down.
For Shoshana Padro, who received help with about half her meals from her daughter or private caregivers, which typically took 45 minutes, the extra attention meant she usually ate three-quarters of her food, Lenore said, compared to only about one-quarter when she was fed by staff of Cummer Lodge, her City of Toronto-operated home.
At her monthly weigh-in in early April, the elder Ms. Padro was down to 52 kilograms from 53.6 kg, a loss her daughter attributes to the two-week period after the home was closed to non-essential visitors on March 14. Ms. Padro died before her May weigh-in, but her daughter, who was allowed to visit her during her final days under Ontario’s rules, believes she lost additional weight.
Brad Ross, a spokesman for the City of Toronto, said staffing at Cummer Lodge has been at or above normal levels throughout the pandemic, and nurses “have been assigned to provide all appropriate care, including feeding and nutrition, and encouraging eating at mealtime.”
Ms. Padro, who plans to launch a lawsuit, said she believes her mother’s death could have been prevented if she had more help with meals.
“Knowing that there’s no family or caregivers coming in to even oversee any of that, I mean, how much do they really try?”
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