Long-term care homes in B.C. that have not had an outbreak of COVID-19 are continuing to admit new residents, giving priority to people coming from hospitals.
The emphasis on admissions from hospital over people who may be waiting at home for a long-term care spot is part of B.C.'s overall pandemic response, because it makes more hospital beds available for a potential surge in patients with COVID-19.
Still, the policy has raised questions about whether long-term care facilities, which have proven to be vulnerable to deadly outbreaks of the virus, are able to manage the protocols required to keep staff and patients – both those coming in and those already there – safe.
Some transfers from hospitals are reasonable, even during a pandemic, says B.C. Seniors Advocate Isobel Mackenzie.
"We cannot close the long-term care system to new admissions. ... That would just create challenges in our hospitals,” Ms. Mackenzie said in a recent interview.
Incoming residents are screened for COVID-19 before they move and there are policies in place to protect them and staff should a new resident become ill after they arrive, Provincial Health Officer Bonnie Henry has said.
“There is a policy that requires them to be on their own, to be isolated from others, for 14 days after going into long-term care, to be sure that if someone is incubating the virus that it is detected before they have contact with others in the care home,” Dr. Henry said in an April 28 briefing.
Dr. Henry said she was not aware of any outbreaks in B.C. long-term care homes that had been linked to transfers from the community or from hospitals.
In April, Ontario and Quebec placed hospital admissions into long-term care on hold, as part of a flurry of measures introduced in response to multiple outbreaks in long-term care facilities in those provinces.
Although B.C. has had multiple outbreaks in long-term care facilities, the number of people infected in many of those outbreaks has been low, sometimes only one or two people in each instance. As of Wednesday, there were 17 active outbreaks in long-term care facilities, and outbreaks had been declared over at 17 different centres.
North Saanich resident Mairi Campbell says she was alarmed when she learned three residents had recently been transferred from acute hospital care to the Craigdarroch Care Home, a private facility in Victoria where Ms. Campbell’s mother, 88, has lived for nearly three years.
Ms. Campbell worries the facility does not have enough space, staff or personal protective equipment to prevent transmission if a new resident turns out to have COVID-19.
“I don’t feel it is safe to bring new residents into this residence at this time,” Ms. Campbell said, adding that she was worried about staff as well as her mother.
“We need to be extra careful in these kinds of environments,” she said.
Trillium Communities, the operator of the facility, did not immediately respond to a request for comment.
Craigdarroch is licensed by Vancouver Island Health Authority (VIHA). The health authority’s spokesman Dominic Abassi said he was not able to comment on any specific complaints, but that all licensed facilities are required to comply with provincial regulations, including any orders related to COVID-19.
While Dr. Henry has strongly recommended 14-day isolation, that recommendation is not official policy and health authorities are taking slightly different approaches, Ministry of Health spokesperson Stephen May said in e-mails to The Globe and Mail. VIHA requires new admissions to care homes to be isolated for 14 days, as does the Vancouver Coastal Health Authority. Other health authorities are screening potential new residents before they are moved and isolating where possible, Mr. May said.
The BC Care Providers Association, which represents privately run long-term care facilities, said 14-day isolation for transfers is the norm throughout the province.
Fraser Health, however, currently does not require people transferred from hospital to be isolated for 14 days, Mr. May said. But the health authority takes significant precautions to ensure transfers do not pose a risk of transmission, including checking whether people were exposed to the virus before or during their hospital stay and screening for symptoms.
“So when a person is ready to be discharged ... we are pretty reassured they don’t have COVID-19,” Fraser Health’s Chief Medical Health Officer Martin Lavoie said in a recent briefing.
If someone were to develop symptoms after moving into a long-term care facility, there are measures in place to protect residents and staff, Dr. Lavoie said.
“We’ve put all these measures in place to safely transfer patients from acute care when they are ready to be discharged and no longer need that level of [hospital] service,” he said.
Before the pandemic, B.C. hospitals typically ran at greater than 100-per-cent capacity, with some of that capacity going to patients categorized as “alternate level of care” – patients approved for discharge but waiting for placement somewhere more suitable, such as a long-term care facility.
Up-to-date data are not readily available so it is not clear whether there has been a significant increase in transfers. Information from B.C.'s Ministry of Health for the province’s most populous health authorities –Vancouver Coastal Health and Fraser Health – shows 253 people were transferred from hospitals to long-term care in recent months.
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