Dr. Roger Wong is the executive associate dean of education and a clinical professor of geriatric medicine at the University of British Columbia’s Faculty of Medicine
As an internationally recognized geriatrics doctor and past president of the Canadian Geriatrics Society, I’ve dedicated my career to supporting seniors. In many ways, my life’s work is culminating now, in real time, with each new development of the COVID-19 outbreak. Everyone wants to help. From frontline health-care workers, who risk infection caring for those in need including our seniors, to our neighbours who leave groceries on the front steps, ringing the doorbell before walking away.
That collective desire to help, to alleviate stress and suffering, is one reason to remain hopeful even as the number of cases and, tragically, deaths increase. But that same spirit – to do something, anything – can sometimes lead to missteps. If the COVID-19 crisis has taught us anything, it’s that there’s no blanket solution to a pandemic.
This includes how Canada responds to the situation unfolding at seniors’ residences across the country. There have been cases of COVID-19 in at least 600 nursing and retirement homes, with some locations reporting multiple deaths among residents. This grim news has some wondering whether these facilities are the best place for our seniors. And some are asking if loved ones should be pulled out of these homes.
Consider for a moment what that means.
Experts unanimously advocate physical distancing to reduce transmission of the coronavirus in the population. And there’s no population more at risk than senior citizens, especially in care homes. Of course, these homes must be hyper-vigilant with their infection prevention and control, now more than ever. Where improvements are needed, they must happen immediately. But what might appear as a blanket solution – effectively a mass exodus of our most vulnerable seniors from care homes into the general population – contradicts even the most basic public health guidelines in a pandemic.
The first question is, where would they go? In ordinary times, some seniors can seamlessly transition from care home to the home of a family member or friend. But these aren’t ordinary times. Even families with the means (financially and otherwise) to accommodate seniors may themselves pose risks of transmission. The virus spreads through contact. Obviously, it’s more difficult to avoid contact with someone you live with than someone living in a seniors’ care home. Moreover, many seniors in care homes have multiple health issues that require access to special equipment, such as mechanical lifts or tube-feeding machines, which can increase levels of contact and, hence, transmission.
Secondly, we must consider what happens to seniors with dementia or Alzheimer’s disease who are used to the daily routine in their care homes. Any sudden change can trigger a common complication called delirium.
Indeed, families often make the painful decision to place their loved ones in care homes because they experience “caregiver burnout” or simply can’t provide the care and security required in many cases. It can be an excruciating exercise, wrought with guilt and sadness. To suggest this complex decision, made by families often with the input of health-care professionals, may now contribute to the suffering or death of our loved ones, is in my view very unhelpful, particularly as the economy contracts and unemployment skyrockets, when many families are already stretched practically and financially. And crucially, when removing seniors from care homes could negatively affect their health and the health of others.
So what should we do? We should protect seniors where they live. The British Columbia government has taken some important steps such as limiting the number of care homes that individual health-care workers can visit to prevent cross-infection, providing enhanced prevention and control to care-home workers and restricting non-essential visits from families and friends. Physical distancing within the community and among caregivers must continue to be strongly enforced. That said, physical distancing doesn’t mean social isolation. Phone calls, texts and other forms of virtual communication are crucial to combating loneliness, particularly among seniors.
Going forward, we need new consistent policies for homes across the country that lay out clear information on outbreak prevention and control in seniors’ facilities. This should include rapid-response plans for coronavirus, influenza, bacterial diarrhea illnesses and so on.
Our seniors deserve the absolute best in their golden years – that’s surely what their families and loved ones desire. We must all take extra care during this pandemic to make sure our recommendations are practical, sustainable and compassionate – and not prescribe solutions that can have serious unforeseen consequences.
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