“You can’t give someone a bath from six feet away”: What it’s like to work at a long-term care facility right now

“You can’t give someone a bath from six feet away”: What it’s like to work at a long-term care facility right now

From left: Chester Village personal support worker Sivajokam Ramalingam, medical director Brad Birmingham and registered practical nurse Koriza Ali-Mohammed

I work as an attending physician and medical director for two long-term care facilities, Belmont House in Rosedale and Chester Village in Scarborough. Belmont House has 140 long-term care residents, and Chester Village has 203. In both facilities, most rooms are private—in the neighbourhood of 70 per cent—on most floors, and Belmont House has one floor with a larger number of semi-private rooms, many with couples living together. Both homes have plenty of open spaces, sunlight, activity areas and accessible outdoor space for those with dementia. Our residents are elderly and require a lot of care, and it takes 10 employees to look after each person.

Everything seemed to change for us, and the rest of the world, on March 13. One of the first things we did was restrict who was coming in and out of the facility—just essential staff. We quickly realized that physicians could put homes at risk because we work in multiple places, so we changed the protocol to have one on-site doctor for each facility. This is a rotating position: I’m the on-site doctor at Chester Village right now, and doctors continue to care for residents through virtual rounds.

You know how everyone is physical distancing and we’re told to stay six feet apart? You can’t do that in long-term care. You can’t give someone a bath from six feet away. You can’t help them dress from six feet away. We can spread residents out at meal times, but it’s congregate housing. There are still a large number of people in a small space. That puts people at risk. Some of the homes that have experienced real trouble often have four residents in one room. We’re very lucky at Chester Village that most of our residents live privately.

Early on, it became evident that staff needed to start wearing surgical masks, not to protect themselves but to protect the residents. One of our biggest challenges, like the hospitals, was that we didn’t have enough PPE. Belmont House had to scrounge to find masks. They had to ask for help from doctors and friends and pay ridiculous prices—sometimes double or triple the regular cost—but they were able to get masks on staff. At Chester Village, we were fortunate to have a relationship with the East Toronto Family Practice Network and Michael Garron Hospital, which were able to provide us with masks for our staff. That made a world of difference.

They’ve done a whole lot more, too. We have what are called nurse-led outreach teams, or NLOT, where nurses can visit and provide early intervention before a resident has to go to emergency. Previously, NLOT would come during usual daytime hours but now they’ve expanded their hours. They come as soon as they’re able, usually on the same day. They’re able to do things we don’t normally do, like start IVs. There’s also a program called Seamless Care Optimizing the Patient Experience, or SCOPE, which is a phone number we can call to connect with hospital-based specialists. Better still, they have an app called Hypercare, where I can basically text a specialist with a question and receive an answer back. I can get an almost instantaneous consult. So we’re able to avoid sending our residents to the hospital as much as possible. Now all the hospitals in Toronto are being assigned partnerships with long-term care homes so that they will have similar supports. We were lucky to be ahead of the game.

People might not realize it, but we’re already pretty darn good at managing outbreaks. We deal with the flu and similar illnesses every year. The difference with flu outbreaks is there’s a vaccine and a medicine called Tamiflu that’s on our side. We have experience with this kind of thing. As soon as we have any suspicion that a resident may have Covid-19—if they have any atypical symptoms or respiratory symptoms—we isolate that resident, do a nasopharyngeal swab and keep a close eye on that person.

We’re lucky that there have been no positive cases at Chester Village. We did have one staff member test positive, but they weren’t symptomatic while working, and they wore the mask and practised hand hygiene, which are both hugely important. They tested positive a few days after working. Nonetheless, we were very diligent in isolating and monitoring all the residents on that floor for two weeks. They all tested negative, and our staff member is okay.

It’s hard for me to speak on behalf of the residents, but I’ll say this. They’ve been through everything. They’ve lived through the Depression and world wars. They have life experience. If there’s frailty and strength at the same time, that’s them. Their age doesn’t put them at risk for catching the virus, but their co-morbidities, such as dementia, do put them at risk for the worst outcomes. The virus isn’t that bright. It will be just as happy on a child as an adult. But our residents will experience the most severe repercussions.

Of course there’s fear. There’s fear amongst the staff—fear of dying, fear of contracting Covid and taking it home to their families—but they’re putting that fear aside and coming to work. Short-staffing has not been a problem at Chester Village. I’m sure some of the residents are fearful as well, but they’re coping with it incredibly well. One resident’s daughter wanted to take her home, but our resident flat-out refused to go. She said, “This is now my home. I know what’s going on and I’m staying here.” And our staff have stepped up and helped facilitate iPad visits to maintain as much contact as possible between residents and their families.

Long-term care homes have done their best in very difficult times with inadequate support, and with an evolving knowledge about what safety measures were best. Early on in the pandemic, there was a lot of emphasis placed on preparing hospitals—which is important, of course—but the same was not readily in place for long-term care homes. I don’t think it’s a time for people to be finger-pointing about why this is happening or who is to blame. It’s a time for everyone in health care to come together and deal with this as a team. That’s how we’re going to get through this.

As told to Isabel B. Slone