Long-term care homes face road blocks

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The senior leadership at Oxford County’s largest long-term care homes are pushing for increased testing of their residents but say the local public health team is not letting them test incoming – but asymptomatic – residents.

Dr. Barry Roth, Woodingford Lodge’s medical director, and Mark Dager, the lodge’s director, said Southwestern Public Health has declined to process the COVID-19 tests of at least five new residents because they weren’t experiencing symptoms of the virus.

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But testing all residents is crucial, they said, because seniors are more vulnerable to COVID-19 and some, because of other medical issues, may be unable to convey they’re suffering early symptoms of the virus.

“We wanted the knowledge if they have COVID-19 or not. It would give us more knowledge about this illness in our population,” Roth said. “If we get it at Woodingford Lodge, it would have serious consequences.

“We need to do everything we can to prevent it.”

At the request of the Southwest LHIN, the homes recently agreed to take eight more residents to free up hospital beds expected to be needed for an influx of COVID-19 patients.

Dager said the inability to test new residents included both those coming from the hospital and from the broader community.

New provincial testing guidelines issued by the province on Wednesday, however, say all residents coming into long-term care homes need to be isolated for 14 days and tested within that time. Patients being transferred in from hospital should be tested before they’re moved.

That guidance was not in effect when patients were transferred from Woodstock Hospital to Woodingford Lodge. Dager did say all new residents would be isolated for 14 days as a precaution.

In a statement, Southwestern Public Health’s top doctor pointed to the April 1 guidelines in place at the time the patients were moved from hospital to the care home. Those guidelines called for the testing of symptomatic patients only.

“This has been communicated to the long-term care homes in the Southwestern Public Health region. We believe this approach makes the best use of available resources and is in line with the evidence and the guidelines under which we work,” said Dr. Joyce Lock.

“Information changes daily as this pandemic continues. Our practices will evolve in line with the available evidence, new guidelines and new directives.”

Public health did not address the latest guidance from Ontario’s top doctor on Thursday that all incoming residents should be tested, or what that would mean for new incoming patients.

Dager noted many residents have cognitive impairments or dementia, which can leave them unable to express possible symptoms.

Throughout Canada and Southwestern Ontario, there have been multiple outbreaks of COVID-19 at long-term care facilities and retirement homes. The outbreaks have proven deadly and spread quickly.

According to the Ontario Health Coalition, which tracks the number of outbreaks in facilities across the province, 86 residents have died as a result of care home outbreaks and nearly 350 staff are sick.

The Pinecrest Nursing Home in Bobcaygeon has become emblematic of outbreaks in care homes, where the home’s 30th resident died Thursday morning. Other facilities in Sarnia and Hagersville have seen multiple virus-related related deaths.

“Long-term care is a communal environment,” Dager said. “When you’re in a communal environment, it’s very difficult to prevent people coming into close proximity to one another because of the nature of long-term care. We have to do our due diligence to keep our staff and residents safe.”

Woodingford Lodge has more than 300 staff, including nurses, maintenance, laundry workers and personal service workers.

The homes have strict screening processes when staff enter the building. Workers have their temperature taken while being checked for potential signs of symptoms, Dager and Roth said. Provincial directives have limited the visitors, volunteers and other personnel allowed to enter homes for several weeks to help mitigate the spread of COVID-19.

It’s something outside health experts also recognize: care homes are vulnerable to outbreak and isolating people is difficult.

“Any new admissions is supposed to be isolated for 14 days and tested within 14 days. That’s a long time,” said Natalia Mehra, executive director of the Ontario Health Coalition. “These outbreaks have swept the homes within 14 days. The requirement for isolation is just impractical. How are they going to do that there is nowhere to put people?

“The premise is wrong. Isolation might be enough if there were proper personal protective equipment and space and staffing and the ability to isolate. That is not the case.”

When COVID-19 swabs are done, Dager said they’re refrigerated until Southwestern Public Health picks them up for testing at a public health lab. Results are returned within 24 to 72 hours.

Ramping up testing has been a focus for Premier Doug Ford, who on Wednesday called the low number of tests being done “absolutely unacceptable.”

“There’s no more excuses why we’re testing 3,000 people a day. We need to see 13,000 people tested every single day moving forward. We’re going to move forward on a rapid fashion to make sure every single person possible can be tested,” Ford said.

Ford said Thursday afternoon long-term care residents, their workers and the seniors population would be a “priority” for testing, something Roth echoed.

“We need more testing. We need to swab and the most critical group is in the long-term care setting,” Roth said. “We need to know and we’ve seen the results of what can happen when you don’t know where the virus is.”

Both Roth and Dager commended Public Health for the work they’ve done during the pandemic, but said their focus is on the safety of residents and staff.

“We shouldn’t be fighting to get swabs tested in this age group and this setting,” Roth said. “If we’re going to be successful in keeping it out of our long-term care homes, we need to know where it could be.”

Mehra and the health coalition are calling for the mandatory testing of all personnel entering care homes – staff, management and the limited numbers of family or volunteers still permitted.

“There is the choice not to do it that would accept the continued spread of COVID-19 in the homes,” Mehra said. “The extent to which Ontario is able to stop the spread in long-term care homes and save the lives of people involved depends on how aggressively they move to protect homes against people coming in with COVID-19, even if they are asymptomatic.”

– With files from Canadian Press