Making long-term care homes safer

Overview

Residents and staff at long-term care homes have been particularly vulnerable to COVID-19. Uncertainty during the initial wave of the pandemic included unclear and changing guidance, confusion about moving between long-term care homes and shortages of personal protective equipment. Wave two of the pandemic has also had devastating impacts on long-term care residents and staff. As of late 2020, 63 per cent of all deaths due to COVID-19 in Ontario were in long-term care.

In July 2020, the provincial government launched Ontario’s Long-Term Care COVID-19 Commission to investigate how the virus spreads in long-term care homes, how staff and families were affected and the adequacy of measures taken by the province and others to prevent, isolate and contain COVID-19. The commission will also provide guidance on how to better protect long-term care residents and staff from future outbreaks.

The OMA has supported the work of the Commission through two submissions. The first submission, in October 2020, provided interim guidance and immediate strategies to address the pandemic. The second submission, provided in December 2020, analyzes issues that have challenged the long-term care sector and identifies recommendations for improvement.

The Commission’s final report is expected to be delivered by April 30, 2021.

First submission

The OMA Interim Guidance to Ontario’s Long-Term Care COVID-19 Commission contains 14 recommendations regarding resident care and well-being, infection prevention and control, and physician leadership.

Recommendations include:

• prioritizing COVID-19 testing for residents, staff and essential visitors in long-term homes
• ensuring everyone caring for residents in those settings has an adequate supply of personal protective equipment and training on how to use it properly
• expanding virtual health care and mobile teams to provide specialized expertise and on-the-ground support to long-term care homes when needed
• grouping and isolating long-term care residents with COVID-19
• making sure long-term care homes have enough staff and that they avoid non-essential movement of staff between homes
• making sure long-term care residents have safe access to essential visitors, caregivers and other social supports to protect their mental health and avoid the devastating impacts of social isolation
• having more and earlier conversations about advance care planning

Second submission

The OMA Second Submission to Ontario’s Long-Term Care COVID-19 Commission contains 31 recommendations on health-care system issues affecting long-term care, including medical management for COVID-19, access to specialized care, public health and infection prevention and control, human health resources and long-term care delivery. An OMA-led survey of physicians who work in long-term care homes or deliver care to residents in long-term care homes informed the submission.

Recommendations include:

• establishing a chief medical officer of long-term care for Ontario
• providing the physical space in homes to allow for quarantine for positive residents
• ensuring long-term care homes have adequate supplies of PPE for all staff and adequate training for staff related to infection prevention and control practices
• ensuring that staff are appropriately trained and equipped to support advanced care planning and provision of end-of-life care in long-term care homes
• accelerating the target completion of the commitment to provide each resident with average daily direct care of four hours per day per resident by 2024-25 to 2022-23

Response to the proposed Phase I Regulations Under the Fixing Long-Term Care Act

The OMA submission in response to the proposed Phase I Regulations Under the Fixing Long-Term-Care Act contains 11 recommendations that focus on the roles of medical directors and attending physicians as well as the palliative approach to care in long-term care. An OMA-led consultation of the OMA’s sections on Long-Term Care and Care of the Elderly and Palliative Care informed the submission.

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