Elder Neglect : COVID Onset

Revera, one of the largest operators of Canadian seniors' residences and long-term care homes in the country, is calling for provinces to adopt widespread surveillance testing as part of an internal review. (Ivanoh Demers/Radio-Canada)

"[The homes' doctors wee often] unfamiliar with the online platforms needed to run appointments remotely [while elderly residents] found it difficult to participate in virtual consultations."

"[The grim toll has caused a] national reckoning."

Revera expert panel report

 

"Managing an insidious virus that spread often asymptomatically, both in the communities where personal care staff lived, and in the four-bedded rooms where some residents slept, was an impossible task."

"In wave two, that number has generally been below 20 [as opposed to the first wave when up to 40 deaths a day occurred in long term care in Ontario]." 

"[Caring for the poor and the aged originated in the context of the poor house]. That has changed dramatically in terms of what we expect for our parents and grandparents, but has our thinking caught up -- the thinking that allows for four people to be in the same room?"

"It's nobody's fault this happening. It was a perfect storm of features that came together to put residents at risk."

Dr.Bob Bell, chair, Revera panel

Nathan Stall, geriatrician, Mt. Sinai Hospital, Toronto  (CBC)

"[Often there is a lack of eyes to identify who is sick and who is not, and] there is still a lot of winter ahead."

"It's probably a bad idea to have a lot of people sharing a room and a bathroom, especially when you're in the middle of a pandemic with a highly transmissible infection."

"It's predictable you're going to have outbreaks [in long-term care] in spite of trying to create an iron ring. Really what you're left with is more like an iron sieve."

Dr.Nathan Stall, geriatrician, Mount Sinai Hospital, Toronto

Late February of 2020 saw COVID-19 begin to make its mark in Canada and in the face of the oncoming, unstoppable threat to human health, hospitals assessing the situation of European nations struggling to cope with a massive infection rate and hospitalization and resulting deaths, anticipated much the same for Canada. Hospital officials visualized their facilities being overwhelmed and people would be left as vulnerable as those playing out in Italy, Spain and New York. 'Elective' surgeries were put off for some future date.

Non-urgent surgical procedures were cancelled, hospital storage units yielded whatever ventilators were available, wards were emptied as the push to 'decant' as many patients as possible into alternate places such as nursing homes was carried out on an urgent basis. And hospitals awaited the inevitable 'crush' of incoming patients in critical need of urgent care. But it was in the places where the patients were 'decanted' to that patients died of insufficient attention, poor training, inadequate worker numbers, dehydration and abandonment.

As of December 17, there were 9,771 deaths in Canada all told due to COVID; the vast majority of which took place in Ontario and Quebec for a 73 percent tally out of the country's COVID-related casualties. And 82 percent of that total represented deaths due to maladministration of the elderly and health-compromised residents of long-term care homes and retirement homes as the contagion quietly infiltrated and circulated to produce outbreaks in 1,300 sites across ten provinces in the spring.

In the early onset of the coronavirus there was little realization what the symptoms might look like in the elderly. Rather than fever and cough -- delirium, fatigue and anorexia became the initial symptoms of infection. Those infected seemed other than their usual selves; they were fatigued, they slept more, and they had little interest in consuming food. And doctors under contract with homes for the provision of medical care absented themselves, choosing to remain away rather than to visit such sites breeding infection.

 

In Winnipeg, 49 people linked to the Revera-owned Maples Long Term Care Home have died from COVID-19 as of Nov. 30. (Lyzaville Sale/CBC)

 

Some doctors were concerned they lacked proper training in infection control evidently, and while family doctors were urged by their governing bodies to provide as much virtual care as possible, they had little idea how to begin. Now begins the second wave, after government heads and their agencies at every level swore that more help was on the way and the virus sweep through those homes would never again occur. It is, however, playing out a second round. In Ontario alone over 700 residents have perished since the second wave arrived the end of August.

Outdated homes with four-bed wards and communal bathrooms, a workforce that is short-staffed, underpaid, mostly unregulated with a high rate of burnout. Added to overcrowding, poor infection control which though documented time and again even predating the virus remains as it was. No changes. "Not really, not fundamentally" wrote the expert panel examining the situation. "We failed them", the elderly who, the panel stated, deserved a better end.

Fully 60 percent of long-term care home residents have dementia, 70 percent heart and circulatory system issues. A typical resident is 84 years of age, with a remaining median life expectancy of 18 months, according to statistics. The elderly in these homes suffer health problems, are generally older and certainly more frail than their counterpart seniors still living in their own homes. Some families of such residents were informed that treatment in hospital would be futile since no proven therapies exist for COVID.

The province announced Saturday that the management of two more long-term care homes battling outbreaks  — Rockcliffe Care Community in Toronto and Langstaff Square in Richmond Hill — is being temporarily handed to local hospitals. (Frank Gunn/The Canadian Press)

"[Even as we're living longer, and medicine has] transformed the trajectory of our lives, the bottom eventually falls out."

"We reduce the blood pressure here, beat back the osteoporosis there, control this disease, track that one, [until eventually, frail and weak], managing without help is no longer feasible."

Atul Gawande, author, In Being Mortal