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Ontario should urgently address staffing shortages in nursing homes, commission says

Critical staffing shortages in Ontario's long-term care homes should be urgently addressed as the second wave of the pandemic intensifies, an independent commission said in interim recommendations released Friday.
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Critical staffing shortages in Ontario's long-term care homes should be urgently addressed as the second wave of the pandemic intensifies, an independent commission said in interim recommendations released Friday.

In a letter to the government, the Long-Term Care COVID-19 Commission said the province must spend more money, on a permanent basis, so the homes can hire more personal support workers and nurses.

"We have heard repeatedly and consistently about critical staffing shortages pre-COVID and the reasons for long-standing recruitment and retention challenges in long-term care homes," the commissioners wrote. 

"The staffing challenges have been well documented with numerous reports on the subject. Covid-19 exposed these challenges in stark terms."

The commission is investigating how the novel coronavirus spread in the long-term care system and will submit its final report on April 30, 2021. 

It's being led by the Superior Court’s associate chief justice Frank Marrocco, along with long-time public servant Angela Coke and Jack Kitts, a medical doctor and former president of the Ottawa Hospital.

The commission said 55 per cent of all long-term care homes in Ontario had COVID-19 outbreaks in the first wave.

"Some common characteristics among the most impacted homes were: location in communities with high infection rates; insufficient leadership capacity; pre-existing and COVID-related staffing shortages; and a lack of strong infection prevention and control measures, including difficulty cohorting and isolating positive residents," the commissioners wrote.

The commissioners said the government should immediately mandate and formalize relationships between the homes, hospitals and public health units, as well as strengthen their infection prevention and control protocols.

They also said the province should implement its own staffing plan that came out of an inquiry into a serial-killing nurse who preyed upon nursing-home residents.

The province released that staffing study in July in response to the inquiry about Elizabeth Wettlaufer, a long-term care nurse who used severe staffing shortages to her advantage. She killed eight residents over nine years with lethal injections of insulin, often while working alone on the night shift.

That study recommended a minimum of four hours of direct care per resident per day.

"Further 'study' of the study is not necessary," the commissioners wrote. "What is required is the study’s timely implementation."

The commissioners also said families should have ongoing access to their loved ones in the long-term care homes, 

"Given the essential role of families and caregivers in supporting not just physical care needs but the psycho-social well-being of residents, we reinforce the calls from residents, families and caregivers to ensure that families and caregivers have ongoing, safe and managed access to long-term care residents," they wrote.

Merrilee Fullerton, Ontario's minister of long-term care, said in a statement that the government is doing whatever it can to help seniors and staff against the novel coronavirus.

"We are carefully reviewing each of these recommendations as we continue to work hard to solve the long-standing and systemic challenges facing the long-term care system," she wrote.

Doris Grinspun, the CEO of the Registered Nurses' Association of Ontario, called on Premier Doug Ford to adopt the recommendations immediately.

"The increased staffing will allow seniors and residents in nursing homes a dignified life," Grinspun said. "The time has come and the time is now. It will take two years to staff up, so we must start now."

The Ontario Long-Term Care Association, which represents 70 per cent of the nursing homes in the province, also said the province must act at once.

"The Commissioners are right: long-term care staffing is in crisis, and was in crisis well before the pandemic," said Donna Duncan, the association's CEO. 

"Ensuring that the fundamentals such as timely access to personal protective equipment, rapid testing, hospital partnerships and dedicated infection prevention and control expertise are available in our homes is fundamental to protecting our residents, staff and family."

Premier Doug Ford and Health Minister Christine Elliott defended the province's actions on long-term care homes.

"We have been acting and even before the commission have come out with recommendations," Ford said. "We have not stopped on long-term care making sure we get as many (personal support workers) as possible."

Elliott said the government is already implementing the plan from the July staffing study, but the premier's office later clarified that the document was being used to help develop a "comprehensive staffing strategy" to be released later this year. 

To date, 1,913 long-term care residents and eight staff have died of COVID-19.

- with files from Paola Loriggio. 

This report by The Canadian Press was first published Oct 23, 2020.

Liam Casey, The Canadian Press




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