Long-term care facilities house some of our society’s most vulnerable: those who need help eating, using the bathroom, or simply turning over in bed. The fact that some of our elders are facing neglect and abuse from those meant to care for them incites justifiable outrage. We need to ask what can be done to improve long-term care and assisted living. But we also need to ask how our governments’ (federal, provincial, and municipal) responses to COVID-19 contributed to this.

Long-term care homes were known to be high risk

Outbreaks of highly contagious viruses have ravaged care home populations before. Research demonstrates how to minimize viral spread in these environments, and even the general public has recently become extremely well-versed in these measures. So yes, long-term care homes faced a new virus, but this was a crisis they should have been well prepared to handle.

The fact that many long-term care homes handled it so poorly is not due to ignorance of best practices for preventing the spread of a virus, nor is it necessarily due to gross mismanagement and general neglect by long-term care owners and employees. Rather, the aggressive spread of COVID-19 through care facilities stems from lack of access to supplies, lack of staff, and lack of communication. The fear and isolation felt by many in long-term care were exacerbated by the ban on visitors, which may have also contributed to diminished standards of care.

These issues were in part caused by governments that apparently forgot what a target looks like and simply took a scattershot approach to combatting coronavirus spread. Despite international evidence that the elderly in care homes were at exponentially higher risk, the government spent their time (and immense amounts of money) shutting down huge swaths of low-risk society. Compare this general approach to the exemplary response in Kingston, Ontario, which applied targeted efforts early on, even reassigning restaurant inspectors to assist at care homes, avoiding outbreaks at all of their 27 long-term care facilities.

Meanwhile, things in other Ontario and Quebec care homes got so bad that they had to call in the military. The Canadian Armed Forces’ report from their experience in five Ontario care homes cited lack of supplies as a major issue noticed in these homes. While the general public was encouraged to sanitize everything in sight and wear masks while staying six feet apart from others at the grocery store, in care homes catheters went unsanitized and personal support workers wore masks well past their useful life. The masks they did have didn’t always fit right, linens ran out and residents slept on bare beds waiting for laundry to be done, and gloves were not changed between each patient.

Besides issues with access to adequate supplies, personnel shortages were a key problem. The military report cites cases where a single Registered Nurse was responsible for up to 200 patients, and where one Personal Support Worker was trying to tend to 30-40 patients in one shift. These are impossible demands and calling in the military for humanitarian aid was a necessary measure. But would it have been necessary if resources directed elsewhere had instead gone first to protecting long-term care residents and workers, knowing (as government should have) that they would take a markedly more severe hit from COVID-19 than almost any other segment of society?

Perhaps the biggest issue in the standard of care at long term care facilities not covered in the military’s report is the total prohibition on visitors. While public health measures could have been increased and some limitations made, banning outside visitors entirely only increased isolation and delayed awareness of the conditions some were facing. Visitors serve as a valuable informal surveillance system monitoring the standard of care. Visitors may take on certain responsibilities for their loved one, such as helping with feeding, thus easing pressure on staff. Visitors also provide valuable interaction and purpose to residents’ days. This relational human contact was clearly missed, as evidenced by the report citing cases of unnecessary narcotic administration in response to loneliness and depression.

What can be done? Improving end-of-life care

Though we may be shocked by what we’re hearing about conditions in these homes, and though it is of course uniquely bad during this crisis, people have been sounding alarms about problems at long-term care homes for decades. These concerns cannot be ignored, either by society or by our government. Perhaps the current crisis is what will spur action that has been needed for a long time.

COVID-19 is not the first virus to hit the elderly, specifically those in care homes, much harder than the general population, and it will not be the last. This is also not the first time care homes have been short-staffed or low on supplies. What is lacking in Canada is a well-funded, well-run long-term care plan for elderly Canadians. Whether this increase in funding comes from taxpayers through a government healthcare program and/or through donations to non-profit organizations is not as relevant to this article as the need for clear standards of care, accountability, and respect for the wishes of the elderly.

A plan to ensure access, excellence and accountability in long-term care homes should be rooted in the same principles as palliative care and recognized as the end-of-life care that it is. In British Columbia, the average length of stay in long-term care is 871 days – just over 2 years.  Entering long-term care is generally a last stopping place. Should the care, then, not be based on the same principles of the holistic, compassionate approach on which palliative care is based?

The Canadian Hospice Palliative Care Association has called for more compassionate visitation protocols even during the pandemic, and we should join them in that call. Palliative care views patients as individuals with relationships, and recognizes the immense value of maintaining those relationships through the process of dying. Yes, these patients are medically high risk, but we need to balance physical health risks with the mental and psychosocial impact of isolation. Respecting the rights of the elderly includes respecting their wishes to see family members and/or friends. It is patronizing to tell them what is and isn’t a good idea for their health and well-being, and wrong to restrict their communication against their will. It is also important to respect the rights of families to be involved in the care of their loved one, and to ensure high standards of care are being maintained. Staff can never replace familial and community connections, nor should they be expected to.

If we recognize that long-term care is end of life care, we should treat patients the same way in both palliative and long-term care environments. This will mean palliative care training for personal support workers, increased staff to improve quality of care, and consultation with and expansion of palliative care outreach teams. Staff need to be trained well, paid well, and supported well so that they are able to do the incredibly challenging, draining work of providing excellent care while aware that they may lose their patient a few months down the road.

Our response

As Christians, we do not fear death, but reports such as these may make us tremble at the prospect of dying. Dying can be a process, and we may become utterly dependent on the care of others. The people in long-term care homes are people with histories, families, stories, and most of all, they are image-bearers of God. It is our calling to love our neighbours as ourselves. We should advocate for the care we would want in old age, the care we want for all human beings created in the image of God. How we care for, advocate for, and show up for our elderly family members and neighbours is an opportunity to witness to the value of all human life, and to display Christlike self-sacrificial love.

Take a moment today to write to your representative asking them to advocate for the elderly with some of these talking points:

• Encourage the expansion of palliative care in Canada, and extend its implementation into long-term care homes.
• Ask that restrictions on visitors be eased for long-term care facilities. Tell them how much visits mean to you or to others you know.
• Help them to see, respect, and support the incredible value of community-based long-term care homes, particularly those that meet the unique spiritual and cultural needs of particular citizens.
• Ask them to respect the rights of the elderly and not patronize them by telling them what is good for them and isolating/restricting them against their wishes.
• Ensure long-term care facilities have priority access to personal protective equipment, along with hospitals.
• Ask them to follow up on the military report in Ontario to ensure all recommended improvements are made and maintained.