An alternative to finger-pointing on COVID-19 and long term care
By: Brigitte Pellerin
Tags: Pandemic, Long Term Care, Seniors, Lessons Learned, Covid 19

A report from a private, for-profit provider brings a different perspective

On COVID-19 and the severe impact it’s had on long term care homes especially in Ontario, it’s time to try a different approach. After pointing fingers to such an extent that we no longer have digits to point anywhere, we should give listening, empathy and compassion a try.

The private firm Revera, which owns and operates more than 500 properties across North America and the UK, does not at first blush feel like it needs our empathy. There are many people who now realize “profit” and “long term care” do not belong in the same sentence. Or even paragraph. And it’s a very compelling argument, although maybe it’s shareholders that don’t belong in this business. Perhaps a discussion for another day.

A recent report Revera commissioned from volunteer experts sheds some light on the difficulties the company encountered dealing with the COVID-19 pandemic in its long term care and retirement homes — difficulties that were not all of its making. The report deserves a fair airing.

There is a lot of blame to go around for what happened to seniors in congregate settings this year. The long term care sector has long been neglected by just about everyone. Too many buildings are old, too many residents live in cramped conditions, sharing bathrooms, and having to make do with less hands-on care than what they’re entitled to because the sector suffers from a long-standing shortage of staff.

Personal support workers, or PSWs, are in short supply and have been for a long time. And not without reason. It’s not a very glamorous job — washing people, dressing them, making their beds, keeping them company, listening to their issues, cajoling them into taking their medicine and reminding more than a few of them — again, that it’s not appropriate to yell.

The pay is pretty awful, too.

But now there’s a pandemic and a quarter of PSWs aren’t at work. Some have been told to isolate because they may have been at risk of catching COVID-19. Others got it and took time off to recover. Others… we just don’t know. They’re not at work. Maybe they’re scared of catching the bug at work and bringing it into their home and making their own family members sick. Who could blame them.

It’s been several long months of rushing this way and that, fighting a war against an invisible enemy and losing badly. Those PSWs who have been at work since the spring are tired. Family members of the residents, even though they’re essential caregivers, have been locked out for a long period. Doctors aren’t showing up either. Too many residents are sick. Every second or third day one of them dies alone, scared, fighting to breathe and failing.

We don’t know the names of those PSWs, but we can be pretty sure most of them are women. Often from marginalized groups — recent immigrants, women of colour. People who don’t earn a lot of money doing a job that most people wouldn’t want to do at twice the salary. They’re at work despite the risk, the pain, the worry and the crushing weight of expectations placed on their shoulders.

An overwhelming majority of the residents they look after have some form of cognitive impairment. Some of them don’t understand what’s happening. Others wander around despite being asked to stay in their room. They forget their mask, have trouble washing their hands without assistance. They require a lot of hands-on care, which contributes to spreading the virus.

The pandemic has wreaked havoc in long term care homes in Ontario and elsewhere in the country. Of all the COVID-related deaths in Canada, roughly 80 percent occurred in LTCs. That’s a lot more than in other countries. People are angry, and understandably worried about their loved ones living isolated from their family in crowded homes with a crying need for more staff that’ll never come. They see their roommates dying. They wonder if they’ll be next.

PSWs are used to people dying. In that business, death is a common occurrence. It doesn’t scare them, but it never leaves them indifferent either. And now… now they hold a phone to the ear of dying residents so families can say goodbye. It breaks their heart.

One PSW wrote a letter to her employer, Revera, that was reproduced in the report mentioned above. Sometimes, she says, she will remove her face mask at the very end of a resident’s life “so that they could see my smile when I saw the fear in their eyes to give them a sense of peace, knowing the risk, but feeling it the right thing to do for them in the moment.” She knows it’s dangerous. She knows it goes against infection prevention and control protocols. She does it anyway. Because she’s a human being with emotions even though she ends her letter with “we are broken and we are sad. I do not feel.”

I cried reading that.