How one nursing home director's fast actions may have saved lives
This care home has no COVID-19 deaths. Another one nearby has 39 deaths. Why?
At one seniors home in the west end of Toronto, more than half the residents have tested positive for COVID-19, along with 66 staff members. Another 39 residents at Eatonville Care Centre have died of the virus.
But at another home, just seven kilometres down the road in Etobicoke, it has been a very different experience. So far, there have been no cases of the virus — and no deaths — at Ivan Franko Home.
For advocates of long-term care residents and leaders of the unions representing workers at the homes, the different realities reflect different early and ongoing responses to the pandemic.
Jane Meadus, a Toronto lawyer with the Advocacy Centre for the Elderly, says care homes were not doomed to experience a COVID-19 outbreak and some administrators could have done more to protect their residents and staff.
"I don't think it had to be this bad."
For Meadus, "this bad" means the number of deaths experienced in Ontario's long-term care homes since COVID-19 hit Canada. As of April 27, provincial data showed there have been 705 deaths and 2,491 residents with confirmed active cases of the virus. An additional 1,205 staff members have tested positive.
Eatonville is one of five care homes in the province to receive military support to help fight the virus. Its parent company, Responsive Group Inc., was also named in a court injunction granted after a request from the Ontario Nurses Association, which accused it of failing to adequately protect their staff from the novel coronavirus. On April 23, Ontario's Superior Court of Justice granted the injunction, ordering the homes to comply with provincial infection control and health standards.
Some care homes could have taken early steps to help protect their residents and staff from outbreaks, said Meadus.
Proper use of personal protective equipment (PPE) like masks and gloves, along with separating residents who were infected from those who weren't, could have helped homes avoid large outbreaks, she said.
Provincial data shows that at least 188 long-term care homes in Ontario have experienced a COVID-19 outbreak.
Meadus considers that number "much too high."
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These homes should have learned from other parts of the world where COVID-19 hit sooner than it did in Canada, she said.
"Long-term care homes here should have been put into a position where they were much better prepared and obviously that didn't happen."
What can go right?
But some homes implemented measures that appear to have kept COVID-19 out. Provincial data shows about 70 per cent of Ontario's long-term care homes have not experienced an outbreak.
At Ivan Franko Home, the management team implemented a comprehensive pandemic plan before the Ontario government declared a provincewide state of emergency.
"There's been talk of pandemics for years, so we had a complete emergency plan and pandemic plan in place, which we decided to implement as of March 16," said Terry Tonkovich, executive director of Ivan Franko Homes.
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Ontario Premier Doug Ford declared a state of emergency the following day.
Since then, Tonkovich said, the home has required staff to only work at one facility — either Ivan Franko or another one, but not both. For part-time staff who normally worked in multiple homes but chose to work permanently at Ivan Franko, Tonkovich said she and her team increased their hours to full time.
The home took that measure more than a month before Ford said it would be mandatory in Ontario that staff only work in one home, an announcement that came on April 15 and took effect April 22.
Every long-term care home must also have an infection prevention and control program that includes guidelines for detecting infections and actions to prevent transmission, but the implementation of those protocols is up to each individual home, said Meadus.
The building that houses Ivan Franko Home is 50 years old, with mostly shared bedrooms and communal washrooms. Tonkovich said that's one of the reasons why she and her staff knew they'd have to take early and rigorous precautions to ensure shared facilities stayed clean.
The home hired an additional housekeeper to help with constant disinfecting of commonly touched surfaces like handrails, door knobs, telephones and bed controls. All deliveries to the home are disinfected, including mail.
Management also provided two masks for each employee each day, while maintaining a strict control on its PPE inventory.
"We had a supply because you always have to be prepared for outbreaks," said Tonkovich.
Staff training and education on hygiene practices like hand sanitation and proper use of PPE was also increased.
Sharleen Stewart, president of SEIU Healthcare, which represents health care workers such as personal support workers and registered practical nurses, said staff at Ivan Franko "went over and above" guidelines for infection control.
"I'm really excited that they don't have a breakout."
Staff 'forced to reuse' masks
At Eatonville, however, the union representing employees said the home failed to keep staff and residents safe.
The home failed to provide proper PPE to staff, to communicate clearly with staff on which residents had tested positive for the virus and to take every reasonable precaution to protect its workers from COVID-19, according to a 204-page emergency application SEIU Healthcare submitted to Ontario's Labour Relations Board on April 20.
In that document, the union requested that the board force the Ministry of Long-Term Care to immediately take over control of Eatonville as well as two other care homes, one of which, Anson Place in Hagersville, Ont., is also owned by Responsive Group Inc.
Jonathan Reid, a dietary aide who's worked at Eatonville since 2016, provided a statement in the application.
In that statement, Reid said that the home was already in the midst of a respiratory outbreak when the pandemic began. He said he and fellow staff members asked for masks to wear at all times, but the employer only provided masks for workers who had to enter rooms where residents were in isolation. Some staff were bringing masks from home and reusing them on multiple shifts.
As of April 20, management at the home were not providing N-95 masks to front-line workers, but supervisors were wearing them, according to Reid. He said when surgical masks were given to staff, they would be worn all day and weren't replaced.
"Masks are not being discarded after a COVID-19 patient has been treated; staff are being forced to reuse them with other residents."
In response to the request for the court injunction filed by the Ontario Nurses Association, Responsive Group Inc. argued that it was trying to save PPE for its health-care workers and that it was also trying to take into consideration future need for PPE. The home also said in a statement to the media following the court order that all staff across all its homes have had access to the necessary PPE as outlined by "the very stringent safety requirements" from the provincial Ministry of Health.
'I don't understand why'
Management at the home was not transparent with staff about which residents were infected with the virus, said Reid.
"Staff are being forced to 'guess' who is infected based on who is in isolation and who has a 'STOP' sign on their room doors," he said. "As a staff member, we found out about rates of infection and COVID-19-related deaths by watching the news."
Meadus believes open communication can make a big difference for families and staff.
"One of the most important things would have been to provide information to staff, to residents, to families, to substitute decision-makers about what was going on in these homes so that people could make proper decisions and ensure that their safety, the safety of their loved ones, the safety of the staff, is being protected."
Families of residents at Eatonville feel the same way.
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Henry Tomaszewski's mother, Maria, was a resident at Eatonville for 14 years before she died at the home on April 15. Tomaszewski said he was told his mom was "doing fine" all week until suddenly she was in grave condition.
"I don't understand why they weren't on top of this far sooner than they were," said Tomaszewski.
"There was a potential if they actually jumped on board and took these preventative measures much sooner, my mom still would have been here," he said. "It pulls on your heart strings."
One family said the only communication they received indicating that their family member, who was a resident at Eatonville, had suffered from COVID-19 was on the death certificate from the funeral home that listed the cause of death as COVID-19, according to the proposed class action lawsuit filed against Responsive Group Inc.
These allegations have not been proven in court and the company did not answer CBC's questions about these allegations.
'No excuse not to be prepared'
Like the residents in Ivan Franko Home, Eatonville residents live in shared rooms with shared bathrooms.
Because being in close quarters can increase the chance of transmitting the virus, Ivan Franko's management team was quick to segregate residents by floor, creating makeshift dining rooms on each level so residents would only interact with those on their floor.
"This way residents can see each other and maintain physical distancing," said Tonkovich.
Staff were also divided up and permanently assigned to specific floors.
Stewart said that because Eatonville didn't do something similar earlier on, especially after residents became infected with COVID-19, it likely caused the virus to spread more quickly.
"Isolate the residents that were infected onto … one or two wards," she said of what Eatonville should have done.
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Unlike Ivan Franko Home, which ensured that all staff and residents had their temperatures checked and were screened for respiratory symptoms twice a day, Reid painted a different picture at Eatonville.
"Staff taking body temperatures at the door use an ear thermometer and do not change the ear cup between every person or alternatively just ask people if they have a fever," he said in his statement.
And while Eatonville is a larger facility than Ivan Franko — with 247 beds compared to the Ukrainian long-term care home's 85, Stewart said that is no excuse to not be prepared.
"If you have a home with more seniors in it, then that should have been your priority," she said, noting that the virus can affect seniors more seriously.
She said if Eatonville is larger than Ivan Franko, the home should have adjusted the number of staff and resources accordingly.
"It doesn't matter what the size of the home is," said Meadus. "A lot of this should actually be easier for somewhere like Eatonville, [which] is part of a corporation that owns a number of different homes, so they should have more expertise in these areas."
On April 24, the Ontario Labour Relations Board made an order that includes sending a Ministry of Labour inspector to visit Eatonville and the other two homes on a weekly basis.
The order also said management must inform the union and staff of the number of resident and staff cases of COVID-19 as well as resident deaths on a daily basis. The home must begin separating infected residents and requiring all visitors and staff to wear appropriate PPE.
When asked about the allegations in the OLRB application, a representative from the Responsive Group Inc said in an email that the company is pleased with the outcome of the OLRB hearing.
"We welcome the opportunity to work with them to formalize many protections for our hard-working staff. We remain committed to ensuring we have appropriate PPE available to all staff at all times."
At Ivan Franko Home, families of residents say they are pleased with how staff have handled the situation.
"Knowing that the Ivan Franko Home has done a lot of that in advance of it being mandated is just such a comfort to me and my family," said Christine Witowych, whose 84-year-old mother, Paulina, lives at the home.
While Tonkovich is pleased with how her staff have handled the situation so far, she's hesitant to let her guard down any time soon.
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"In spite of everything we do, we are fully aware that it could happen any day ... and our staff are very concerned, our families are very concerned. They have been doing everything to support us."
With files from Ellen Mauro