Opinion

COVID-19 rips bandage off the open wound that is our nursing home system

The pandemic has exposed the dismaying inadequacies of Canada's long-term care system for seniors, writes Dr. Amit Arya.

Pandemic has exposed the dismaying inadequacies of Canada's long-term care system for seniors

Funeral home workers remove a body from the Residence Yvon-Brunet long-term care home in Montreal on April 18, as COVID-19 cases continue to rise in Canada and around the world. (Graham Hughes/The Canadian Press)

This column is an opinion by Dr. Amit Arya, a front-line physician working in nursing homes as a palliative care specialist. For more information about CBC's Opinion section, please see the FAQ.

None of us can imagine a beloved parent or grandparent in one of the nursing homes we are reading about without an involuntary shudder. Human beings dehydrated, starving, and left sitting in their own feces and urine in one Quebec institution. Military personnel deployed to homes desperate for staff. More than 1,000 people dead in long-term care homes across the country, and many more cowering in fear, sealed off from their loved ones as COVID-19 stalks the hallways of the nursing homes they live in.

Some of this is particular to this pandemic. No one could have been completely prepared for it.

However, COVID-19 has also ripped the bandage off an open wound, revealing what was previously there. It has exposed the inadequacy of the existing system.

Most nursing home residents have advanced incurable conditions — often dementia, but also heart, lung or kidney disease. People like me who work in nursing homes already know that care is driven by efficiency, rather than giving seniors with declining function the life they deserve. COVID-19 is showing us all why many of us would not choose these places for ourselves.

So what can we do?

Let's start with the living space. How many of us would choose to spend our last years sharing a small room with one, two or even three other strangers?

The crowded conditions in which we warehouse our frail elderly aren't just an issue of personal privacy, they contribute to the spread of disease. Even in normal times, seasonal flu can be a killer in these homes. And with COVID-19, everyone is now discovering what those of us working in the system always knew: many nursing homes simply do not have the space to isolate patients in order to keep people safe during an outbreak.

We need to create the space to provide the privacy seniors want for their dignity and autonomy – space which also serves to combat the spread of viral illness.

What about staff?

These are the people our elderly are so dependent upon. They dress many of the residents and brush their teeth. They take them to the bathroom, clean them afterwards, and give them baths.

To stop the spread of COVID-19, some provinces are now saying support workers may work in only one home, rather than different institutions from day to day or week to week. This will reduce the spread of the virus, but it will also build better relationships between workers and their patients.

As COVID-19 continues to spread in Ontario’s nursing homes, organizations like the University Health Network are providing backup 2:09

Obviously, also mandating that nursing homes provide workers with proper protective gear as well as sick leave is as important to the patients as it is to the staff.

However, support workers need to be paid a decent wage, and receive full-time work and benefits. Earlier this year the Ontario government capped the wages of personal support workers at many nursing homes, for example, but the truth is that few of these workers make much more than minimum wage.

And we need more of them — not just to protect against illness, but also to relieve the regimentation of daily routine for the residents

Few people realize how thinly nurses are stretched in these homes. There is usually only one nurse for about 30 often very ill residents in the daytime, one for about 60 at night. Usually there is no doctor on-site — residents typically see a doctor once every week or two.

There aren't enough doctors and nurses to look after the routine needs of these patients, including palliative care in many cases, much less address the COVID-19 crisis.

The long-term care crisis in Quebec is having an impact on seniors’ health even if they don’t have COVID-19. Doctors are seeing elderly patients coming to hospital with signs some basic needs aren’t being met. 2:04

In this pandemic, we have seen some people rushing to get their loved ones out of nursing homes to protect them — and others in anguish because they could not, forced instead to wave to them through a window after the homes were locked down.

The truth is that there would be fewer residents in these institutions if families had more help at home. Increased funding is needed for geriatric and palliative home care, to support not just the patient but also their family.

COVID-19 has made everyone think about what it means to be isolated and alone. For people in nursing homes, loneliness may be the most powerful condition of their everyday lives. When the pandemic is over, each one of us – whether we have a loved one in one of these homes or not – needs to consider whether there is something we can do to improve the living conditions and relieve the monotony and loneliness of our sickest seniors.

Many of our parents and grandparents will live their last months and years in these places. Many of us will end our days there, too.

Governments are stepping up and acknowledging that changes are needed.

Now and after the pandemic, let's make sure that nursing homes are not a feared destination in which to live or die.


About the Author

Dr. Amit Arya is a front-line physician working in long-term care homes as a palliative care specialist.

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