Ontario's long-term care system is in crisis, with COVID-19 infections at nursing homes across the province and an outbreak at just one facility in Bobcaygeon believed to be responsible for 14 deaths.
According to the associations that represent the nurses and personal support workers who staff those homes, two problems have worsened the crisis and allowed the deadly virus a broader reach: a long-term, systemic staffing shortage and a policy that denies workers masks until after an outbreak has occurred.
"The situation is dire, completely dire," said Doris Grinspun, CEO of the Registered Nurses' Association of Ontario.
"It's Hell," said Miranda Ferrier, president of the Ontario Personal Support Workers Association. "And I'm not just saying it to be dramatic, and it's legit Hell."
On Monday, Premier Doug Ford vowed to create an "iron ring" around the homes to protect the frail, vulnerable residents from the coronavirus. Associate Minister for Long-Term Care Merrilee Fullerton said that means the province is continuing to look at ways to better screen those coming into long-term care, and isolate those with COVID-19.
"We're doing everything we can to make sure that we protect the most vulnerable seniors, to make sure we have 24/7, making sure that we've increased the funding for cleaning, making sure that we give the resources to the frontline health-care workers at long-term care, we're doing everything we can," said Ford Tuesday. "I just wish I had a crystal ball a month-and-a-half ago to see where this was going."
It is too late for many homes to stop the virus from infecting residents and staff, and because of that the province has lifted the regulations that, in normal times, are meant to ensure residents' health and safety.
The change, made under the province's emergency order, allows workers who wouldn't otherwise be qualified to pitch in, and lets the facilities' management teams off the hook in terms of what information they report to the provincial government. The province is also redeploying the inspectors who would normally enforce the regulatory regime, directing them to help homes maintain their staffing supply, co-ordinate care, and prevent and contain infections, the province announced.
According to a coalition of groups representing the sector, the stripping of regulations was necessary to keep homes operating amid a dramatic loss of staff.
"We are facing the potential loss of half of the frontline long-term care workforce during the pandemic. Despite the heroic efforts of dedicated staff, a severely short-staffed home simply cannot provide the level of care that residents need during this pandemic," said a statement from the Ontario Long Term Care Association, AdvantAge Ontario, Ontario Long Term Clinicians, Family Councils Ontario and the Ontario Association of Residents’ Councils.
"This severe and growing staffing shortage had to be addressed to ensure that care could continue to be provided in a situation that our regulatory framework never contemplated. With the crisis becoming more critical every day, the government was right to recognize that an Emergency Order was the only viable answer."
The associations that represent employees are taking the lead co-ordinating the redeployment of nurses and personal support workers, with an online portal for nurses called VIANurse, and Ferrier reaching out to her members and long-term care homes directly.
But the ability to backfill staffing has been somewhat ad hoc: Ferrier said she was able to give a nursing home in east Toronto names of available PSWs who could come in within hours, but had no help to offer a nursing home in Parry Sound that was desperate. In part, that's because personal support work isn't a regulated profession, and membership in the Ontario Personal Support Workers Association is voluntary.
Both Grinspun and Ferrier said long-term care homes have been dangerously understaffed for years, a problem they say is exacerbating the current crisis. Some workers are sidelined because they're sick or required to self-isolate. In other cases, workers who had been working part time at different homes, which was common, have been restricted from continuing to do so to stop them from spreading COVID-19.
Ferrier said PSWs have stepped up to help, including many who normally work in home care but have seen most of the clients cancel their services, either out of fear of contracting the virus or because they now have a loved one who isn't working and can care for them.
"Even though are a lot of them are scared and there's a lot of anger around this new emergency order they've really stepped up to the plate," she said. "We're seeing some heroes come out of this one."
It's not just nurses and personal support workers: nursing students, PSW students and developmental service workers are also going into long-term care homes.
Some of Ferrier's members were upset to see the province allow anyone to fill the roles in long-term care homes usually reserved for personal support workers, but she said her organization agreed to the emergency regulatory change to prevent a burnout crisis that was already brewing in the long-term care sector before the coronavirus hit.
"I'm praying every day it doesn't get worse, but if it does get worse and turn into a war zone, I think then they'll be happy there will be more hands on deck, but right now they're not too thrilled about it," she said.
Ontario would be in a different situation now if homes hadn't been short-staffed for years, according to both Ferrier and Grinspun.
Grinspun said her organization has been calling for higher staffing levels in long-term care for a decade or more, particularly the number of registered nurses and nurse practitioners. Before the coronavirus pandemic, Fullerton had launched a review of staffing levels based on the long-term care inquiry prompted by the Elizabeth Wettlaufer serial killings.
Ferrier said when homes are short staffed, infections are more easily spread because everyone is human and when they're overwhelmed, simple things like a hand-washing, cleaning a bed rail, or changing gloves between patients can get missed.
"It's no one's fault, it really truly isn't," she said.
The stress that causes also causes PSWs to leave the system altogether — and Ferrier said the PSW retention problem has become so severe she's worried there won't be anything of the profession left by the time the crisis is over.
"It's exhausting," she said. "When you can't clean their dentures, when you can't lotion their legs, or sit and chat with them, it's heartbreaking. And that's how the PSW gets burnt out. It's not only physical burnout, it's emotional and mental burnout."
The message that understaffing poses a risk to resident was echoed by Unifor President Jerry Dias, who said his union has been calling for better working conditions in long-term care for years.
"What is becoming increasingly evident in the pandemic, however, is that safe and decent working conditions for staff at long-term care facilities are also safe and decent living conditions for the residents," said "The two cannot be separated. Residents can’t be safe if the workers aren’t."
Meanwhile, another of Ferrier's major concerns is the lack of masks available for PSWs working in long-term care. That concern was echoed by Grinspun, who said her organization has been asking for weeks for the government to ensure all long-term care employees to get two surgical masks a day.
"Right now, they're getting the surgical masks after they get an outbreak, not just the virus, an outbreak," Grinspun said. "We would not have had the degree of outbreaks we've had should we have had access — so now is the time to act, not to talk any more."