Dear Colleagues: Welcome to our Friday, June 12 report – now in the fifth month of COVID-19 in Ontario. Visit the COVID-19 Portal for the many resources RNAO offers on COVID-19. You can refer to earlier update reports here, including thematic pieces in my blog. Feel free to share this report or these links with anyone interested – they are public.

More than 600 registered participants for RNAO’s 95th AGM – are you?

We already have more than 600 registered participants, and you can still register online or join live stream. All events will be broadcast live on RNAO.ca, YouTube and Facebook. Registration is free and open to anyone. Go here to register, and go here for all the information. This is our press release summarizing all the events. And click here for our absolutely stunning AGM Report.

Yesterday, June 11, we had our Opening Ceremonies from 6:00pm to 7:00pm, featuring live remarks from Christine Elliott, Deputy Premier and Minister of Health and Mike Schreiner, Leader, Green Party of Ontario, as well as video greetings from Dr. Merrilee Fullerton, Minister of Long-Term Care, Andrea Horwath, Leader of the Official Opposition, and Steven Del Duca, Leader, Ontario Liberal Party. We also featured video greetings from Dr. Barbara Stilwell, CEO Nursing Now Global, and a letter from Richard Ricciardi, President, Sigma Theta Tau. We also had a very special guest – of course I am referring to Ms. Florence Nightingale. Yes, you heard me correctly, and you can see it for yourself here! Most excitingly, we celebrated our LTC BPSOs designation ceremony for 2020.

Today, Friday, from 4:00pm to 7:00pm, we’ll hear from Premier Doug Ford, and we will conduct our usual business including the Association’s auditor, provincial committees, followed by my yearly report that will undoubtedly showcase RNAO in action before and during COVID-19. As always, we will enjoy the consultation session on resolutions, media and member recognition awards, our president’s remarks and the passing of the gavel from President Angela Cooper Braithwaite to incoming President Morgan Hoffarth.

All this is followed by an important closing keynote panel on Saturday from 11:30am to 1:00pm titled: Celebrating the Year of the Nurse: Scaling Up Our Voices, featuring international nursing leaders Dr. Barbara Stilwell, Executive Director of Nursing Now Global and Dr. Mary Wakefield, former Administrator, Health Resources and Services Administration (HRSA) and Deputy Secretary, U.S. Department of Health and Human Services under President Obama. This session will focus on the history of nursing and set the foundation for the next generation of nurses. 

If yesterday’s opening ceremony was any indication with over 300 joining via Zoom and others joining our live stream – then today and Saturday should be filled with energy and fun as well. I am so excited myself, and looking forward to this boost of energetic and meaningful time together, albeit virtually.  

Petition on masks for Canada

We received the following message from Dr. Jennifer Kwan, a family physician, inviting health providers to add their signature to a petition calling on mandatory masks in Canada in three high-risk settings: all indoor spaces outside the home, crowds, and public transit. We support this request wholeheartedly and I already signed and urge you to do the same! And – as important – let’s start to personally abide by this call.

Masking is an important public health prevention tool we should utilize as we restart the economy. It is simple, cheap and effective. Masks, in addition to – not instead of – other public health measures, can add an additional layer of protection and contribute to reduce the risk of spread.

Message from Dr. Kwan: I'm working with a group of colleagues to recommend mandatory masking policies for high-risk settings in Ontario (such as indoor spaces, crowds, and public transportation). We recommend minimizing fines and penalties, focus on public education (when/how to wear), and distribute masks for the most vulnerable. Many studies, and most recently the WHO, have concluded that universal masking in these settings is key to getting the pandemic under control and reducing community transmission. Masks will help save both lives and the economy! 

You can view the open letter to our Public Health and political leadership here: http://bit.ly/masks4canada 

We would greatly appreciate if you, a medical and/or scientific professional, can lend your voice to this important cause and sign at this link: http://bit.ly/masks4canadaMedFormON

Please forward this message to your contacts, including nurses, physicians, scientists, researchers, dentists, dental hygienists, optometrists, nurses, PTs, OTs, MLTs, pharmacists, all health professionals, and concerned citizens, and help Ontario reopen safely!

Our plea for action to safeguard the safety of residents in LTC continues

RNAO continues pushing with determination to make things better in long-term care in Ontario. We have all been in shock at the tragedy that has befallen so many of our elders due to systemic neglect and faulty policies that have been going for too long. RNAO issued last week a new report summarizing two decades of reports, inquiry and commission – and calling on the government to take action, not engage in more study and deliberation. Here is the press release.

RNAO releases list of 35 reports and recommendations dating back 20 years documenting the government’s failings of Ontario long-term care sector

If the Ontario government is serious about fixing the long-term care (LTC) system, it must adopt evidenced-based solutions documented in numerous reports that have examined the sector’s failings.

RNAO today released a list detailing dozens and dozens of recommendations in the areas of staffing and funding made in 35 reports as well as a public inquiry and a coroner’s inquest looking into the problems in LTC over the past 20 years. The recommendations in these reports call for more staffing in LTC homes, the proper skill mix of regulated and unregulated staff to meet the increasing acuity, and a funding model that responds to growing needs.

RNAO compiled Long-Term Care Systemic Failings: Two Decades of Staffing and Funding Recommendations because we are among those who have examined this issue for years. “We implore the Ministry of Long-Term care, the Ministry of Health and the premier to act NOW. It is disheartening, exhausting and expensive to continue to study problems that are known and understood and where the missing factor is the political will to act decisively rather than, once again, kick the can down the road with more commissions and more reports,” says Dr. Doris Grinspun, RNAO’s CEO. “Enough of over-studying and under-acting in this sector – we know and the government knows what needs to be done to improve and save the lives of LTC residents.”

“Premier Ford has vowed to fix the system. He says there will be accountability. However, as much as I want to believe him, I have heard heartfelt words from political leaders before. Accountability begins at the top and must be delivered with swift actions. Residents living in long-term care, along with their families, and staff can’t wait any longer for change. No study and no words will deliver better care for residents, only better funding and better staffing will,” Grinspun insists.

RNAO has proposed a staffing formula that builds on earlier reports and studies and addresses those needs. It wants each LTC home resident to receive at least four hours of direct nursing and personal care per day, based on a skill mix of regulated and unregulated care providers. Of those four hours, 0.8 hours (48 minutes per day) should be provided by a registered nurse (RN), 1 hour (60 minutes per day) by a registered practical nurse (RPN), and 2.2 hours (132 minutes per day) by an unregulated personal support worker (PSW). In addition, each home should have one nurse practitioner (NP) for every 120 residents as well as a nurse specializing in infection prevention and control.

RNAO explains such a formula is necessary because about 55 per cent of LTC residents are 85 years or older and 90 per cent of all residents have some form of cognitive impairment, including dementia. The majority of residents in LTC also have complex health needs including chronic conditions such as heart disease, diabetes or arthritis - needs that require the expert care and skill mix NPs, RNs, RPNs and PSWs provide. 

RNAO’s President Dr. Angela Cooper Brathwaite says a critical deadline is looming. “July 31, 2020 is an important date on the government’s calendar. It’s the deadline Justice Eileen Gillese gave the government to table in the legislature a detailed report on the adequacy of regulated staffing in LTC. It was a key recommendation in her report The Long-Term Care Homes Public Inquiry (2019).”

“The July 31 government report gives the opportunity to Premier Ford to demonstrate he means action. We need to address staffing and funding issues in LTC immediately. We don’t need more studies, as the list released by RNAO today demonstrates. Let us get on with improving the lives of people, in real ways. We owe residents in LTC a debt of gratitude for the contributions they have made during their lives. They should be able to live with dignity, comfort and love, and they and their staff should be better equipped and protected, especially when the second wave of the pandemic hits,” adds Dr. Cooper Brathwaite.

Your messages: Voices and responses

Each day we receive numerous messages. Each day we also welcome new readers to this daily report: Thank you deeply for the work you do always and especially during this public health crisis, and also for keeping us well informed. You can see previous reports here. Feel free to share these updates with other health professionals and other organizations both at home and abroad. RNAO media hits and releases on the pandemic can be found here. Daily Situational Reports from Ontario's MOH EOC can be found here. Many of the articles you see here are posted in my blog, where you can catch up with earlier issues. The COVID-19 Portal is here.

COVID-19 webinar: Let’s talk about racism

Join us on Monday, June 15, at 6:45 pm - 8:00 pm Toronto time, for our COVID-19 webinar: Together We Can Do It! for a panel discussion on the topic, Let's Talk About Racism. We will have panelists addressing questions such as: How has COVID-19 exposed systemic racism? What actions can nurses and other health providers take to address systemic racism? We will have the opportunity for open discussion. Health providers from Ontario, Canada, and anywhere in the world are welcome to join. You can find information about the webinars here. Register now for this free webinar here.

Expanded EOC Situational Report

We were very pleased to see an expanded EOC situational report starting on June 8, with much more detail than previously provided regarding cases, active and resolved, deaths by sector, mode of acquisition, daily counts, effective reproduction number, testing, acute care, and active outbreaks.

As our readers are aware, we have been encouraging more data transparency for quite some time. A clear understanding of the epidemiology and where Ontario is situated with COVID-19 is essential to continue the opening of the economy. An expanded Situation Report is, despite the belated arrival, a good step in the right direction.

The new format is too long to include in full in our report, so in the MOH EOC Situation Report section below we are going to include a link to a posted version of the latest Situation Report.  

Together we can do it

MOH EOC Situational Report #138 for Thursday, June 11

Situation:

The full EOC Situational Report #138 for Wednesday, June 11 can be found here.

For a more detailed Ontario epidemiological summary from Public Health Ontario, go here.

EOC report #133 for June 6 informs of the following actions taken:

• The Ontario government, after consultation with the Chief Medical Officer of Health, has extended all emergency orders currently in force under s.7.0.2 (4) of the Emergency Management and Civil Protection Act until June 19, 2020.

EOC report #134 for June 7 informs of the following actions taken:

• None

EOC report #135 for June 8 informs of the following actions taken:

• Today, the Ontario government announced that it is getting more people back to work and more recreational activities open by moving forward with a regional approach to Stage 2 of reopening the province. In consultation with the Chief Medical Officer of Health and local health officials, the government is easing restrictions in communities where it is safe to do so, based on trends of key public health indicators such as lower rates of transmission, increased capacity in hospitals, and progress made in testing.

EOC report #136 for June 9 informs of the following actions taken:

• Today, the Ontario government announced its plan to reopen child care centres across the province to support the next stage of the province's reopening framework. Developed in consultation with Ontario's Chief Medical Officer of Health and medical leaders at The Hospital for Sick Children, the plan will require child care operators to follow strict health protocols to ensure the safety of child care staff and children.
• On June 8th, 2020, the Minister of Health issued an updated order and direction under the Health Protection and Promotion Act requiring specified health care providers as well as retirement homes to report on their CSE inventories and anticipated needs. This order and direction replaces the order issued on March 27th, 2020, and allow for a reduction in reporting frequency from daily to twice weekly. The updated Minister’s order and direction is available here and here and here and is available on the MOH COVID-19 Website. Instructions for participation are published on the Ontario Health Website.

EOC report #137 for June 10 informs of the following actions taken:

• The Ontario government has developed a plan for the gradual and safe resumption of in-person instruction at postsecondary institutions across the province for the summer term. The plan was developed in consultation with the Chief Medical Officer of Health.
• The Ministry of Education released an operational guidance document for childcare center re-opening. It is available here.

EOC report #138 for June 11 informs of the following actions taken:

• In consultation with the Chief Medical Officer of Health, the Ontario government announced the gradual resumption of visits to long-term care homes, retirement homes, and other residential care settings, starting on June 18, 2020 (see here and here).
• Directive #3 (see here and here) has been revised to include various updates to:

• Admissions and Re-admissions to enable the transfer to LTCH/RH from hospitals or community.
• Short-Stay Absences to support Retirement Home residents to leave in accordance to MSAA policies and transfer to hospital, under specific circumstances, from a home in outbreak.
• Allowing for certain visitors in alignment with the MLTC and MSAA visitor policies.  
• Changes to address ending a suspect outbreak/outbreak assessment steps based on negative test results.
• Updating language around advanced care planning and expressed resident wishes about future treatment

• Documents supporting the revised directive are attached and include:
  • Memo Re-introductions of Visits & Transfer of Hospital Patients and Community Clients to Long-Term Care Homes (see here)
  • MLTC Policy on Visitors – Resuming Visits in Long-Term Care Homes
  • MLTC Policy on New Admissions and Re-admissions to Long-Term Care Homes (see here)
• Long-Term Care guidance documents will be updated in accordance with the revised Directive.
• All attached documents will be available shortly in French and English on the Ministry’s website. Please consult the most recently posted guidance documents.

Staying in touch          

Please continue to keep in touch and share questions, comments and challenges. Send these to me at dgrinspun@rnao.ca and copy my executive assistant, Peta-Gay (PG) Batten <pgbatten@rnao.ca>. Due to the volume of comments and questions, we are responding as fast as we can. RNAO’s Board of Directors and our entire staff want you to know: WE ARE HERE FOR YOU!

Thank you deeply colleagues in the front lines; in administrative roles; in all labour, professionals and sector associations, and in governments in Ontario, in Canada and around the world. We are here with you in solidarity. These are stressful and exhausting times; the only silver lining is coming together and working as one people – for the good of all!

Together, we must redouble our efforts to tackle COVID-19 with the best tools at hand: full, accurate and transparent information, calmness, determination and swift actions. 

Doris Grinspun, RN,MSN, PhD, LLD(hon), Dr(hc), FAAN, O.ONT
Chief Executive Officer, RNAO

RECENT RNAO POLICY CORNER ITEMS:

6 June   - Statement – RNAO stands together with our Black sisters and brothers – go here.

3 June   - Adapting harm reduction during a pandemic – go here.

29 May - Foot care nurses – go here.

29 May - Update on pandemic pay; pandemic pay in consumption and treatment sites – go here.

28 May - RNAO Calls for Immediate Action in Response to the Canadian Armed Forces’ LTC report – go here.

26 May - Update on VIANurse – go here.

26 May - Ending homelessness: Will you join us to build a COVID-19 recovery for all? – go here.

24 May - Technology as a solution: Opportunities and pitfalls of COVID contact-tracing apps – go here.

21 May - Debunking PPE myths with Dr. Jeff Powis: Which masks should health care workers wear during COVID-19? – go here.

20 May - RNAO response to announcement of an independent commission into Ontario's long-term care system – go here.

19 May - With the pandemic curve flattening, VIANurse program will focus its effort on outbreaks – go here.

14 May - Nursing Week update – go here.

14 May - Pandemic puts health system to the test: Nurses have answers for shortfalls – go here.

14 May - Disappointment for not being included in pandemic pay – go here.

13 May - RNAO saddened by the loss RN Brian Beattie to COVID-19 – go here.

13 May - End racism and prejudice – go here.

12 May – Enhancing Community Care for Ontarians (ECCO 3.0) – go here

11 May - Nurses share their successes and challenges during National Nursing Week – go here.

10 May - A story of hope, ingenuity, support and genuine care for an LTC resident – go here.

7 May    - Counting the missing deaths: Tracking the toll of the coronavirus outbreak – go here.

5 May    - Life on the front lines of the pandemic: Profile of RNAO member NP Daria Gefrerer – go here.

5 May    - Addressing differential access to virtual care due to technology inequities – go here.

3 May    - Being person-and-family-centred during COVID-19 – go here.

1 May    - Migrant agricultural workers and the COVID-19 crisis – go here.

30 April - COVID-19 pandemic in provincial institutions and correctional centres – go here.

28 April - Supporting First Nation Communities during COVID-19 – go here.

27 April - Responses to COVID-19 for persons experiencing homelessness in Toronto: An update – go here.

25 April - Lessons learned through a COVID-19 nursing home outbreak – go here.

25 April - Letter from a retired RN to Premier Ford: The problems with LTC were evident long before COVID – go here.

23 April - Working with seniors in long-term care requires specialized knowledge – go here.

22 April - Shaking the stigma: We need a proactive COVID-19 response for mental health and addiction – go here.

21 April - We Require Expanded and Accessible COVID-19 Data in Ontario – go here.

20 April - Can Loss of Smell and Taste Help Screen for COVID-19? – go here.

18 April - COVID, Trump and the World Health Organization – go here.

16 April - A Home Based Model To Confront COVID-19 – The Case Of The Balearic Islands – go here.

15 April - COVID-19 and the Challenges in Homecare – go here.

14 April - Reprocessing Of N95 – An Update – go here.

14 April - A New COVID-19 Facility For Persons Experiencing Homelessness In Toronto – go here. 

13 April - Practical Tips for Safe Use of Masks – go here.

10 April - Ontario’s Tragedy in Long Term Care Homes and Retirement Homes – go here.

10 April - RNAO Action – Supporting Long-Term Care – go here.

10 April - Update For Nursing Students – NCLEX Exam – go here.

9 April - Celebrating Passover, Good Friday, Holy Saturday, Easter Sunday and the start of Ramadan during a pandemic – go here.

9 April - Guidance on use of N95 mask – go here.

7 April - Sentinel surveillance and on-site testing in the homeless service sector – go here.

7 April - Reprocessing of n95 – safe? – go here.

5 April - We must change the way we do testing and case definition – go here.

5 April - Ringing the alarm bells on critical care beds – go here.

4 April - COVID-19, stay at home and domestic violence – go here.

We have posted earlier ones in my blog here. Please go and take a look.

Information Resources

Public Health Ontario maintains an excellent resource site on materials on COVID-19. This is an essential resource for Ontario health providers. 

Ontario’s health provider website is updated regularly with useful resources here.

Ontario’s public website on the COVID-19 is there to inform the general public – encourage your family and friends to access this public website. The WHO has provided an excellent link for you to share with members of the public here.

Please promote the use of Ontario’s COVID-19 self-assessment tool: It also has a guide where to seek care, if necessary. Its use will provide the province with real-time data on the number and geography of users who are told to seek care, self-isolate or to monitor for symptoms. Data will inform Ontario's ongoing response to keep individuals and families safe.

Health Canada's website provides the best information capturing all of Canada. It contains an outbreak update, Canada's response to the virus, travel advice, symptoms and treatment, and resources for health professionals.

The World Health Organization plays a central role in addressing the COVID-19 pandemic. See here and here.

You can find up-to-date global numbers in Coronavirus COVID-19 Global Cases by Johns Hopkins CSSE.

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