Dear Colleagues: Welcome to our Friday, June 26 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. RNAO media hits and releases on the pandemic can be found here. Daily Situational Reports from Ontario's MOH EOC can be found here. Feel free to share this report or these links with anyone interested – they are public.
Doris’ blog goes weekly
Colleagues and friends – It has been a long haul and this blog and all of us at RNAO have walked with you every step of the way! I started the COVID-19 updates on January 27, two days after the first Ontario case was announced. For a period of three months, until May 1, we kept an almost daily schedule for the updates. During the month of
May we kept a schedule of three times a week, and in June we have moved to a schedule of once a week. We will continue with the weekly update, including a summary of the week and other topics of interest (i.e., LTC Commission, government consultation for wave #2 of COVID-19). Should you have ideas you want discussed or want to offer to submit a piece for my blog – send me a note at
The Daily Situational Reports we get from Ontario's MOH EOC are being posted daily in RNAO’s website. That way, you can access the Ministry’s guidance without having to wait for my COVID-19 report. The link is here and you can check it every day.
We don’t know how long and with what intensity COVID-19 will come back, but what it is certain is that we are still not free from it and will not be until there is an effective and widely used vaccine and/or treatment.
As many have said, this is a marathon, not a sprint, so we must keep our strength and our responsible action through a long and difficult period. Although we are already preparing for wave #2 of COVID-19, we must also take time to regain energies and there is nothing like good weather to do so!
As always, feel free to continue writing to me and my staff and we will continue to do the best we can to respond.
Masks for all – the policy imperative in Canada
RNAO has been for several weeks calling on public health authorities in Ontario and in Canada to immediately implement mandatory masking in certain settings. Specifically, we follow the Masks4Canada letter from healthcare professionals asking that mandatory masking (or face covering) policies be established for “ACT”:
Anyone with a relevant medical condition or disability should be exempt from this policy, and the same should go for young children under the age of two. We recommend distribution of free masks to populations that may be vulnerable and/or at higher risk, in order to reduce inequity.
Furthermore, these measures should be implemented through an educational approach and not a policing one. We recommend avoiding fines, arrests, or criminal penalties to enforce the policy. Instead, we encourage politicians to role model and encourage mask use, same for our medical officers of health and all of us as leaders in health care. We are also asking government to engage in campaigns to help the public understand how to wear a mask properly, and the importance of masks for health and economic recovery.
The evidence on the effectiveness of masks to reduce the spread of COVID-19 grows daily and by now is irrefutable. In RNAO’s view, any further delay in the implementation of mask policies constitutes poor public health policy that will cost lives and have serious economic impacts.
RNAO calls on public health officials to ACT today: some already did – please RT!
If you want to hear an expert on why we should push for Masks for All, join us this coming Monday, July 1, 6:45-8:00 pm with Dr. Jennifer Kwan, one of the organizers of #Masks4Canada. The webinar is open to all, including reporters. Please register here.
Nursing Home Basic Care Guarantee
RNAO action alert – RNAO demands government implement a Nursing Home Basic Care Guarantee - please read the following action alert and sign it.
We must demand that the government take action to address the severe understaffing and inadequate numbers of registered staff in long-term care. The deadline is July 31, 2020 when Minister Fullerton must table in the legislature her report on the adequacy of regulated staff. There have been 35 reports in the past 21 years! Let this be the government that delivers action, not more study!
Seventy‐nine thousand (79,000) of the province's older adults call Ontario's 626 long‐term care (LTC) facilities home and trust them to meet their physical, social, spiritual and cognitive needs on a daily basis. Tragically, COVID-19 has wreaked havoc through these homes, exposing long-standing shortcomings in the LTC system including severe understaffing and inadequate numbers of registered staff given the increasing acuity, the intensity of nursing care required, and complexity of residents.
On June 9, 2020 RNAO released the in response to the Long-Term Care Staffing Study Advisory, struck to address Recommendation 85 of the Gillese Inquiry into the criminal acts of a staff member that resulted in the murder of eight residents. Justice Eileen Gillese gave the government a deadline of July 31, 2020 to develop a staffing plan for long‐term care and table it in the legislature.
RNAO’s submission provides detailed, evidence-based analysis supporting the basic care guarantee and staffing formula. It calls for implementing and funding recommendations from past inquiries and commissions, rather than engaging in more study and deliberation. RNAO says such action must begin right away, with Minister Fullerton’s tabling of her staffing plan by July 31, 2020.
RNAO calls on the government to adopt, fund and implement a nursing home basic care guarantee, and its related staffing formula, so residents of nursing homes can be assured safe care and quality of life, their families can sleep at peace, and staff will no longer need to struggle to meet the minimum care needs of their residents. It means that no home – whether for-profit or not-for-profit – will provide care below the guarantee. The staffing formula is based on evidence that builds on and addresses resident needs.
The Nursing Home Basic Care Guarantee minimum staffing formula provides no less than four (4) hours of direct nursing and personal care per resident, per day. The formula also calls to ensure the proper skill mix by allocating a minimum of:
Each home should have one nurse practitioner (NP) for every 120 residents and a full time registered nurse specializing in infection prevention and control.
RNAO says the recommended four hours of care, based on past studies of care need, is very conservative. In 2017, the government committed to providing these four hours of direct care. Shockingly, only 2.71 hours of direct care are currently provided to each resident on a daily basis. This means LTC residents in Ontario receive one third less nursing and care hours than the very conservative estimate government committed to, but hasn’t implemented since 2017.
Equally alarming is that current legislation in Ontario does not specify skill mix ratios for RNs, RPNs and PSWs. It only assigns one RN on-site per shift, which is grossly deficient. We estimate the current skill mix at 0.30 hours of RN care per resident, per day, 0.49 hours of RPN care and 1.92 hours of PSW care.
All three groups are below the recommended levels of nursing and care hours. For RNs, the shortfall is 63 per cent from the recommended level. For RPNs, there is a shortfall of 51 per cent. And for PSWs, the shortfall is 13 per cent. Added to these deficiencies is the reality that only a small number of nursing homes have NPs. Most homes must do without an NP.
The increase in staffing to meet the guarantee must be accompanied by immediate changes in human resources policies permitting staff to work in only one LTC facility; providing wage parity with hospitals; and ensuring that full-time employment with benefits is offered to staff who want full time work to enable continuity of care for residents, improve staff retention, and remove the need to work in multiple locations.
Action alert: Premier Ford has vowed to fix the LTC system. We urge you to demand the government implement with funding, the Nursing Home Basic Care Guarantee based on the minimum staffing formula. Let Minister Fullerton, Premier Ford, and the Staffing Study Advisory know that this is a necessary step to protecting Ontario’s older adults who call LTC their home. Ontario’s seniors deserve nothing less.
Please, add your voice today - sign the action alert here.
Connection: Updates, voices and opportunities to engage
We have continued to hold weekly webinars on Mondays, 6:45-8:00 pm together with external guests. Attendance is always anywhere between 200 and 350! The COVID-19 Webinars: Together We Can Do It! are free and open to all. The information for the upcoming webinar, as well as the archive for earlier ones, can be found here.
The upcoming webinar is this Monday, July 1, 6:45-8:00 pm, and we are delighted to host Dr. Jennifer Kwan, a family physician and one of the organizers of #Masks4Canada. She will speak about what we need to do to have a successful re-opening of the economy, and the role that COVID-19 surveillance and masking have in achieving that. To register go here.
If you have not had a chance to watch previous webinars, here are the last two:
Together we can do it
MOH EOC Situational Report
As announced above, we will be posting each day the Daily Situational Reports from Ontario's MOH EOC at RNAO’s website. That way, you will be able to access the Ministry’s guidance without having to wait for my COVID-19 report. Again, the link is here and you can check it every day.
Since this report will come out once weekly, that will provide a more timely access to Ministry guidance.
For a more detailed Ontario epidemiological summary from Public Health Ontario, you can always go here.
Here is a segment from the latest Situation Report #152 for 25 June:
Staying in touch
Please continue to keep in touch and share questions, comments and challenges. Send these to me at firstname.lastname@example.org and copy my executive assistant, Peta-Gay (PG) Batten <email@example.com>. 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
RECENT BLOG ITEMS:
18 June - Annual General Meeting – an exhilarating week! – go here
12 June - Petition on masks for Canada – go here
12 June - LTC: RNAO releases list of 35 reports and recommendations dating back 20 years – go here
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
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.
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.
You can find up-to-date global numbers in Coronavirus COVID-19 Global Cases by Johns Hopkins CSSE.
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