Dear Colleagues: Welcome to our Friday, July 17 report – now in the sixth 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.

Continuing to pursue family reunification

RNAO’s push for family reunification continued this week by laying out a step-by-step process by which LTC homes can bring this about in a safe, humane and responsible way. See, next, RNAO’s press release on Wednesday, July 15.

RNAO calls on government to immediately reunite families with their loved ones in all long-term care homes in Ontario

RNAO urges the Ontario government to immediately direct all nursing homes in Ontario to reunite residents with their loved ones, including those in nursing homes experiencing a COVID-19 outbreak. RNAO’s call is driven by the need to address a basic human right, and also to provide the foundational person- and family-centred care that is critical to quality of life for LTC residents and their families. 

RNAO says the length of the COVID-19 pandemic, the likelihood of a second wave, and the lessons-learned from outbreaks in LTC necessitate a different approach, and one that is uniform across the province. All nursing home operators must be required to follow this approach.

“We have heard from families who have shared their hardships trying to connect with spouses, parents, grandparents and other relatives. It’s obvious that the lack of clear direction from Ontario’s chief medical officer of health is the reason we have a patchwork of protocols that is leaving families confused and some residents without the meaningful connections they need for their health and well-being,” says Dr. Doris Grinspun, RNAO’s CEO. Grinspun says the last few months have been excruciating for residents, their family members and friends, and staff. Grinspun says residents have paid a huge price in terms of their quality of life and their safety. “It’s heartbreaking and must change immediately.”

Grinspun says such change can come in the form of a five-step process RNAO developed in consensus with experts, including families of LTC homes. It lays out clearly defined steps that facilitate family (friend) visits that are vital, safe, meet people’s needs and prevent further suffering:

1. Step 1: The LTC home invites families, including the resident (as appropriate) to identify up to three Essential Family Care Partners (EFCP) for each resident. During the EFCP identification process, every effort is made to achieve consensus, however in cases where consensus cannot be reached between the family and the LTC home, family members have access to the office of the patient ombudsman to help reach a mutually agreeable decision.    
2. Step 2: The LTC home utilizes and/or augments current internal policies related to COVID-19 screening, personal protective equipment (PPE) provision, and communication, specifically to staff and others related to the identified EFCPs and their role. For LTC homes in an active outbreak, the EFCP will be asked to sign a statement of understanding that they are placing themselves at an increased risk of contracting COVID-19 and accept all responsibility for it. 
3. Step 3: The LTC home provides the formally identified EFCPs with current and regularly updated information/education related to PPE, required infection prevention and control practices, and any directives in place because of COVID-19. To minimize risk, each EFCP is responsible to follow the guidance provided by the LTC home while attending to their loved one, and failure to do so may result in losing EFCP status.  
4. Step 4: The EFCP is provided with identification to be used for entry to the LTC home and to facilitate documenting their presence in the home should contact tracing be necessary. One EFCP is able to be present at a time in the home and in the company of the resident, without undue restriction on the number or length of visits.  
5. Step 5: Government facilitates access to PPE and the LTC home ensures there is adequate PPE for use by EFCPs, consistent with the requirements for staff, given the resident's care needs. The goal is a risk-tailored strategy that focuses on safety while simultaneously providing a humane and ethical approach to interaction between the resident and their family member. This approach can include touch, hugging, and close face-to-face interaction between the EFCP and the resident. However, the EFCP commits to keep two metres physical distance from LTC home staff, any other residents and other EFCPs.

RNAO President Morgan Hoffarth says the process addresses RNAO’s consultations with families and emerging evidence that restrictions on family visits in the name of safety have resulted in more harm than good. Such restrictions are now considered unethical, inhumane and unsafe.

“As nurses, we can no longer support the imposed restrictions most nursing homes have placed on family members. There is no evidence for it and the harm caused is significant. RNAO will continue to do everything in its power to ensure families and residents reunite in a meaningful and fulsome way. We will also urge that these rights not be taken away when COVID-19 outbreaks occur. Our process provides the necessary structure long-term care operators need, and gives residents and their families the respect and speedy attention they deserve,” Hoffarth says. “For families, this means being able to provide the emotional support their loved one yearns for, as well as assist with personal care, such as help with eating, hydration and toileting. Families and (friends) play a vital role in residents’ health and well-being. We want the government to honour these relationships by immediately heeding our advice.”

Update: Hours after RNAO’s press release, Ontario Minister of Long-Term Care Merrilee Fullerton announced Wednesday the new rules that will permit indoor visits of two friends or relatives at a time, starting July 22. Before entering the home, all visitors will be required to attest they have tested negative for COVID-19 within the past 14 days. Outside visits, which began June 18, no longer require a COVID test. These visits will only be allowed in nursing homes that are not in an outbreak. 

RNAO’s Response: Check here and RT

Connection: Updates, voices and opportunities to engage

RNAO launches new social media campaign #Maskathon

RNAO has launched a campaign to promote the use of masks. Here is our July 14 press release:

As we continue to battle COVID-19 in our communities and around the world, we must all play a part in staying safe and healthy. That’s why RNAO has launched #Maskathon. 

The social media campaign builds on #Masks4Canada, an initiative that has moved municipality after municipality to make masks mandatory – with Quebec being the first to make masks mandatory for the entire province. RNAO applauds politicians who realize that masks are an additional effective step to reduce the spread of COVID-19 to save lives and mitigate the economic impact of the pandemic.

RNAO urges everyone – including children and youth – to wear a non-medical mask or face covering in indoor public spaces (shops, malls, other businesses), busy areas and transit and send us photos via social media (Twitter, Facebook, Instagram) with the hashtags: #Maskathon and #TogetherWeCanDoIt.  

“Nurses, doctors and other health professionals have already spoken out about the importance of wearing masks in indoor public spaces and show that wearing a mask – on top of practising safe physical distancing and good hand hygiene – makes a difference to contain a second wave of COVID-19. #Maskathon encourages you and your loved ones to raise awareness about masks and why everyone should be wearing them to stop the spread of COVID-19,” says RNAO CEO Dr. Doris Grinspun, adding we must remain vigilant and do all we can to slow down a second wave of this dangerous virus.  

“Children and young adults many times can act as role models for their siblings and parents by demonstrating that wearing a mask can be fun. This is especially true this summer as we go out more and as businesses, playgrounds and other public places are opening. It is important that we stand together and play a part in this fight against COVID-19,” says RNAO president Morgan Hoffarth.  

What: #Maskathon campaign to encourage everyone – including kids and young adults – to wear a mask in public indoor spaces (shops, malls and other businesses), busy areas and transit.

How to participate: We urge participants to post their pics on social media using the hashtags: #Maskathon and #TogetherWeCanDoIt. For those who do not have social media, but would still like to participate, please send us your photo at maskathon@RNAO.ca and we will share it on our social media channels. Please be sure to also include a caption with your photo (e.g. this is my daughter wearing her mask while grocery shopping with me).

Weekly contest: Every Thursday, we will be selecting one “photo of the week” and sharing it across our social media channels and CEO Blog. 

How to wear a mask properly: When wearing a non-medical mask or face covering, please remember to wear it all the way up, close to the bridge of your nose and all the way down under your chin. The mask should also fit snug around your face without gaps.

#Maskathon is the latest initiative of RNAO’s campaign #TogetherWeCanDoIt, which launched on March 19, 2020. The campaign is designed to show support for health workers and other essential personnel who are doing all they can during the pandemic on behalf of Ontarians and around the world. 

Tune in this Saturday and Sunday for TD Salsa in Toronto Festival: Keep Dancing

Are you a fan of salsa or Latin culture?

Tune in on Saturday, July 18 at 6 p.m. ET and Sunday, July 19 at 7 p.m. ET (encore performance) for the virtual TD Salsa in Toronto Festival. The festival is Canada’s largest celebration of Latin culture and will feature musical performances, dance class instructions, culture parade features and a lot of dancing!

RNAO will be making a special appearance featuring some of us with Latin-American blood running through our veins J including me, Patricia Ruiz Skol -- an active RNAO member and Chief Nursing Executive at Toronto Grace Health Centre -- and neighbours. We will be celebrating our appreciation for Latin culture and diversity as well as our#Cheer4HealthWorkers initiative and #TogetherWeCanDoIt campaign.

The festival will be streamed worldwide at tln.ca and broadcast on the TLN TV channel.

Update on webinars

RNAO has held weekly COVID-19 webinars every Monday evening since March 30. The last one, on July 6, was on family reunification in LTC (see item above). Attendance is always anywhere between 200 and 350! The COVID-19 Webinars: Together We Can Do It! are free and open to all.

We are now decreasing the frequency of webinars. There was no webinar on Monday, July 13. For the remaining of July and August, there will be three webinars a month. The information for the upcoming webinar, as well as the archive for earlier ones, can be found here.

The next webinar will be on Monday, July 20, 6:45-8:00 pm. As updated earlier, RNAO has launched a task force to tackle anti-Black racism within the nursing profession. The task force is co-chaired by RNAO immediate past-president Angela Cooper Brathwaite and Chantal Sorhaindo, RNAO member and NP at Toronto’s St. Michael’s Hospital. The webinar will offer an update on the work of the task force and an open consultation with participants. Details will be posted here.

On Monday, August 10 the webinar will provide a brief update on health system transformation and focus on nurses’ mental health and wellbeing (see item above). Please register here.

If you have not had a chance to watch previous webinars, here are a couple of them:

• On July 1, we hosted Dr. Jennifer Kwan, a family physician and one of the organizers of #Masks4Canada. She spoke about what we need to do to have a successful re-opening of the economy, and the role that COVID-19 surveillance, good data and masking have in achieving that. You can watch it here.
• On June 22 we discussed the Impacts of COVID-19 on Indigenous Communities with three guest speakers: Ontario Regional Chief RoseAnne Archibald; Mae Katt, Nurse Practitioner with Temagami First Nation; and Marilee A. Nowgesic, CEO of the Canadian Indigenous Nurses Association. You can watch it here.

#Togetherwecandoit

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 #174 for 17 July: 

Actions taken:

The Ontario government announced a made-in-Ontario Intellectual Property Action Plan to help ensure the tremendous social and economic benefits of taxpayer-funded research and innovation stays right here in the province. In addition, the government unveiled the second round of research projects approved and supported through the $20 million Ontario COVID-19 Rapid Research Fund. Through these efforts, researchers will be working to find ways to prevent, detect and treat COVID-19. 

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. We want to send huge love and support to our colleagues and BPSOs in Latin America – they are still hit hard – especially in Peru, which is the country with the highest per-capita COVID-19 related deaths – striking the poorest communities. 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 BLOG ITEMS:

10 July - Nurses’ mental health, leave of absence and return to work experiences – go here.

10 July - RNAO continues to pursue family reunification in LTC – go here.

10 July - Support Zimbabwean nurses arrested and fired for protesting deteriorating pay and working conditions during pandemic – go here.

3 July -   RNAO launches task force to tackle anti-Black racism within the nursing profession – go here.

3 July -   Rather than praise, let’s protect our nurses – go here.

3 July -   Nurses celebrated diversity during Pride month – go here.

26 June - Nursing Home Basic Care Guarantee – go here.

26 June - Masks for all – the policy imperative in Canada – go here.

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.

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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