COVID-19 in long-term care: A nurse’s witness statement

Nurses and other healthcare workers in the frontlines of Ontario’s COVID-19 pandemic – especially in long term care, but increasingly in other sectors – are experiencing trauma. This is the result of sheer exhaustion, insufficient and late government action leading to escalating spread of COVID-19, episodes of public disregard for the necessary rules to contain the virus, and the excruciating loss of lives. And there is more – the muzzling of healthcare workers’ voices. There are hundreds, if not thousands, of untold stories of devastation, which workers keep for themselves for fear of repercussions.

Nurses are more and more confiding on RNAO and we are hearing about what happened during the first wave of COVID-19, and what is happening now. These accounts of preventable illness and death take added gravity as we count with 1,855 new cases in Ontario today – many preventable.

RNAO is inviting nurses – RNs, RPNs and NPs – and other healthcare workers to speak anonymously through us. Please write in full confidence to dgrinspun@rnao.ca with copy to pgbatten@rnao.ca 

Next we present with permission and unedited, the words of a registered nurse who has asked to remain anonymous. She was redeployed to a long-term care home in COVID-19 crisis in the spring. What she found is unbelievable and disturbing. The long-lasting personal impact on this nurse is palpable. Here is her account:

COVID-19 is once again surging and claiming the lives of residents in long-term care (LTC) homes, and the government is only offering weak or temporary solutions to a deeply flawed system.

Early on in the pandemic, my coworkers and I were redeployed to a COVID-19 unit at a LTC home in critical need of support. When we arrived, it was very quiet and there were no staff to be seen. It took some time to find the only healthcare worker on site, an agency nurse. She looked frantic and informed us she was in the middle of working a double shift.

None of us had been given training or any kind of orientation upon entering this LTC home. Looking around and assessing the situation – it was worse than we had anticipated. Residents were in their rooms, but many had not been assessed, changed, fed, or cared for in hours. We quickly decided to focus on basic necessities, but there was no infrastructure or support in place to help us meet this basic level of care. There was no access to information regarding residents’ dietary needs or social history, and we had no login passwords or access to medication records.

We tried to get in contact with the LTC home’s upper management, but had no luck, and it had already been some hours since arriving. Thankfully, in the middle of the day a personal support worker (PSW) arrived on her own merit, despite knowing that it was likely no one else would be coming in to help. She seemed genuinely worried about the residents’ well-being. This PSW guided us through the rest of the day, telling us the names of the residents and showing us where any limited supplies may be found.

Even with our combined efforts to provide basic care to the residents, we were failing. We found a resident on the floor and had to lift them back to bed. One resident was found lying in a different resident’s bed. Another was short of breath, at the end of their life, and dying with no one by their side. Our hearts were breaking, hopelessness set in and we were holding back tears. However, there was nothing more we could do but keep moving. We did not use the bathroom, eat, or sit for 12 hours and were afraid to remove our personal protective equipment.

As a nurse, I have frequently heard about the alarming and unique challenges the LTC sector faces. Now with the addition of COVID-19, this home was in a complete state of emergency. From my perception, they likely never had appropriate staffing levels and were hanging by a thread even prior to the pandemic. With the added stress of COVID-19, it seems that many LTC homes will not stand a chance.

Today, months have passed, and I still think about my experience and the residents often. I haven’t been able to openly discuss the details because as a nurse, we are discouraged from speaking out against the system in which we work. Nonetheless, our government was aware of the staffing shortages, among other complex challenges the LTC sector has faced for years. They have ignored many voices that have raised concerns regarding the state of the LTC sector. What will it take for our voices to finally be heard? How much more suffering needs to take place before more actionable changes are implemented? 

RNAO, once again, plays major role in the media during November

Media outlets, large and small, mainstream and otherwise, have played a very important role in the response to the pandemic. We at RNAO thank those in the media reading this blog for your vital contribution to inform the public as we work together – each of us in our roles – to tackle this nasty virus. It is through the media and by all of us pulling together that we sustain the togetherness that is needed to get us all to the finish line, hopefully no longer than a year from now.  

Today, we bring you a summary of RNAO’s media engagement for the month of November. Our extensive media exposure focused on key issues addressing the urgency of the pandemic situation. This includes the problematic provincial leadership in recent weeks; the auditor general’s report on the province’s handling of the pandemic; the ongoing crisis in long-term care; burnout among nurses and other healthcare workers; as well as the need for a #COVIDzero strategy. 

This past week, two issues in particular attracted the media to RNAO. The first was Premier Ford’s decision to introduce a surprise motion in the legislature to extend the contract of Ontario’s Chief Medical Officer of Health Dr. David Williams to September 2021. His contract was set to end in February 2021. As many of you know, RNAO has been vocal about the urgency of having decisive science-based leadership during the pandemic, both in terms of keeping COVID-19 under control, and the ability to communicate clear, trustful and consistent messaging. Unfortunately, Dr. Williams has not provided that leadership, and that’s why RNAO (and others) had earlier called for his resignation. The media was replete again this week with reactions, with many showing surprise, disapproval and alarm over Premier’s Ford decision. Numerous media outlets contacted us for our response, including the Toronto Sun, Toronto Star, CTV News and Now Toronto. I told the Globe and Mail that I was “speechless” by the news of Dr. Williams’ extension because the government “did not take advantage of the summer with low numbers of cases to suffocate this virus, and that at every single turn, we (Ontario) have done things slower than we should have.”

The second issue that attracted media to RNAO was Wednesday’s release of Auditor General (AG) Bonnie Lysyk’s report, in which she notes the province fell short on emergency management, outbreak planning and decision-making, and laboratory testing and contact tracing. She outlines that Ontario’s response to COVID-19 was slower and more reactive relative to other jurisdictions, and was disorganized and inconsistent. She also said Dr. Williams “did not fully exercise his powers under the Health Protection and Promotion Act to respond to COVID-19.” RNAO has been speaking out for the past eight months about the province’s delayed response to COVID-19. We also shared our frustration and concerns regarding not taking full advantage of the quiet summer months to prepare for the expected pandemic wave during the fall. On CP24, I said: “It’s critical we get that feedback (from the AG). We were late in starting and our concern all along about Dr. Williams has been too little, too late. The way we need to act now needs to change. If we don’t send clear messages, we will go from bad to worse.” We are also urging to avoid politicizing the pandemic, including the vaccine related plans. On this, I urge you to listen to this interview and retweet this important tweet.  

As the second wave continues, the strain on nurses and other health workers has intensified. Burnout is a major concern. Nurses are exhausted, working longer hours and forgoing vacations. An academic study sponsored by CUPE was released this week on the stressors they are experiencing. It showed that Ontario healthcare workers are feeling overworked and facing psychological stress due to COVID-19. At RNAO we were not surprised with this study. Nurses and health-care workers are hanging on by their nails. “People are exhausted and are grieving all the time. Both because of wanting to do good, and having slow movement in replenishing of [staffing] and other resources,” I told 580 CFRA. In another interview with CTV news, I explained that we want politicians to focus on controlling the spread of the virus. It’s suffocating our health providers, Ontarians, the health system and our economy. On CTV News, I urged the public to keep respecting social distancing, hand washing and wearing masks; as well as to stay home as much as possible. These measures will protect health-care and other essential workers, so they can keep helping us all.

Last Friday (Nov. 20), the Ontario government announced that Toronto and Peel would be moving into a lockdown for 28 days. Although we welcomed the announcement, it fell short of expectations RNAO outlined during its media conference on Nov. 13. We wanted a complete lockdown of all non-essential businesses; we were not looking for half measures. While the government dithered for another week, the virus continued to spread unabated in the community.  A failure to take bold, decisive action much earlier is the reason COVID-19 is running rampant in several communities today. Please read our complete statement.

The fight against COVID-19 continues and our loved ones in long-term care (LTC) are dying. In the summer, we urged Minister of Long-Term Care Merrilee Fullerton to address the severe staffing shortfalls of RNs, RPNs, NPs and PSWs in Ontario’s LTC homes to prepare for the second wave of COVID-19, yet no action has been taken to secure the health and safety of residents and staff. As I told CP24 in an interview, the Ontario government needs to act urgently to commit both funding and action to LTC if we are to ensure seniors receive safe and dignified care. We were glad to see the Ontario government commit to a minimum of four worked hours of direct care for residents, as this is something RNAO has been advocating for over a decade, as outlined in our Nursing Home Basic Care Guarantee. However, when we learned that the four hours of care won’t be fully implemented until 2024-2025, it sounded like an election promise as more lives continue to be tragically lost due to gaps in the LTC sector.

We are relentless in our insistence for four worked hours of care per day, per resident, to be immediately and urgently implemented. And we encourage you to add your voice to our Action Alert and on Twitter using our hashtag #4Hours4Seniors.

Our seniors deserve to live with dignity and to be safe. I told Global News that the government has lost its moral compass when it comes to protecting our seniors in LTC. “How many more seniors will needlessly die and how many more staff will get sick?” RNAO has been also urging action from Minister Fullerton, yet the abandonment and tragedy has been unfathomable. I told CBC News: "I have never seen such disregard for the lives of residents and their staff in long-term care, and by extension, the lives of families left in anguish.” We must use our collective voices to put pressure on the government to fix LTC.

On Nov. 9, The Globe and Mail’s health columnist André Picard hosted an RNAO cross-country meeting with six panelists about the need for implementation of national standards for LTC, a commitment the federal government made in its Speech from the Throne.  COVID-19 has put a spotlight on what we’ve known for a long time: long-term care in Canada is broken, and the time to fix it is now!  We will continue the conversation on mobilizing for reform in LTC throughout Canada, and we encourage you to join our webinar on Dec. 14 – which will be moderated by André Picard once again. Again we will call to ensure families and essential care partners are allowed to continue to visit and support their loved ones in LTC. This call is guided by a basic human necessity and right.

The provincial budget was released on Nov. 5 and we were disappointed to see that no money, not a single penny, was allocated in that budget to helping vulnerable communities survive COVID-19. We are well into the second wave and we will have no chance at containing this virus if serious restrictions are not put into place. Ontarians deserve more. Our seniors deserve more. The budget did not include any funding for hiring RNs, RPNs, NPs and PSWs for LTC homes in the province. Our President Morgan Hoffarth told the Toronto Star: “There is no excuse for postponing the urgently needed staffing increase in the province’s nursing homes.”

Several epidemiologists and other experts, including RNAO, began a Twitter campaign calling for the federal and provincial governments, public health units and public officials to pursue a #COVIDzero strategy. This approach addresses the need for a common objective to reinvigorate the national pandemic response. It aims to: target zero cases and tolerate a minimal number of COVID-19 across Canada; invest and deploy a world-class test-trace-isolate-support system; and support communities and businesses disproportionately impacted by the virus. RNAO is fully engaged in this campaign and urges you to join the call – retweet my tweet and RNAO's tweet. Add the #COVIDzero banner to your feed.

With more than 400 media hits between Oct. 26 and Nov. 27, and robust daily social media traffic, RNAO is demonstrating its extraordinary and ongoing commitment of speaking out for nursing and speaking out for health during this unprecedented time. For the coverage of our media presence, visit RNAO’s COVID-19 Press Room.

MOH EOC Situational Report

We are posting each day the Daily Situational Reports from Ontario's MOH EOC at RNAO’s website. That way, you can access the Ministry’s guidance at any time.

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 #306 for 27 November:

Update:

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>. RNAO’s Board of Directors and our entire staff want you to know: WE ARE HERE FOR YOU!

Thank you all for being there for our communities – everywhere and in all roles! Together, in solidarity, we are stronger and more resilient. These will continue to be tough times for the next few months for everyone and most especially our colleagues working in the front lines here at home and in countries around the world hit hard by evil COVID-19!

As we have said before, the silver lining of COVID-19:  Coming together and working as one people – for the good of all!

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

RECENT BLOG ITEMS:

20 Nov - Government’s measures too late and insufficient; calling for a COVID-Zero strategy – go here.

13 Nov - Mobilizing collective action for long-term care reform in Canada – go here.

13 Nov - RNAO’s media conference to address the crisis in long-term care – go here.

6 Nov - Fall 2020 provincial budget once again leaves vulnerable populations to fend for themselves – go here.

6 Nov - Elections in the US: A path to healing and respect for science – go here.

30 Oct - 2S-LGBTQ+ Seniors: Our Existence is Our Resistance! – go here.

23 Oct - Responding to the second wave of COVID-19: RNAO continues to speak out – go here.

16 Oct - RNAO advocates for national long-term care standards in Canada – go here.

16 Oct - Reta’s Story  (a contribution of Judy Smith, Reta’s daughter-in-law) – go here.

9 Oct - RNAO relieved that Premier Ford engages late, but essential, action – go here.

9 Oct - Patient-centred-care – the dream and the reality – go here.

2 Oct - RNAO urges stricter measures to combat rapidly rising number of COVID-19 infections – go here.

25 Sept - Nurses say throne speech advances A Just Recovery for All – go here.

18 Sept - Is Your Hospital Using Blood Wisely? – go here.

18 Sept - RNAO calls to Delay Action on CNO Council Decision to Expand RPN Scope – go here.

11 Sept - International Overdose Awareness Day: Statement from RNAO – go here.

11 Sept - RNAO joins global movement: A Just Recovery for All – go here.

28 August - RNAO letter to Prime Minister Justin Trudeau regarding Speech from the Throne – go here.

21 August - Black August and an update on RNAO’s Anti-Black Nursing Task Force – go here.

21 August - Winter Surge Planning: How one Ontario Health Team is Preparing – go here.

14 August - Insights from Cuba: Primary care as the focus of COVID-19 prevention – go here.

7 August - School reopening: Ontario government can still do the right thing on class sizes – go here.

We have posted earlier ones in my blog here. I invite you to 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.

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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