Dear Colleagues: Welcome to our Friday, December 4 report – now in the tenth month of COVID-19 in Ontario. Visit the COVID-19 Portal for the many resources RNAO offers on COVID-19. Find earlier update reports here, including thematic pieces in Doris’ COVID-19 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. As always, feel free to share this report and links with anyone interested.

Ontario’s Long-Term Care COVID-19 Commission released today its second set of recommendations, with a distinct sense of urgency about the COVID-19 situation. RNAO continues to meet with the Commission and inform their work. At our last meeting on November 20, we thanked the commissioners for issuing interim recommendations. In their first release, October 23, the commissioners called for a comprehensive human resources strategy that addresses the full range of staffing issues. That letter was an urgent call to action. Today, the Interim Recommendations focus on leadership and accountability, performance indicators (including staffing levels), restoring comprehensive inspections, improving compliance and enforcement of care standards, and improving infection control measures. This latter point, infection control, is the focus of my blog.

Nurses urge dedicated funding for infection prevention and control to combat wave of COVID-19 outbreaks in long-term care homes

IPAC is a critical issue in long-term care (LTC) homes at all times and more so in the midst of a pandemic. With the rising death toll and insufficient nursing and other resources, IPAC is even more important. RNAO issued today a report and a media release (text follows) with a survey on this life-and-death matter. Please RT this tweet.

As the number of long-term care (LTC) homes fighting outbreaks of the COVID-19 virus increases, the Registered Nurses’ Association of Ontario (RNAO) is demanding the government mandate and provide the necessary funding and nursing expertise to ensure homes are able to contain and prevent further infections.

RNAO conducted an online survey of Ontario’s 626 LTC homes in November to obtain information about infection prevention and control (IPAC) measures. The survey was open for five days. Of the 246 homes that responded to the survey, only 15 per cent have a staff member fully dedicated to IPAC. The remaining 85 per cent of homes reported their IPAC staff had other duties that occupied their time, including 65 per cent being the director of nursing, which is a heavy administrative role. Half of the homes surveyed did not have a formal position description for the IPAC lead. Thirty per cent indicated their IPAC staff had no formal training. And, close to 80 per cent of homes indicated they had to rely on a variety of external sources and services to bolster their IPAC program.

In the midst of an aggressive resurgence of the virus with outbreaks in more than 115 homes (as of  Dec. 3, 2020) and more than 2,300 residents losing their lives to COVID-19 since the pandemic began, RNAO is once again urging the government to make staffing, clinical supports and best practices in infection prevention and control measures top priorities.

The report released today outlines six recommendations government must heed:

1. IPAC should be enforced as a mandatory role in long-term care, with specific full-time equivalent (FTE) requirements depending on the size of the home. This requirement should start with a base of 0.5 FTE for homes with up to 50 beds. Homes with 51 to 150 beds should be funded and allocate one (1) FTE. Homes with 151 to 200 beds should be funded and allocate 1.5 FTE. Homes with 201 to 250 beds should be funded and allocate 1.75 FTE; and those with over 251 beds should receive funding for two (2) FTE.   
2. All IPAC roles must be supported by a standard position description, which clearly outlines the role, expectations, accountabilities and resources, and reflects recognized IPAC standards.
3. All staff in the IPAC lead role must be provided with time and funding to achieve formal and/or specialty education in IPAC.
4. All LTC homes must be given immediately the funding and directives to fulfill the requirement of a registered nurse (RN) or a registered practical nurse (RPN) in the IPAC role, which meets the above three recommendations.
5. LTC homes must be staffed to the level of RNAO’s Nursing Home Basic Care Guarantee in order to provide the necessary staff support for safe care and IPAC compliance.
6. A network of LTC IPAC specialists must be developed and supported by continuous quality improvement and best practices’ rapid learning to ensure we build and sustain IPAC capacity within the LTC sector in Ontario.

“We recognize that homes are doing their very best in the midst of this extraordinary and challenging time. They are trying to cope while facing two decades of severe staffing shortages exacerbated by COVID-19. The need to deliver on the four worked hours of nursing and support care preceded the pandemic; and so is the need for a dedicated IPAC nurse specialist. If LTC homes do not receive these resources, residents and staff will continue to suffer,” says RNAO president Morgan Hoffarth. She adds that it’s imperative that the province step up. “Months ago, the premier said he would place an iron ring around LTC homes. We don’t need an iron ring. What we need is the funding and the human resources to provide safe care.” 

“Hospitals are the only sector where emphasis on infection prevention and control has been made a funding priority and it is the result of the tragedies endured during SARS, and the recommendations that came out of the Justice Archie Campbell public inquiry,” says RNAO CEO Dr. Doris Grinspun, who called for the public inquiry at the time. “In LTC, this is not the case, despite the fact it is a requirement under the Long Term Care Homes Act, 2007 and Ontario Regulation 79/10 to have dedicated IPAC staff. It is evident from the results of our survey that this is not funded, nor it is enforced. Given the number of LTC homes that do not have adequate space to isolate residents who test positive for the virus – or other communicable diseases – and since many residents share a room with more than one other resident, infection prevention and control is even more difficult to achieve,” Grinspun adds.

Continuing the Conversation: Mobilizing Collective action for Long-Term Care Reform in Canada

RNAO organized a path breaking Cross Country Meeting to engage Collective Action for Long-Term Care Reform in Canada. This special Health System Transformation & COVID-19 Webinar happened on Monday, November 9. See the press release for the November 9 event here. You can watch the webinar here.

The overwhelming response and active engagement during the November 9 webinar is indicative of the urgency and opportunity for collective action. To this end, we are hosting another Cross-Country Meeting. We will continue the conversation on Monday, December 14, 6:45 to 8:00 pm. You can register here.

The December 14 webinar will once again be moderated by The Globe and Mail columnist André Picard, the author of Neglected No More: The Urgent Need to Improve the Lives of Canada's Elders in the Wake of a Pandemic, and the panelists will be (in order of presentation):

• Nathan Stall, staff geriatrician at Sinai Health System, will update on COVID-19 outbreaks in LTC in Canada, with particular attention to Alberta, British Columbia, Ontario and Nova Scotia. Dr. Stall will also share emerging research regarding COVID-19 and its impact on residents and staff in LTC. 
• Carole Estabrooks, nursing professor, University of Alberta, expert on knowledge translation in LTC, will challenge us to reject quick fixes and ask about our collective vision for LTC in Canada. Dr. Estabrooks brings a wealth of knowledge from the research program of TREC (Translating Research in Elder Care) and its impact during COVID-19 and beyond.    
• Morgan Hoffarth, RNAO President and Director of Care at Mount Hope Centre for Long Term Care, will discuss current challenges and opportunities faced by front line providers and managers in LTC homes. She brings real life experience from a leader who was inspired to join an LTC home during COVID-19.  
• Wendy Francis, Family Councils Collaborative Alliance (FCCA), will share the vital role of family councils during COVID-19. The FCCA brings a collective voice to inform the challenges of families during the first and second waves of COVID-19, as well as learning for a post COVID-19 era. 
• Doris Grinspun, RNAO CEO, will inspire a call to action. Our feisty CEO and sophisticated analyst and strategist will remind us this is our “last kick at the can.” We should honour the lives already lost – due in part to government failure, ageism and discrimination – and the anguish of their families, by securing a brighter future for all who call LTC their home. Dr. Grinspun will offer thoughts for targeted action.

Everyone from across Canada, and internationally, is invited to attend. If you care about seniors, and want to join forces to ensure our provincial, territorial and federal governments turn tragedy into action by establishing national standards for LTC, this meeting is for you!  

Register for the upcoming December 14 webinar and register here.

Information on past webinars, including videos and presentation slides, can also be found here.

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 #313 for 4 December:

Update:

• Ontario Appoints Members of the Ministers' COVID-19 Vaccine Distribution Task Force. Today, the Ontario government announced the appointment of nine members of the new Ministers' COVID-19 Vaccine Distribution Task Force. The task force, chaired by General (retired) Rick Hillier, former Chief of Defence Staff for the Canadian Forces, will oversee the delivery, storage and distribution of COVID-19 vaccines.

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:

27 Nov - RNAO, once again, plays major role in the media during November – go here.

27 Nov - COVID-19 in long-term care: A nurse’s witness statement – go here.

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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