Retirement homes work to protect seniors from COVID-19
A full look at directives followed by care homes across provinces
This is our look at how governments and retirement homes are working to protect seniors during the COVD-19 crisis. Please note that this is informational only, for families. Find links to official government statements and other information below.
Last updated May 22, 2020.
How retirement homes in the Alberta are responding
On the 20th of March, the province announced new measures impacting long-term care, supportive living and congregate living settings, limiting visitations to only one essential visitor. Visitors must also be verified and undergo a health screening, which includes a temperature check or a questionnaire before entering the facility.
"These measures, while necessary to protect our seniors and staff, will be extremely difficult for residents of seniors’ facilities," says a notice from Alberta Health Services (AHS). "We therefore encourage Albertans to look for other ways to reach out to their loved ones, particularly those seniors who live alone. Even spending just a few minutes on the phone with a senior can go a long way toward reducing feelings of loneliness and isolation."
Retirement homes may in fact be more diligent than the prescribed measures. Teresa Merryfeld of the Lodge at Valley Ridge says their preparations are extensive. "At the beginning of March as we began to understand the magnitude of what was coming," she says, "our administration team quickly put strong measures in place to ensure resident and staff health and safety. All public areas were cleared so that congregation was no longer possible. Outside visitors have been restricted. No new tours are currently being conducted. All outside entertainment and events have been cancelled or postponed."
While these changes have been "challenging" for residents who love the social aspect of retirement living, they have made adjustments. The community is now offering dining service three times daily at residents' doors. "Our Chef leads a team of incredible individuals who have done an excellent job of providing tasty, tempting hot and cold selections for the meal service."
The biggest challenge is for activities directors to keep residents' occupied and stimulated. "Our Lifestyles Team is offering things like mobile library services and activity cart, shopping list completion, mobile tuck shop and the ever-popular mobile happy hour," adds Merryfield. "Social isolation is very challenging for our seniors, we do our best to be aware of changing needs as they evolve."
As of April 3rd, all Alberta long term care homes must report all suspected cases of COVID-19.
Read more about Alberta:
Addendum to outbreak management. April 1, 2020. Alberta Health Services
How retirement homes in BC are responding
On March 16, British Columbia's provincial health officer, Bonnie Henry, and Health Minister Adrian Dix restricted access to long-term care homes and assisted living facilities to essential visits only. This includes compassionate visits for end-of-life care and visits crucial to residents’ care and well-being.
Bonnie Henry has been the face of updates in the province since the start of the outbreak. On Thursday April 2nd, On Thursday, Henry made mandatory orders limiting movement of staff at public and private long-term care facilities and requiring all operators to hand over a staff roster to the Ministry of Health.
Advocates for seniors and long-term care have praised the moves. “The restriction of the visitors, the workers assigned to one site and the decision to institute outbreak protocols on one case — and that case can be either a resident or a staff member — yes, those measures will make a difference,” said Isobel Mackenzie, seniors advocate for B.C.
Daniel Fontaine, CEO of the B.C. Care Providers Association, says that Henry’s order restricting staff to a single facility is one important measure. “It will help reduce the potential for [community spread] to go from multiple sites.” Changes and restrictions implemented by Henry are “helping to support the operators to stabilize the homes so that staff can focus more on the seniors and keeping them protected, as opposed to worrying about who’s coming in and out of the front door,” he adds.
The challenge to change attitudes
The challenge for retirement homes is that independent seniors love to be social. Quite often, that was their reason for moving to a retirement community. And the fact is that some seniors have a stubborn streak. They don’t always want to do what they’re told. Many have strong religious faith and believe their faith has helped sustain them this far in life. A common attitude is, “if it’s my time to go, well then, it’s my time to go.” They want to be in control of their own fate. So, it can be a challenge for retirement homes across the country to get seniors to comply with government directives.
Balancing the desire for independence with outbreak-prevention policies at PARC
Retirement homes like PARC Retirement Living Communities must employ “staunch measures to protect our residents, working to balance their desire to live independently while implementing our outbreak-prevention policies.” This works, and many seniors fall in line with the precautions at PARC’s communities, including:
- Allowing only essential visitors and outings
- Increasing sanitization (often requiring extra labour, in many retirement communities)
- Mandating physical distancing
- Requiring all employees to wear masks
- Reducing employee points of contact
- Adding more lines of communication
- Helping residents shop and socialize online
- Working with suppliers to stock essential items
This response mixes a "bit the bullet" attitude with compassion for its residents as well as staff. Since "employees cannot work at more than one senior residence, or for more than one health care employer, we have also asked our regular, part-time, and casual employees if they would be willing to increase their hours at PARC, so they don’t have to work elsewhere." The post, "How PARC is protecting residents from COVID-19" exemplifies their diligence (mirrored in communities across Canada).
Retirement home requirements in Ontario
Directives from the government of Ontario and provisions of the Retirement Homes Act protect seniors during the COVID-19 outbreak. If retirement communities don’t respond to your concerns, it’s because their first obligation is to protect all the seniors in their care, and to follow the law.
Here’s an abbreviated look at provincial directives and how they affect your loved ones, visits you wish to make, and activity within your loved one’s retirement home. The following is an overview, pulled from material from the Ontario Retirement Communities Association (ORCA). For full directives, resources, and information, visit their COVID-19 resource page.
Restricted work locations and directives for long-term care
As of April 14th, Premier Ford announced the enactment of an emergency order that restricts long-term care home staff to work in only one location.
As of April 22nd, workers are restricted to working at one location only. They shall "not also perform work in another retirement community operated by the licensee; as an employee of another retirement community; or as an employee of a health service provider."
As of April 24th, "Ontario Health (OH) Regions will be leading regional and local efforts -- with partners from hospitals, home care, public health units, Ministry of Long-Term Care and elsewhere in the health system -- to plan and support the needs of long term care homes to provide staff, and other supports for homes, and ensure resident care is stabilized. Notably, these plans are expected to include resourcing for staffing, infection prevention and control, testing, and any other needs as identified as a result of COVID-19." Read the full text of this measure.
As of May 9th, The Ministry of Health and Ontario Health issued a memo to all Local Health Integration Networks (LHINs) regarding the delivery of home care services in retirement communities. The ministry is requesting that all LHINs work with service provider organizations and retirement communities to limit the number of home care staff working in retirement communities and to limit the number of care settings in which home care staff are working. The ministry is strongly encouraging LHINs to establish or expand shift-based care models and leverage virtual care in retirement communities. Where shift-based care and virtual care is not feasible, LHINs are encouraged to work with the ministry to explore the feasibility of other delivery models – including the possibility of contracting directly with a retirement community to deliver the care.
Long-term care vs. retirement homes
It's important to note that throughout this time, very few retirement homes include anything less than completely private suites. If suites are shared that is almost always only by couples. Thus, social isolation enforced within many retirement homes, provides the same inherent safety as all measures enforcing social distancing or directives to "stay home." They share a roof with other people, but many retirement homes are similar in safety to apartment buildings.
Communities in Ontario must actively screen all staff and anyone else entering the home
The only exception is emergency first responders, who should, in emergency situations, are permitted entry without screening.
Screening includes twice daily symptom screening (at the beginning and end of the day), including temperature checks.
Anyone showing symptoms of COVID-19 is definitely not allowed to enter the home and is told to go home and self-isolate. Staff responsible for occupational health at the home must follow up on all staff who have been advised to self-isolate based on exposure risk.
Retirement homes are actively screening all residents
Ontario retirement communities must conduct active screening of all residents, at least twice daily (at the beginning and end of the day) to identify if any resident has fever, cough or other symptoms of COVID-19. Residents with symptoms (including mild respiratory symptoms) must be isolated and tested for COVID-19.
If a resident shows mild respiratory symptoms and/or atypical symptoms, they must be isolated and tested for COVID-19.
All new residents must be placed in self-isolation upon admissions to the home and tested within 14 days of admissions. If test results are negative, they must remain in isolation for 14 days from arrival. If test results are positive, they are reported as a confirmed case and follow case management protocol. Patients transferred from hospital to a retirement community must be tested prior to the transfer.
Retirement communities are closed to visitors, except for essential visitors
Essential visitors include a person performing essential support services (e.g. food delivery, maintenance, and other health care) or a person visiting a very ill or palliative resident. If an essential visitor is admitted to the home, the following steps must be taken:
- The essential visitor must be screened on entry for symptoms of COVID-19, including temperature checks and not admitted if they show any symptoms of COVID-19.
- The essential visitor must only visit the one resident they are intending to visit, and no other resident.
- The essential visitor must wear a mask while visiting a resident that does not have COVID-19.
- For any essential visitor in contact with a resident who has COVID-19, appropriate PPE should be worn in accordance with Directive #1.
How retirement homes protect staff and residents from the spread of the virus
Retirement homes in Ontario are required to limit the number of work locations that employees are working at, to minimize risk to patients of exposure to COVID-19. As of April 22nd, they are restricted to working at one location only. They shall "not also perform work in another retirement community operated by the licensee; as an employee of another retirement community; or as an employee of a health service provider."
If Ontario retirement homes detect one case of COVID-19 they must declare an outbreak
Retirement communities must consider a single, laboratory confirmed case of COVID-19 in a resident or staff member as a confirmed respiratory outbreak in the home, and take actions as indicated for influenza (need to link to noted documents). To identify potential cases of COVID-19, retirement communities must test individuals who have symptoms compatible with COVID-19 and must not wait for additional cases of respiratory infection before testing takes place. The outbreak must be documented once an outbreak is declared.
Retirement homes must ensure their COVID-19 preparedness:
Retirement communities, in consultation with their Joint Health and Safety Committees or Health and Safety Representatives, if any, must ensure measures are taken to prepare the home for a COVID-19 outbreak including: ensuring outbreak swab kits are available, ensuring sufficient personal protective equipment (PPE) is available, training of staff on the use of PPE, reviewing advanced directives for all residents, reviewing communications protocols, reviewing staffing schedules, reviewing internal activities to ensure social distancing and reviewing environmental cleaning protocols, develop polices to manage staff who may have been exposed to COVID-19.
- Communications: Retirement communities must keep staff and residents informed about COVID-19. Staff must be reminded to monitor themselves for COVID-19 symptoms at all times, and to immediately self isolate if they develop symptoms. Signage in the retirement community must be clear about COVID-19, including signs and symptoms of COVID-19, and steps that must be taken if COVID-19 is suspected or confirmed in staff or a resident.
- Food and Product Deliveries: Food and product deliveries should be dropped in an identified area and active screening of delivery personnel should be done prior to entering the home.
As this outbreak evolves, there will be continual review of emerging evidence to understand the most appropriate measures to take. This will continue to be done in collaboration with health system partners and technical experts from Public Health Ontario and with the health system.
The above was originally adapted from Directives from the Ontario government, dated March 31, 2020 and updated April 8, 2020. This is for informational purposes only. Consult the directives and procedures links above for details.
Two examples of Ontario retirement homes facing the crisis head-on
1: Sts. Peters and Paul Residence, Scarborough (updated April 16, 2020)
Dennis Levesque of Sts. Peters and Paul Residence in Scarborough speaks for many retirement communities when he says, "[Our] goal has always been, first and foremost, the safety of [seniors in our care]." And as of April 15, 2020, they have been able to keep residents safe and healthy. This unique community includes apartments as well as a retirement community wing.
Here's an abbreviated look at significant proactive changes made to protect seniors in this building, an atypical retirement living complex:
On March 13th (the same date the provincial government implemented strict new measures, including the announcement that schools would be closed past March break), they posted security screening at the main entrance, where they began to supervise everyone entering and leaving the building to ensure they sanitized their hands.
The following week, they created a "sterile" common area on the first floor. Partitions were placed at the front door to prevent their apartment tenants from entering the first floor common areas, and another partition was placed on the first floor elevator foyer to split the elevators. Two more partitions were purchased to create a passage through the office from the Nursing Station to the community's Great Hall. Essentially an ad hoc renovation in their case, this created a completely safe passageway for their community members.
At the same time that the partitions were erected, they decided to restrict all visitors to the building. In the case of this residence, they have no authority to restrict visitors to the apartments, but virtually all tenants accepted the need for self-isolation, given the close proximity to seniors in the retirement living wing. As of April 16th, any visitor to an apartment must actively screen, including having their temperature taken and answering a series of six questions, before they sanitize their hands and proceed for a short visit to drop off food or prescriptions. For the BBW the direction to restrict visitors was given by the Government.
From the beginning, they focused on the safety of the staff, working to minimize their exposure to the virus outside of the workplace. Staff members were was issued hand sanitizer to keep in their car, and masks to wear outside of the building.
Ahead of any government mandate to restrict retirement home employees to one community, Sts. Peter and Paul instituted this policy in March. They also provide staff members with meals from the kitchen, with the intention of reducing external shopping trips. Finally, they provide a vacant furnished apartment to any staff member who wishes to remain overnight.
As Levesque very fairly admits, "All of these precautions bring additional labour costs." However, precedence is given to people's wellbeing, not only seniors in their care, but staff, who also endure heavy stress these days. To mitigate the additional stress on care staff, Levesque hired people to assist with elevator operations and evening cleaning of the building. Additional housekeeping staff is also being hired to assist with sanitizing rooms and common areas. From there, the list goes on, too long to detail here, but it includes lengthened shifts for PSWs, to provide additional sanitizing, elevator operator support, and additional support to resident care.
As Levesque says, "Everyone is working hard, demonstrating a professionalism and dedication that makes me incredibly proud of them." They are in the process of adding ceiling-to-floor plastic coverings in some areas. They have had to close off certain parts of the building, making things less homey, but, as he says, "at this time, looks aren’t everything!"
This independent communtity has been able to secure a very adequate supply of Personal Protective Equipment (PPE), with the Director of Care "constantly looking for more." Donors have given "1400 masks, gloves, face visors, and gowns."
In the midst of all these changes, it's been challenging to keep families informed, but their prime concern has been the safety of senior loved ones.
This extremely dangerous, very infectious virus has caught much of the world off guard. Retirement communities like this are working around the clock, incurring unexpected expenses, making significant changes to staffing, and instituting impromptu facilities' renovations to keep people safe. As he says to family members in his community, "after 4 ½ weeks of isolation your loved one is safe and healthy!"
2. Schlegel Villages (April 15, 2020)
Across Ontario, long term care homes are especially hard hit with outbreaks, much more so than retirement homes. Most of those have been tragically deadly. As with so many stories around the virus, we all have a tendency to fault. The long-term care has long been a challenge in this country. Certainly, improvements will be made in the wake of these deaths.
Here, though, we mourn with retirement home staff — as well as family members and other loved ones — for the loss of people they cared for. Schlegel Villages is one company with several long-term care communities that have been particularly hard hit. Like many who have witnessed the devastation of this virus firsthand, they could not have foreseen events as they have played out. Few news stories report on the strength of staffers in retirement homes. Few news reports detail precautions and care taken by care home staff in the pandemic. Our collective awareness of the virus’s infectiousness, persistence, and danger has grown for all of us, over the timeframe of the pandemic.
It’s important to remember that although many long-term care communities share the same name and the same property with independent retirement villages, the facilities are essentially independent of each other. Long-term care is administered with the help of the provincial government, and funding for care in these facilities is through the government. For example, at the Village of Erin Meadows, three people have died in long-term care (as of April 15th), but none in the retirement home population. The Village of Humber Heights’ retirement home population has suffered losses, re-emphasizing the vulnerability of people in this age group.
Schlegel Villages initially applied a nine-point list of infection control protocols that includes diligent practices like:
- Twice daily temperature checks and active screening of residents
- Enforcing all essential visitors to wear full PPE, including mask, gown, gloves, goggles/visor
- ‘Cohorting’ in effect in all neighbourhoods, meaning residents do not travel between neighbourhoods within communities, let alone between Retirement and Long-term care.
They also worked in consultation with Dr. Mark Loeb, Chair of Infectious Diseases, McMaster University, and added additional precautionary measures
- Residents are provided with cloth masks to wear when leaving their suites and when interacting with others
- Every Village must conduct hand hygiene audits on each shift
They also been transparent and proactive in reporting COVID-19 outbreaks on their website. As of April 22nd they report that "there has been extensive testing underway in all Villages and the number of negative tests we’ve seen is testament to the effort of all of our teams as they execute the highest standard of Infection Control Protocols."