Some Ontario LTC homes under pressure to return to dangerous levels of overcrowding: Association

Some Ontario long-term care homes say they're under pressure to increase admissions to their homes — even if it would mean housing residents three or four to a room, putting them at greater risk in a COVID-19 outbreak.

Donna Duncan, CEO of the Ontario Long-Term Care Association, said some of her member homes have told her they are being "quite firm" in their refusal to increase the occupancies of their homes when asked to do so.

"Quite honestly, they're frightened," she said in an interview with QP Briefing. "We're all frightened. We want to make sure we do everything we can to protect our residents."

The fear of overcrowding in long-term care homes comes from the tragedies that occurred of the first wave of COVID-19 — research found that outbreaks in homes with old, ward-style rooms where three or four residents live in close quarters were larger and more deadly. By the end of the first wave, more than 1,800 residents had died.

As a result, the province issued a directive in June to long-term care homes allowing them to admit new residents from a hospital or the community, but only if they could be placed in a room that is already occupied by no more than one resident, stating that there "shall be no further placement of residents in three- or four-bed ward rooms."

At the same time, the province promised homes would receive full funding regardless of the actual occupancy of the homes.

However, the government has not banned three- or four-bed occupancy outright. Directive #3 applies only to new admissions — and admitting a resident to a room with only one resident while keeping three or four residents in other rooms or moving residents within a home back into multi-bed ward rooms — would violate the spirit, if not the letter of the directive.

The pressure to fill homes again stems from rising hospital occupancy rates, said Duncan.

The number of COVID-19 hospitalizations is rising and hospitals are resuming medical care put off during the first wave of the pandemic. At the same time, the number of hospital patients awaiting a bed in long-term care is also increasing to record levels, according to the Ontario Hospital Association.

It falls to regional bureaucracies that co-ordinate long-term care placements to seek space for those patients in long-term care homes. Dr. Nathan Stall, the geriatrician who led the research into overcrowded homes, said he fears the pressure homes are facing shows that the needs of the hospital sector are being prioritized over long-term care, which was one of the "failings of the first wave."

Repeating that fundamental mistake and packing nursing homes again would have "disastrous consequences," said Stall.

"Our work showed us from the first wave, that crowding within a home, where there were more residents per room and bathroom, was a very powerful risk factor for the incidence of COVID-19 and the number of COVID-19 deaths within a nursing home," he said.

Complicating matters, the Ministry of Long-Term Care was unable to provide any information on how many residents are living in three- or four-bed wards at any given time. According to a ministry official, that information would be "valuable" to the ministry but it is not collected.

The independent commission investigating long-term care in Ontario recently posted a transcript of a briefing it was given by Michael Hillmer, assistant deputy minister for the capacity planning and analytics division of the Ministry of Health. He told the commissioners the government doesn't "have a very good real-time understanding of occupancy of long-term care homes," as it does in hospitals, which are required to report their occupancy levels.

He explained that is because before the pandemic LTC homes were essentially 100 per cent occupied at all times. "But we know that's not going to be the case going forward," he added, "and occupancy is a big determinant of spread."

The OLTCA is seeking to fill that gap somewhat, by surveying its members, which make up the majority of the homes in the province, because it wants to see plans put in place to immediately reduce crowding in homes when they're in a COVID-19 hotspot, which increases their likelihood of an outbreak. To that end, the association has asked to meet with the provincial government and hospital association to discuss where capacity exists in different regions, said Duncan.

"We've got to mobilize, and mobilize quickly," said Duncan. "We know what the root causes were.... We have to act now."

In response to questions from QP Briefing, Long-Term Care Minister Merrilee Fullerton said the health and safety of seniors is a top priority for the government.

"As I have shared on a number of occasions, ward rooms and congestion have amplified the person to person and asymptomatic spread of COVID-19 in our long-term care homes, badly exacerbating this crisis," she said in an emailed statement.

"In response to the COVID-19 pandemic and based on public health evidence, requirements related to admissions and re-admissions were implemented through Directive #3 so that there should be no placement into ward rooms. We fully expect homes to adhere to the Directive for the safety of all residents and staff," she said.

"Our government recognizes the importance of continuing to admit individuals into long-term care homes, particularly Alternate Level of Care patients in hospital who are awaiting long-term care home placement. Homes are encouraged to accept new residents and re-admissions in alignment with the requirements in Directive #3."