Thursday, May 28, 2020

Retirement homes used to free up hospital space

How shoring up hospitals for COVID-19 contributed to Canada’s long-term care crisis | Globe and Mail - Kelly Granthealth:

May 21, 2020 - "In the early days of Canada’s coronavirus response, when officials were consumed with fears of overwhelmed hospitals and rationed ventilators, a hospital in Oshawa, Ont., discharged an elderly patient named Nina Watt to a nearby nursing home.... Orchard Villa, the nursing and retirement home to which she had been transferred, went on to experience one of the worst outbreaks in the country, with 77 dead of COVID-19, including Ms. Watt.

"Ms. Watt, 86, was one of thousands of seniors discharged to nursing and retirement homes as Ontario, Quebec and other provinces rushed to clear beds for a flood of COVID-19 patients.... At the same time the acute-care sector was searching for space, some hospitals, physicians and long-term care facility administrators were discouraging families from sending infected nursing-home residents to the hospital.... As a result, it appears most of the nursing- and retirement-home residents who have succumbed to COVID-19 in Canada died inside the virus-stricken, understaffed facilities, while many of the hospital beds opened for coronavirus patients sat empty....

"An estimated 80 per cent of the Canadians who’ve died of COVID-19 have been residents of seniors’ facilities, according to the Public Health Agency of Canada. No province has been hit harder than Quebec, where 2,355 long-term care residents and 653 retirement-home residents have succumbed to the coronavirus and its resulting COVID-19. Ontario has reported 1,427 deaths among nursing-home patients and 125 among residents of retirement homes, while British Columbia and Alberta have each managed to keep COVID-19 deaths at seniors’ facilities below 100 as of Wednesday.

"At the start of the coronavirus crisis, the Quebec government ... wanted to prevent ... what Premier François Legault called 'an Italian-style scenario,' in which hospitals would run out of ventilators and intensive-care beds. During the month of March, Quebec hospitals were directed to do 'load shedding,' freeing beds by postponing elective procedures and transferring patients.... 'It had to be done, taking people who could be transferred to LTC homes to free beds in hospital and eventually handle the incoming wave caused by COVID-19,' Mr. Legault later told reporters to justify the decision.

"In Ontario, hospitals transferred out nearly 2,200 alternate-level-of-care, or ALC, patients from March 2 to May 3 – 1,589 of them to long-term care homes and 605 to retirement homes, according to the province’s Ministry of Health.... Alberta hospitals discharged 901 patients into long-term care and supportive-living facilities in March and early April.... March transfers were the highest recorded in history, Alberta Health Services said.... Nursing-home patients infected with the coronavirus were never supposed to be denied hospital care if they needed it, according to Ontario’s Ministry of Health, but it’s not clear how much of that message filtered down to the independent players in the system....

"The Quebec government also tried to cut down on movements back toward hospitals. Clinical guidelines issued on March 23 said that residents in long-term care facilities who contracted the new illness should only be sent to hospitals 'on an exceptional basis and after consultation with the doctor on duty'.... Quebec’s Premier and Health Minister insisted that it was better to keep elderly residents in long-term care facilities. 'It is never good to transfer people, to move people to other facilities, including the elderly, who get settled in and then become distraught when they change locations,' Mr. Legault told reporters on April 2.

"A few days later, the Quebec government realized that, with fewer than 700 COVID-19 patients in hospital, the dire forecasts of overwhelmed emergencies and intensive-care units weren’t materializing. At the same time, the increase in deaths among elder-care-home patients was accelerating at a faster pace. By April 10, more than a month after the first COVID-19 case was identified in the province, the Quebec government ordered an end to transfers from hospitals to elder-care homes. Ontario’s Ministry of Health followed suit on April 15, asking hospitals to temporarily halt transfers to long-term care in a memo that said only 64.1 per cent of acute-care beds in the province were in use....

"Toronto Public Health, which reported on coronavirus outbreaks at individual nursing and retirement homes over two weeks in April, found that of as of April 17, only 22 of 899 residents with confirmed cases of COVID-19 were being treated in hospital. That is about 2.5 per cent. By May 1, when there were 1,691 cases in Toronto seniors’ facilities, 95 residents, or 5.6 per cent, were in hospital. In Alberta, there had been 364 confirmed cases of COVID-19 in long-term care as of May 12. Of those, 24 had been hospitalized."

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