Cases of COVID-19 in long-term Care (LTC) homes soared in the early days of the pandemic. News articles highlighted longstanding inequities and failings in LTC that contributed to the problem – the poor living conditions, too few staff, lack of response in many LTC homes early on that have been detailed in a recent report. From April 2020 to April 2021 it is estimated that nearly 4,000 residents and 11 LTC staff died as a result of COVID-19, reflecting 54% of the COVID-19 deaths in all of Ontario, despite the LTC population representing only 0.5% of Ontarians. The careful scrutiny of LTC has also highlighted how prioritizing safety in a global pandemic may come at the expense of wellbeing.
I spent five months working in LTC in the early days of the pandemic. As a medical student working a summer job in LTC, I was a part of the recreational therapy team helping to organize activities for residents. I saw how quickly the LTC home I worked in enacted restrictions for residents and staff alike: personal protective equipment, restricted movement around the building and more. I felt immensely privileged to work in a facility that prioritized safety and we were fortunate not to see any COVID-19 cases in the home during the first wave.
However, with the priority on safety, I also saw resident social wellbeing become a challenge due to the numerous restrictions in place. Throughout the summer, I had both the privilege and the challenge of connecting families with their loved ones via video or phone call. Many of these loved ones would not be able to visit in person for months. Being a part of these phone and video calls was heart-wrenching. Families who hadn’t seen their loved one, watched their mental status deteriorate over the phone or video calls. They watched with sadness, yet with great appreciation for their loved one being kept safe. The residents were often confused as to why their loved ones were trapped behind a video screen or in tears because they couldn’t visit in person. For those with substantial cognitive impairment, the perceived time that had elapsed since the last in-person visit was short and the hardest part for me was watching their loved ones experience grief and relief both at the same time, knowing that the time has been both short and incredibly long – something I have felt personally with a loved one in LTC.
Perhaps the hardest part as a LTC employee was supervising outdoor patio visits for residents and their families. It seemed like a simple task but the emotional challenges that came with it were burdensome. While I tried to stay hidden in the background so as to allow as normal an interaction between them as possible, it was also my job to ensure that the distancing protocols were maintained. Many times I had to stand between a resident and their loved one and prevent touch, one of the most valued parts of human interaction. It broke my heart to see a resident, or a family member saddened that they couldn’t touch hands or hug one another, even for the briefest of moments. It took every fibre of my being to step in and prevent these opportunities for close interaction between two loved ones. The potential risk for transmission may have been low, given that family members had tested negative within a prior two-week window, the visit was outdoors, and family wore the appropriate PPE; the only thing that prevented me from turning a blind eye was the fear that this one moment of touch could introduce the virus into an incredibly vulnerable population. Families’ only chance for physically close connection would be if the resident was assessed to be for palliative care, in which case one visitor would be allowed in at a time for close interaction in the final moments of that resident’s life.
Now fewer COVID-19 cases are being reported in LTC homes and the crisis has drifted out of focus. But let us not forget the horrific early days of the COVID-19 pandemic – the lives lost to COVID-19 in LTC and those whose final years have been forever changed by the new world they live in. Now, more than ever, we need to investigate and acknowledge the impact that this pandemic has had on those who were amongst the most vulnerable. We need to critically examine how we can move forward and make changes that will prevent what happened to those affected by COVID-19 in LTC from ever happening again.