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Long Term Care: Were LTC patients blocked from hospital?

Editor’s note: spoke with Michael Hurley, president of the Ontario Council of Hospital Unions, about a 2019 report that outlined the violence LTC staff face — and about what needs to be done to keep them safe. While his report dealt with violence against staff, Mr. Hurley also provided an insight into why our Long-term care homes were so ill-equipped to deal with COVID. He suggests there was a conscious effort made to keep LTC patients from being admitted to hospital when their conditions became critical. Mr. Hurley’s comments follow:

I think you need to step back to demographics. We’ve got a baby boom aging. And think about the baby boom. It came after the Second World War. When the war was on, we knew we had to do a lot of things and spend a lot of money on the war. And then, after the war, the baby boom started, and we were like, well, okay, we need to build schools to educate the baby boomers. But we didn’t somehow realize we had to care for them at the end of their life. It really is a question of how are you going to meet your obligations to that generation, and the aging of the baby-boomer generation is now happening at a time of austerity and limited government spending. But honouring the health-care commitments to the baby-boomer generation is a one-time thing right? Eventually, we don’t need all this capacity, because the boomers will gradually pass away. But we need the capacity now. We’ve cut capacity from the system, thousands of beds, just as the population is aging.

Michael Hurley, president of the Ontario Council of Hospital Unions

And then along comes COVID, and, all of a sudden, the government becomes alarmed because Ontario has the worst beds-to-population ratio anywhere of any developed country in the world. We’re tied with Sweden at the bottom. So they become alarmed. How will they deal with it? They decide they won’t transfer COVID patients in long-term-care facilities into hospitals; we’ll treat them where they are. Hong Kong had no deaths in long-term care. Vietnam had no deaths. Taiwan had no deaths in long-term care. They test, and when they find some, they transfer the patient to a hospital.

What this is is rationing. That’s where the long-term-care clientele is being victimized. There was fear in Ontario that we’d end up like New York or northern Italy, and we’d run out of ventilators. And one way to restrict access to hospitals was to have written pandemic plans people or their loved ones would sign, and they’d waive their right to transfer to a hospital. That protected hospital capacity, sure, but it wasn’t very thoughtfully done. People were critically ill in the LTC homes, without the equipment and specialized staff to care for them. Or enough staff of any kind.

And many people in these homes, they don’t stand up for themselves. I tell a story sometimes about a woman I knew: she was 85 years old, and she needed knee surgery, but her doctor didn’t want to give it to her, and she said, “Son, I still walk. I still cherish my life. I still like to be on my own two feet outside. Give me the surgery.” But not everyone speaks up on their own behalf like that. And not everyone has people to stand up for them when those pandemic plans were going around.

There was also the staffing issue. After SARS, we knew that you can’t have part-time staff working in many different facilities. In an outbreak, they spread it. We learned that after 2003, but then we relaxed. So COVID hits, and we order all the part-time staff to only work at one facility. And that was impossible to model — the staff had to make decisions about which facility they’d be at full-time, and some had enough and some lost huge parts of their staff. You couldn’t guess in advance which way any given home would go. And we were slow to close the long-term-care facilities to visitors. What happened wasn’t surprising. The full article can be found here.

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