A review of how things went at long-term care facilities during the pandemic has been conducted by the office of the BC Seniors Advocate and the report Outbreak Review Report came out Wednesday.
One of the many things of note was that only one outbreak of Covid-19 was confirmed to be from a visitor to the facility.
In most outbreaks (76 per cent), the first COVID-19 case was a staff member.
In 22 per cent of outbreaks a resident was the first case and there was only one outbreak where the confirmed first case was a visitor.
BC Seniors Advocate Isobel Mackenzie said she wasn’t surprised that only one outbreak was confirmed to be caused by a visitor because quite quickly facilities were closed to visitors.
“One of the questions would have been - would we have had more outbreaks caused by visitors and the short answer is that is not something we can know definitively,” Mackenzie said.
“For me what is important is that when you think about the whole approach to visit restrictions and what it fundamentally said about how we view our role and the role of families and the agency of people who live in long-term care - to me that’s the bigger issue here that we’ve really go to examine.”
Things were done with the best of intentions, Mackenzie was quick to say.
“We did what we thought was best to keep people safe but what those actions conveyed was we’re in charge, we know what’s best and we can do everything that family members can do and family members are ancillary to what is necessary for the core health of the person in long term care,” she said.
The message was made clear when the doors were closed and everyone was told to stay out and let the experts do their work, she added.
“We felt that the contributions of family members were both in terms of the emotional contribution they make as well as the physical contribution they make and the actual care tasks they perform were dispensable,” Mackenzie said. “And what I think we have to do is step back and realize that long term care and assisted living facilities are not hospitals. People are not there to be cured, fixed or for a short term. The facilities are people’s homes, they go there to live and they are living there because they need assistance. They still have agency, they still have rights - as do the people who love them.”
The approach Mackenzie believes should have been taken was to consider how essential visitors could have maintained their ability to be included in the day-to-day routine during the pandemic that would continue to keep everyone safe while providing those much needed visits to their loved ones.
“That is not the approach we took,” Mackenzie said. “We said one person could visit for 30 minutes once a week and we didn’t think about how before this that person came in every day. We didn’t separate the grandson who would come in and have lunch with his grandma once a month or even the daughter that lives in Toronto that flies in twice a year for a week and has dinner her mom every night - that’s a completely different kind of visitor than someone who comes daily but we really didn’t treat them differently.”
The category was deemed essential visitor but that wasn’t determined by the resident but rather by the care home administrators, she added.
“What that said was that care home operator was going to decide whether I’m essential to my mother’s well being - shouldn’t my mother make that decision?” Mackenzie asked.
“How can another person decide if I say I really need to see my daughter every day - how are they able to decide - no, that’s not necessary. So we really have to examine the underlying philosophy driving these decisions.”
Care homes were not over run with visitors before Covid and would not have been during the pandemic, Mackenzie said.
During the pandemic essential visitors could have been treated like staff and asked to take the necessary safety precautions to protect everyone at the facility, she suggested.
In a 100-bed facility, for example, there may have only been about 30 or 40 residents who had an essential visitor that would want to come and spend a lot of time with their loved one.
“We could have managed that,” Mackenzie said.
As residents were offered vaccinations early on that didn’t change the option for visitors either.
Visits should have been considered on a case-by-case basis, Mackenzie said.
“The approach was that nobody gets it because everybody can’t get it, which to be fair is a public health philosophy,” Mackenzie said.
It was a year where an essential visitor would be allowed to visit for 30 minutes once a week and that restriction wasn’t loosened until early April.
It should have looked different.
“We needed to figure out how to keep these people meaningfully connected because it’s crucial,” Mackenzie said.
Now because so many people - the public, residents and staff - are vaccinated and the most vulnerable are offered booster shots there is the hope that visit restrictions will not be put in place going forward.
“The outbreaks that are occurring right now are quite large but we’re not seeing the deaths that we saw previously - numbers look quite high in cases but nobody is showing any symptoms because they are vaccinated,” Mackenzie said.
Rapid tests are something Mackenzie believes should be used at long-term care facilities.
“If you are a visitor and you are rapid tested and you have Covid you are not bringing the virus into the facility,” Mackenzie said. “We could do that. We don’t need to close the care home to visitors.”
