“Safe” or suffering? The impact of pandemic measures on seniors

BC Seniors Advocate Isobel Mackenzie released heart-wrenching findings Nov. 3 about the ongoing impact of pandemic social-distancing measures on the lives of 15,000 seniors in long-term care and assisted living facilities. Her findings are a wrenching reminder that a goal of “keeping seniors safe” at all costs is in fact leaving them isolated, denied of a loving touch, and without access to their loved ones in what are the final months and years of their lives.

Here is the Advocate’s letter in full that opens the report, which you can find in full either at the link above or at the bottom of this post.

“This pandemic has taught us many things beyond the basic science of infectious diseases. We have learned much about ourselves and each other as we unite to make it through this pandemic together. These troubled times have made us reflect on what we value in life and we have found that, for many of us, the top priority is the time we spend with our family and loved ones.

It is currently predicted that it may be a year or more before life gets back to normal. This time frame is sobering when we think of those seniors who live in long-term care, many of whom are in the last year or 18 months of their lives.

British Columbia experienced the first COVID-19 outbreak in a long-term care home in Canada and we recorded the first death from COVID-19 in that same care home. We saw how quickly COVID-19 can spread in long-term care and we saw the devastating impact of this virus on the older population. In response, we reacted swiftly with a suite of measures that quickly brought COVID-19 outbreaks in long-term care in B.C. under better control.

While we are still experiencing outbreaks, currently more than 80% of long-term care and assisted living sites have not yet experienced an outbreak. Of those that have experienced an outbreak, more than 60% are contained to a single person (mostly a single staff person) and there have been no deaths yet in over 70% of our long-term care/assisted living (LTC/AL) outbreaks.

One of the first measures we implemented to control transmission of the virus in our LTC/AL sites was to restrict all visits. This was an important measure to take at the beginning of the pandemic as the system needed time to ensure the necessary staffing stability, personal protective equipment (PPE) provisions and public health supports were in place to better manage COVID-19 in our long-term care system. However, the impact of these visit restrictions over the longer term are having a profound effect on many of our LTC/AL residents and their family members and we need to examine our current policy and practices as we look at the many months of this pandemic
that still lie ahead.

No single issue has dominated the phone calls, emails and letters we have received here at the Office of the Seniors Advocate as that of the current visit restrictions in LTC/AL. The stories from families that have been separated, some for over six months, are nothing short of heartbreaking. Initially when visit restrictions were implemented, families and residents supported the need for such measures as they realized they needed to stay apart to stay safe while the health care system learned how to manage this virus in LTC/AL; however, as weeks became months, concerns began to rise.

In response, my office launched a survey at the end of August. More than 15,000 people participated in the survey. The stories we heard have made it clear that residents need to spend more time together with the people they love and they cannot wait another year or more until this pandemic is over for this to happen.

While some pre-pandemic LTC/AL visits by family were purely social, the survey found that more than half of visiting family members were performing necessary tasks such as personal care, grooming, assistance with feeding, and mobilization. Despite this, the survey found that very few residents received an essential visit during the first phase of visit restrictions. Less than half of respondents applied for an essential visit and almost half of these requests were denied.

When the visit restrictions were amended at the end of June, many family members thought they would once again take up their role as a vital care partner for their loved one. However, two months after visit restrictions were relaxed, the survey found the majority of current visits are only once per week or less and many of these visits are 30 minutes or less. Prior to the pandemic, most family members were visiting several times a week or daily for much longer periods of time.

In the past, most family members would visit in the privacy of their loved one’s room (75% of LTC residents live in a private room), but only two out of ten are currently able to enjoy these unobserved private visits. Currently, most visits are in common areas and almost one-third of visits are only permitted outside.

Sadly, during this pandemic, 151 residents of LTC/AL have died from COVID-19 to date. During this same time period, however, more than 4,500 residents have died from illnesses or conditions other than COVID-19. We learned that in their final months, weeks and days, most of these residents were not able to spend time with those they loved the most.

This pandemic has upended lives everywhere. However, for most, there is a post-pandemic world that will bring back the freedoms and choices we once took for granted. For residents of longterm care, however, this tomorrow may never come. Perhaps that is why we found that most residents of long-term care are not as worried about contracting COVID-19 as we might think. The comments we heard from hundreds of family members indicate there is a greater fear of death from loneliness. Many residents are despondent as the only thing they look forward to is receiving a visit from their family.

There are also early warning signs of measurable health impacts. After recent years of stability, the rate of antipsychotic use for residents in LTC has increased 7% during
this pandemic and initial reports from the quarterly interRAI assessments show troubling trends of unintended weight loss and worsening of mood among LTC residents.

We implemented visit restrictions and other measures in long-term care and assisted living because we care. During this pandemic, the provincial government has dedicated significant financial resources to increase and stabilize the LTC/AL workforce, to ensure all LTC/AL sites have sufficient PPE, and to fund additional staff who can manage the safe screening and scheduling of visitors. The Provincial Health Officer has consistently and persistently made the safety of seniors a top priority as reflected in the swift measures we took at the beginning of the pandemic in response to the threat of COVID-19 in LTC/AL.

The challenge was and remains finding the balance between the risk from the virus and the need to have some quality of life. We cannot reduce the risk from COVID-19 to zero, but neither can we reduce the risk to zero for a death in LTC due to a fall, a medication error, or infection. Our pandemic response measures are meant to keep our seniors safe, but what are we keeping them safe for if not to enjoy the limited time they have left with the ones they love?In the last eight months, our response to the pandemic has evolved and we now know much more about how the virus is transmitted, how to screen for the virus, and what are effective layers of protection. We need to apply this evolving knowledge as as we allow greater flexibility for residents of long-term care and assisted living to spend time with their loved ones.

With compassion and kindness to temper clinical decisions around safety, we can thoughtfully respond to the needs of our seniors and their families. Finding the right balance will be challenging but it is the right thing to do as we seek to bring joy, comfort and an enhanced quality of life to British Columbia’s seniors.” – Isobel Mackenzie