When a gym becomes a home: Highlighting the need for long-term care reform
As a nation, we have been horrified by the images of long-term care (LTC) residents suffering and dying from COVID-19 with inadequate care. As a palliative care physician, I have mourned for these residents and their families, knowing they suffered needlessly because our healthcare system failed them. The pandemic has illustrated that reform of the long-term care sector is needed now to properly support our aging population and allow all to live life with the quality and dignity they deserve.
Ontario’s palliative care physicians have shown they are ready to help now and going forward. Take, for example, the Windsor Field Hospital. This was a desperately needed success story in a tragedy that spanned not just Canada but the globe. I am honoured to have contributed to the dignity and well being of our long-term care residents while simultaneously ensuring that our hospitals were able to maintain capacity to care for other patients.
In preparation for the possible surge of patients in acute care, our local hospital, Windsor Regional Hospital, transformed the St. Clair College SportsPlex, a stand-alone athletic facility, into a field hospital that could accommodate up to 100 patients to increase healthcare capacity within our region. As we were witnessing the LTC crisis sweep across the nation, COVID-19 outbreaks started in our own LTC facilities. Windsor Regional Hospital stepped into action, moving COVID-19 positive residents out of its LTC facility to the field hospital to help contain the outbreak and relieve staffing shortages within the home.
I was not there when the first 20 residents arrived at the field hospital but I was working on the sidelines to ensure that the facility was equipped to address any of the patients’ palliative care needs. In conjunction with the lead physician, Dr. Marguerite Chevalier, I made sure that the pharmacy was stocked with all the necessary medications for appropriate symptom management and expedited the approval of hospital order sets for the management of COVID-19 positive patients.
I began working at the field hospital shortly thereafter as we continued to admit more COVID-19 positive patients from the LTC facility. That first day, I spent hours on the phone talking to each of the patients’ families and reassuring them that their loved ones were well cared for. Understandably, there was much fear and anxiety about whether their loved ones would survive and how they would manage alone in unfamiliar surroundings.
Many of these patients had dementia so we worked hard to make this gymnasium feel like a home to minimize the possibility of delirium associated with the change in environment and caregivers. The white-tarped walls of their field hospital rooms had pictures of windows on both sides showing gardens on a sunny day. We printed pictures families had emailed and attached them nearby so that our patients could be surrounded by their loved ones. Each of our patients had an iPad so that families could video chat with them whenever they wanted to. For many, this was the first time they were able to see their loved one in months because of the lockdown in LTC facilities. Day by day, I took care of these patients alongside an amazing team of nurses, pharmacy technicians and dietary and housekeeping staff. Everyone pitched in where they could, helping feed and ambulate the patients when able but also sitting by their side to provide comfort and companionship.
As the weeks went on, we suffered our share of losses at the field hospital but these patients were comforted and cared for. Their symptoms were assessed and appropriately managed throughout their end of life journey. Families were supported through difficult times by the healthcare team and were able to hold vigils by their loved ones’ bedside via iPad video forums. On a daily basis, families thanked us for the care we were providing to our patients. This field hospital was a stark contrast to what had been exposed in the news, where LTC residents were found dying alone, neglected and uncared for. By integrating palliative care within the design of our hospital, we ensured that each patient that succumbed to illness did so with comfort and dignity.
For those that recovered, we watched them slowly improve over time. With daily phone calls to family members, we celebrated as their blood pressure stabilized, their oxygen needs improved and their oral intake increased.
As the patients continued to improve, the mood at the field hospital lightened. We celebrated birthdays, held impromptu tea parties and bingo games. By focusing on what our patients needed for quality of life, we turned that gymnasium from a field hospital into a home where our patients not only survived but thrived.
Given the tragedies witnessed during this pandemic, we need to recognize that it is time to redesign how we provide care to residents in long-term care homes. A recent article by Dr. Amit Arya highlights the gaps that have been decades in the making.
The article is not only a critique of the current system but provides real and tangible solutions for improvement. These include increased access to palliative care specialists, appropriate staffing levels and education to provide better care, much of which can be provided through a combination of traditional face-to-face patient care as well as virtual care.
The pandemic has shown that now is the time for a fundamental culture change in how we view long-term care homes and how we provide care within these facilities. Early integrated palliative care within these homes is essential to ensure that our aging population has the quality of care it deserves.