As news broke of coronavirus outbreaks in long-term care homes, Dana Schmidt got a phone call that made his heart sink. His mother was in a seniors facility, and it was her doctor on the line. She wanted to review the family’s wishes that their mother get full life-saving treatment if she ever needed it.
“It was around the level of resuscitation and whether we would be interested in altering it. Whether it was an option.” Schmidt says of the call.
Schmidt’s mother is 64, suffers from dementia, and lives at the Bethany Senior Citizen’s Centre in Sylvan Lake, Alta. But she’s happy and active, he says. Her family had no interest in altering the full resuscitation order.
But then the conversation shifted to questions that families with loved ones in long-term care are facing everywhere. What happens if there is a COVID-19 outbreak in the home? What happens if my loved one gets it? What level of care will they get if it hits hard?
The answers were not comforting.
“She would be denied emergency transfer in the event that she was deathly ill from COVID,” Schmidt says the doctor told him.
“She would be denied access to an ICU. She would be kept in the care facility and treated to the best of their abilities there.”
In Alberta, where Schmidt and his mother live, there are no guidelines dictating when or if residents of long-term care should be transferred to hospital. The province’s chief medical officer of health says the decision on whether to move a patient should be determined through a conversation with the family, facility and doctor.
While most mild and moderate illnesses should be treated at the facility, Dr. Deena Hinshaw says, the severely ill won’t be denied treatment.
“It all really depends on the individual. How ill they are. What care they need. What can be provided in that location, and what they may wish to happen in terms of more intensive treatment.”
Families advised against hospitalization
A letter obtained by CBC News sent to a family member by a long-term care facility in Ottawa says residents who get sick with COVID-19 will stay where they are. In a blunt assessment, the Glebe Centre warned family members and caregivers of their residents that it has no plans to transport residents who become ill with COVID-19, the disease caused by the novel coronavirus, to hospital.
“Doctors have learned there is no benefit for seniors with COVID-19 to go to the hospital, and they would not survive intensive care,” states the letter sent to families by medical directors Gerd Schneider and Benoit Robert.
It states that residents who contract COVID-19 will be cared for and made comfortable at the facility. It offers little in the way of hope.
There is a very high chance that they will die from it, possibly in just a few days.– Letter to family members from The Glebe Centre
“If a senior or an individual with existing medical conditions does get sick … we know now there is a very high chance that they will die from it, possibly in just a few days,” the letter says.
Ontario’s recently revised guidelines on how to treat outbreaks in long-term care homes clearly state that residents who develop severe illness should be transferred to hospital by ambulance. The Glebe Centre did not respond to calls from the CBC.
The family member who shared the letter did not want to be named to protect the privacy of their loved one, who is a resident at the centre. But they were upset by the tone of the letter, saying it left the impression that 100 per cent of elderly or vulnerable people in intensive care wouldn’t make it.
Staff at the home, it seems, are making “decisions for a class of people that deprives them of medical services,” the family member said.
What happened at Pinecrest
The Pinecrest Nursing Home in Ontario’s cottage country is an example of how bad things can get when the virus lets loose in a home for the elderly. An outbreak among the centre’s 65 residents has left 20 residents dead. A spouse who volunteered at the centre has also died, and 24 staff members have been infected.
Residents within the centre have been divided into a sick wing and a healthy wing. According to a nurse working in the facility “the sick wing is heavily populated, the healthy wing is pretty sparse.”
Across the province, at least 40 of the 81 deaths from COVID-19 have been at seniors or nursing homes.
Pinecrest residents who have become ill with COVID-19 have stayed within the facility rather than go to hospital, said medical director Dr. Michelle Snarr. She says the nearest hospital in Lindsay, Ont., has only five ventilators and is in no position to deal with an influx of patients from Pinecrest.
When family members have inquired about hospital admission, the doctor has been quick to point to the downsides.
“I’ve had some terrible discussions about that and said, ‘We can do that. I just want to run you through what would happen to your loved one,'” Dr. Snarr said.
It begins with a long, uncomfortable ambulance ride, then hours or days of lying on a stretcher in the hallway of an overcrowded hospital, she tells family members.
In the end, she says, their loved one will be “paralyzed, sedated and hooked up to a breathing machine with a tube down [their] throat” for two or three weeks.
“So far, we haven’t had any families who have decided to go that route,” she said.
WATCH | Medical director of Pinecrest Nursing Home discusses how staff at the home is handling the COVID-19 outbreak:
Seniors have ‘same rights as others’: WHO
While the World Health Organization’s clinical management guidelines state that elderly people “have the same rights as others to receive high-quality health care, including intensive care,” that’s not always the best option, say some health care workers.
“When the infection takes hold in their lungs in this elderly population, we can just keep them comfortable. Realistically, a ventilator is not an option,” said Dr. Stephen Oldridge, a physician treating residents at Pinecrest.
“It’s just heartbreaking.”
The mixed messages coming from government, public health officials and front line doctors is creating a lot of panic and confusion, says Marissa Lennox, chief policy officer at the Canadian Association of Retired Persons.
She says it makes sense to treat residents with mild to moderate illness within the facility. The concern is that COVID-19 spreads rapidly in closed settings and is particularly devastating for elderly and vulnerable people.
But a hospital admission brings other risks, such as cross-infection from other viruses or bacteria, along with the added stress of being in a crowded ICU.
Lennox says in the absence of any directives, the decision to hospitalize should be made on a case-by-case basis.
In some cases, she says, families may want to consider bringing an elderly parent into their own homes for the duration of the pandemic. With new outbreaks happening every day, and uncertainty around the treatment available, a family home makes sense for some.
“If that’s an option and that’s available to a family, we would certainly encourage it.”
WATCH | Dr. Stephen Oldridge explains why taking seniors home residents to hospital is not always the best option:
Best options for loved ones in care
Even though his mother’s facility has not had any COVID-19 cases, Schmidt is still reeling from the news that she may not have access to emergency hospital care.
“Tough decisions have to be made. So, the rational side of my brain understands that,” he said. “However, you know, it’s my mother that lives in one of these facilities.”
Neither the centre nor the doctor who is caring for Schmidt’s mother would speak with CBC News.
The Canadian Association for Long Term Care, which represents facilities across the country also declined to speak with CBC for this story. Instead, it sent a statement affirming a commitment to providing high-quality care to seniors and touting the benefits of early control measures.
“To that end, the long-term care sector is working with their respective provincial governments to carefully monitor the spread of COVID-19 and is prepared to implement all recommendations and directives from local health authorities,” the statement reads.