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April 30th - Long-Term Care Homes Update from Ottawa Public Health

Long-Term Care Homes Update April 30, 2020

Response Overview As part of the regular updates on the local COVID-19 response, Ottawa Public Health (OPH) will continue to provide weekly information to elected officials with respect to Long-Term Care Homes (LTCHs). Future reports will extend to other congregate settings, such as retirement homes (RH), group homes and shelters. Moving forward, OPH intends to advise elected officials when an outbreak has occurred in their constituency. Please note that some information provided will be limited, as privacy legislation prevents OPH from providing details that could result in the disclosure of personal health information.

Ottawa Public Health’s Role

As per Ministry of Health guidance, one single confirmed case of COVID-19 in a LTCH or RH results in the declaration of an institutional outbreak. Once an outbreak is declared in an institution, members of OPH’s IPAC team serve as a direct liaison to that institution, and provide support by:

• conducting an on-site visit

• providing advice and guidance on IPAC

• offering other resources to institution through outbreak management processes

• conducting on-going surveillance for the duration of the outbreak

• supporting the LTCH/RH throughout the outbreak to ensure all infection prevention and control requirements have been implemented to control the outbreak.

In supporting institutions experiencing COVID-19 outbreaks, OPH provides guidance on which residents and staff require testing and helps to coordinate that these tests are completed. Outbreak management activities also include providing guidance on institutional policies, ensuring the implementation of physical distancing/isolation measures and ensuring protocols are in place for enhanced cleaning and disinfecting, particularly of high touch surfaces within the institution. As with any positive case, OPH also conducts investigates all positive cases of COVID-19 and provides contact tracing to ensure close contacts (including other residents and staff) are made aware if action is required.

Province of Ontario’s Role

LTCHs are part of the provincial health care system and the Ministry of Long-Term Care is responsible to regulate, license and inspect all LTCHs. The Long-Term Care Home Quality Inspection Program (LQIP) safeguards residents’ well-being by investigating complaints and critical incidents, and by ensuring that all LTCHs are inspected at least once per year. Inspection reports for homes are available here.

Concerns with the operation of a LTCH should be directed to the Ministry of Long-Term Care through their complaint process. During COVID-19, the Ministry of Health provides directives to LTCHs with respect to managing cases and outbreaks and is the lead for providing PPE.

Contact Information for Families with Loved Ones in LTCH

Concerned families and friends should communicate directly with the LTCH about their loved ones at the facility. They can also call the Ministry of Long-Term Care's COVID-19 telephone line, which is available seven days a week, at 1-866-434-0144.

Operational Update

New Ministry of Health guidance

On April 21, 2020, the Ministry of Health announced that COVID-19 surveillance testing would begin in LTCHs. OPH is collaborating with the Champlain Health Region Incident Command (CHRIC), including members from the community paramedic team, to implement rapid testing of LTCH staff and residents. New documents provided by the Ministry of Health are available at COVID-19 information for Long-term Care and Retirement Homes settings.

Pilot surveillance exercise

Beginning this past weekend, OPH participated in a pilot surveillance exercise to better understand the current state of COVID-19 infections in LTCHs in Ottawa. As the first step of this pilot, OPH - along with our health sector partners, and the help of 26 Ottawa Paramedics and some assistance invited from their colleagues in Prescott-Russell – helped to facilitate the testing of over 1700 residents and staff at nine LTCHs in Ottawa: Carlingview Manor, Extendicare Laurier Manor, Extendicare Starwood, Extendicare West End Villa, Madonna Care Community, Manoir Marochel, Montfort LTCH, Sarsfield Colonial Home and Township of Osgoode Care Centre.All staff and residents of these LTCHs were recommended to be tested for COVID-19, except for those staff and residents who had previously tested positive for COVID-19 and did not require re-testing. Staff who were not available while the testing team was on-site received a letter recommending they present for COVID-19 testing as soon as possible.

OPH follows up immediately with homes if any positive results are received. The analysis of the test results will provide a snapshot of current infections that will help track where the virus has spread. Considering that COVID-19 can result in asymptomatic infections, it is anticipated that positive staff and residents will be identified.

Plans are currently underway to continue with surveillance testing in other LTCHs and RHs on an ongoing basis.

What is most important to stop transmission of COVID19 and deaths due to COVID19 in LTCHs is strict adherence to IPAC measures. Restrictions on non-essential visitors to LTCHs have been in place for some time. The new normal for IPAC in LTCHs also includes universal masking of healthcare workers when in the building, physical distancing and cohorting of residents and workers as much as possible, and outbreak measures include further practices that include isolating all residents as much as possible.

OPH has been advised by our health system partners that sufficient supplies are available for the surveillance testing, including swabs and personal protective equipment, and that the laboratories have the capacity to process the volume of tests.

Epidemiology Update

The Epidemiology updates available on the Statistics on Coronavirus 19 (COVID-19) in Ottawa webpage provide a summary of COVID-19 activity in Ottawa to date. The following information is from the the COVID-19 Epidemiology Update from April 29, 2020. There have been 76 deaths in total (57 deaths are among residents of LTCH and 5 from RH).

Information is also available on OPH’s Outbreak Reports in Ottawa Healthcare Institutions which includes a summary of all confirmed outbreaks of COVID-19 in Ottawa Long-Term Care Homes, Retirement Homes, Group Homes and Hospitals. The number of residents and staff, living in Ottawa, infected or deceased with laboratory confirmed COVID-19 is included. This report will be updated three times a week, on Monday, Wednesday and Friday. All data is extracted from iPHIS (integrated Public Health Information System) at 4pm the day before posting. The data may differ from other numbers published elsewhere due to data entry lag, different reporting sources, or download times. Please note these numbers are preliminary and will continue to change as new information is received, and quality assurance work takes place. To respect privacy due to the small numbers, age and gender breakdowns for LTC or RH are not available.

Some homes in outbreak are reporting deaths that are not associated with a laboratory-confirmed diagnosis of COVID19 infection. OPH is working on a system to assess and report on such deaths where the physician indicates COVID19 may be suspected as a cause of death or where the symptoms of the person who died were compatible with COVID19.

Frequently Asked Questions

What is being done to support Long-Term Care Homes (LTCHs) and Retirement Homes (RHs)?

All LTCHs and RHs operating in Ottawa receive regular communications and guidance from OPH’s Infection Prevention and Control (IPAC) team and are familiar with outbreak management protocols and COVID-testing guidelines. Further, these institutions have been provided with guidance specific to COVID-19 given the current pandemic. Pursuant to provincial guidelines with respect to COVID-19 testing protocols, OPH has been communicating provincial testing recommendations to all LTC/RHs relating to COVID-19 and will continue to do so as these guidelines continue to evolve.

As per Ministry of Health guidance, one single confirmed case of COVID-19 in an institution results in the declaration of an institutional outbreak. Once an outbreak is declared in an institution, members of OPH’s IPAC team are assigned to serve as a direct liaison to that institution, conducting an on-site visit and providing advice and guidance on IPAC, as well as other resources to guide them through outbreak management.

IPAC measures, including wearing a face mask at all times while at work, and proper cohorting of people infected with COVID-19, continue to be the most effective way to decrease COVID-19 in these homes.

In addition, OPH has been collaborating with the Champlain Health Region Incident Command (CHRIC) to develop and launch new teams that can provide greater supports to LTCH/RHs in our region. These teams are comprised of hospital leads who can provide concrete assistance with staffing, clinical and Infection Prevention and Control (IPAC) support and access to Personal Protective Equipment (PPE), as well as community paramedics who can provide support with testing and non-urgent medical care, and OPH staff who can provide overall outbreak guidance. These collaborative teams are already in place and have been in contact with the highest need facilities currently experiencing COVID-19 outbreaks and will continue to expand to other LTC/RHs and possibly other congregate settings over the coming days and weeks. Ottawa hospitals are mounting a significant effort to staff LTC homes and hospital staff are supporting these facilities, many of which are in outbreak.

Where can I find information on specific Long-Term Care Home (LTCH) and Retirement Homes (RH)?

OPH will notify elected officials if there is an outbreak in a LTCH or RH in their constituency, or when surveillance testing is being undertaken in their constituency. Reports on current outbreaks in LTCHs/RHs are available on OPH’s Outbreak Reports in Ottawa Healthcare Institutions.

When will more testing occur in Long-Term Care Homes (LTCHs) and Retirement Homes (RHs)?

The Ministry of Health directed that public health units across the province work alongside partners, such as CHRIC, to begin universal testing of residents and staff in long-term care homes. Homes identified as high-risk and those in COVID-19 outbreak were tested initially with others to follow, including RHs. A plan to roll out testing to further homes is currently being implemented and ongoing communication is occurring with LTCHs and RHs. The Ontario Ministry of Health will further assess the process and the data to determine next steps for surveillance testing in LTCHs and other congregate settings across Ontario.

Will the military be requested to support Long-Term Care Homes (LTCHs)?

On Friday, April 24, 2020, the Ontario Government announced that the Canadian Armed Forces will be providing support to five long-term care homes that are battling the coronavirus – all of them in the Greater Toronto Area. At this time, we are not aware of requests for similar support for Ottawa area LTCH/RH facilities. We continue to work collaboratively with all partners to assess the needs in our community and to respond appropriately.

OPH Webpage Links

OPH encourages residents to follow the special statements by officials, and to visit OttawaPublicHealth.ca/Coronavirus for evolving information. In addition, you may wish to specifically visit the following webpages for more detailed information.

• COVID-19 information for Long-term Care and Retirement Homes settings

Outbreak Reports in Ottawa Healthcare Institutions

Statistics on Coronavirus 19 (COVID-19) in Ottawa

Older Adults and COVID-19

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©2019 by Jan Harder.