Patient Ombudsman | COVID-19 Special Report 2 | August 2021 1 Table of Contents

Message from the Patient Ombudsman ...... 4 Complaints about Long-Term Care Homes ...... 23 Purpose of the 2nd Report ...... 5 Sector-specific trends/themes ...... 23 Observations on the COVID-19 pandemic following Patient Resident/caregiver stories ...... 27 Ombudsman’s first report ...... 5 Complaints about Home and Community Care ...... 29 Waves 2 and 3 – Different experiences in different sectors ... 7 Interruptions to long-term care home placement ...... 32 Overview of complaints between July 2020 to April Family Managed Care ...... 33 2021...... 9 Recommendations ...... 34 Complaints outside Patient Ombudsman’s jurisdiction ...... 10 Visitation ...... 34 Gaps in health care oversight ...... 12 Communication during a public health emergency ...... 35 Hospital-related complaints ...... 13 Home and Community Care ...... 36 Visitation ...... 14 Long-term support for healthcare workers ...... 37 Health inequities & visitation ...... 16

Poor communication in a pandemic ...... 17 Discharge/Patient transfers/transitions in care ...... 19 Quality of Care...... 20 Sensitivity/Caring/Respect ...... 21 Infection Prevention and Control ...... 21 Access and delay ...... 22

Patient Ombudsman | COVID-19 Special Report 2 | August 2021 2 Land Acknowledgement Patient Ombudsman acknowledges that, traditionally, Toronto, where our office is located, was a gathering place for many nations including the Anishinabeg, the Haudenosaunee and the Wendat peoples. Patient Ombudsman acknowledges the area covered by Treaty 13, also known as the Toronto Purchase, and we pay respects to the Mississaugas of the Credit. Patient Ombudsman also pays special recognition to the other lands or territory belonging to Indigenous people throughout and the traditional lands and territories where individuals who contact Patient Ombudsman may be contacting us from.

Patient Ombudsman | COVID-19 Special Report 2 | August 2021 3 Message from the Patient Ombudsman

As a healthcare Ombuds office, our role is to amplify the In addition to the long-term care home sector, the pandemic voices of the patients, residents and their caregivers who has had a devastating impact on other sectors of Ontario’s come to our office and through their experiences, bring about healthcare system. It is important to note that while we did positive change in Ontario’s healthcare system. Never has this hear about many negative health care experiences, we did not role been more critical than during the COVID-19 pandemic. hear all of them. This means that there are many experiences Since the pandemic was first declared, our office has worked and voices that unfortunately are not reflected in this report. to respond to and resolve complaints from those who have There is much to be learned from the experiences of those been impacted by COVID-19. I want to thank the staff at who came to Patient Ombudsman with their complaints Patient Ombudsman for their dedication and for the throughout the COVID-19 pandemic. This is our second special compassion and sensitivity that they bring to their work. COVID-19 report and a companion report to the powerful The pandemic has laid bare what the health care system deems stories and recommendations coming out of the first wave of to matter and what it does not. Too often during the past year the pandemic that our past Patient Ombudsman Cathy Fooks and a half, considerations around quality of life, human shared with Ontarians in October 2020. connection, individual agency, and fair process have been As Ontario’s current Patient Ombudsman, I am privileged to dismissed or disregarded in the rush to address COVID-19. continue Cathy’s legacy and share this second report with you. At the same time, the pandemic has shone a light on the Craig Thompson, Ontario’s Patient Ombudsman extraordinary courage, resiliency, empathy and compassion of the healthcare staff, patients and caregivers that came to us, and the incredible efforts of many of the health sector organizations we heard from. The loss of life in Ontario’s long-term care homes is a tragedy. It is a sobering reminder that there is much work to be done post-pandemic as we rebuild and reimagine aspects of our healthcare system rooted in dignity, equity, and fairness.

Patient Ombudsman | COVID-19 Special Report 2 | August 2021 4 Purpose of the 2nd Report

This 2nd Special Report on the COVID-19 pandemic is Observations on the COVID-19 pandemic a follow-up report to our 1st Special Report issued in following Patient Ombudsman’s first report October 2020 which focused on the long-term care Patient Ombudsman released our first special report on sector. The scope of this second report is broader COVID-19 on October 8, 2020. At that time, the second wave and includes not only complaints about long-term of COVID-19 was starting to build. Ontario did not fare well in care homes, but also public hospitals and its second nor its third wave of the COVID-19 pandemic. In government agency-coordinated home and long-term care homes more residents died after Patient Ombudsman’s first report was released than as did before, but community care. the situation improved as residents and staff were vaccinated. In this report, you will learn about the complaints Patient Patient Ombudsman made four broad recommendations in our Ombudsman heard related to COVID-19 from July 2020 through 1st Special Report: including backstops and contingency plans the end of April 2021. Each individual complaint is followed up for all healthcare providers, a change in approach to visitation, on; however, not all complaints will have been addressed to the dedicated resources for communication, and enhanced organization in question at this time. Many of these complaints whistleblower protections. These recommendations were are open files and are currently part of either Patient endorsed by several health system leaders such as the ’s early resolution or investigative processes. Caregiver Organization and were consistent with a number of other bodies reviewing the issues in long-term care homes. This report is not a summary of Patient Ombudsman’s current investigation into Ontario long-term care homes’ responses to While the government made attempts to address some of the COVID-19 outbreaks. Patient Ombudsman’s investigative work issues noted in our 1st Special Report, Patient Ombudsman continues, and a public report will be available at the conclusion continued to receive a number of complaints on these issues of the investigation. Also we will comment later on our throughout waves 2 and 3 of the pandemic. organizational response to the pandemic and how we adapted our service for Ontarians in our upcoming annual report.

Patient Ombudsman | COVID-19 Special Report 2 | August 2021 5 In relation to our first recommendation, the backstops and Opportunities to explore meaningful ways of doing things contingency plans put in place were insufficient or not put in differently did not occur in all long-term care homes. place soon enough to mitigate the serious impact of the Communication struggles continued in the second and third second wave of COVID-19 in long-term care homes. While it waves. While there were fewer examples of complete failures appears that homes may have improved their ability to to communicate due to lack of resources, homes struggled to manage COVID-19 outbreaks following the first wave, the explain the reasons for their decisions and their basis in number of COVID-19 cases in the community appears to have government directives, and to communicate in a sensitive way overwhelmed the ability of long-term care homes to keep to residents and their loved ones. COVID-19 out and save lives. Patient Ombudsman saw many fewer whistleblower complaints While visitation restrictions were relaxed somewhat following in waves 2 and 3. This may have been due to fewer catastrophic the first wave, they remain an issue for residents and their COVID-19 outbreaks in long-term care homes, somewhat better loved ones at the time of writing. Visitation in hospitals and staffing resources, or other reasons. That said, neither the long-term care homes was a significant source of complaints Ontario Government nor long-term care homes have instituted to Patient Ombudsman. Many of the complaints Patient robust and comprehensive whistleblower protection. In addition, Ombudsman received related to the impact that isolation and Patient Ombudsman made a public appeal for complaints in the lack of stimulation has had on Ontarians’ loved ones in long-term care homes during the first wave, that specifically long-term care. During the second wave, broad visitor encouraged whistleblowers to come forward with their concerns restrictions were often relied-on by long-term care homes as in April of 2020. their only option to prevent COVID-19 outbreaks.

Patient Ombudsman | COVID-19 Special Report 2 | August 2021 6

1

Waves 2 and 3 – Different experiences in different sectors

Wave 2 – beginning in September 2020 and peaking in Fall, including increasing numbers of COVID-19 outbreaks in mid-January 2021. long-term care homes, in December and January in particular. During wave 2, the increase in COVID-19 infections occurred It appears that there were fewer catastrophically large long- over a longer time with fewer major public health term care home outbreaks in wave 2. The average number of interventions (i.e., restrictions and lockdowns) than wave 1 in residents cases per outbreak of COVID-19 was less than half of spring of 2020. COVID-19 cases grew steadily throughout the what it was in wave 1. However, the highest average number of residents cases per outbreak of COVID-19 was sustained over months during wave 2 whereas it peaked only once at

1 data on COVID-19, https://covid-19.ontario.ca/data. Note: new cases are likely to be under-represented in wave 1 as testing capacity was not fully established.

Patient Ombudsman | COVID-19 Special Report 2 | August 2021 7 the beginning of May 2020 during wave 1. Overall, there were common over the previous year. Throughout this period, the fewer cases and deaths per outbreak in wave 2 but many number of complaints that Patient Ombudsman received more outbreaks of COVID-19. about long-term care had been decreasing and in April 2021 Based on the complaints we received, the outbreaks that represented approximately the share of complaints that long- occurred in wave 2 appear not to have been impacted by term care represented prior to the pandemic (just over 10% of abrupt staffing shortages or from obvious defects in infection our case load). The reduction in outbreaks in long-term care prevention and control, although these issues remained a homes coupled with the increasing access of families and considerable source of complaints. Many long-term care caregivers has likely led to fewer complaints about long-term homes appear to have been overwhelmed by the disease care homes. burden in their communities. There were also several early Due to lower vaccination rates among the general population, and severe outbreaks caused by the Alpha variant of concern the third wave was felt most acutely in Ontario’s public in long-term care homes at the peak of the second wave prior hospitals. Ontario’s hospitals managed an extreme volume of to vaccinations being completed. COVID-19 patients. Hundreds of patients were transferred The number of deaths in long-term care homes due to COVID- between hospitals across Ontario to provide the intensive care 19 during the second wave exceeded the number of deaths in that COVID-19 patients required. The province very narrowly the first wave. The overall loss of nearly 4,000 lives in avoided a need to triage and ration intensive care unit Ontario’s long-term care homes is an enduring tragedy, resources. Patient Ombudsman received several complaints poignant given all that had occurred in the Spring of 2020. related to the emergency measures permitting transfers between hospitals and to long-term care homes or retirement During wave 2, hospitals also dealt with what was at the time homes without consent. thought to be the upper limit of the province’s intensive care unit capacity —with over 300 beds filled with COVID-19 Home and Community Care during the pandemic patients. However, the number of COVID-19 cases in intensive Throughout the pandemic, Patient Ombudsman received care units in wave 3 would eclipse this upper limit of capacity. relatively few complaints about home and community care Wave 3 – starting at the beginning of March 2021 and provided through the Home and Community Care Support Services organizations. This sector has also received limited thereafter. attention by the media given all that occurred in public The province’s early vaccination campaign radically changed hospitals and long-term care homes. the course of the crisis in Ontario’s long-term care homes While the sector was likely uniquely impacted by the during wave 3. Residents were spared a repeat of the pandemic, this impact was not borne out in an increase in experiences of significant illness or death – sadly all too complaints to Patient Ombudsman.

Patient Ombudsman | COVID-19 Special Report 2 | August 2021 8 Overview of complaints between July 2020 to April 2021

Between July 2020 and April 2021, Patient Ombudsman Patient Ombudsman’s first special report2 on COVID- received 2,922 complaints involving 3,097 health sector 19 provided an overview of 568 complaints received organizations. Two or more health sector organizations were between March and June 2020 during the first wave named in 146 complaints. of the COVID-19 pandemic, focusing on the stories The complaints included 1,938 telephone contacts with shared by residents, caregivers and long-term care Patient Ombudsman’s call centre (involving 2,043 health home staff. This special report covers the period sector organizations) and 984 formal written complaints from July 2020 to April 2021 and considers the (involving 1,954 health sector organizations). One hundred experiences of patients, residents, caregivers and forty complainants made initial contact with Patient staff through the second COVID-19 wave and Ombudsman through the call centre and later followed up with a formal complaint. beyond. Overall, 35% of the complaints (1,076) had a clear link to the COVID-19 pandemic. Complaints about long-term care homes were an exception with over two-thirds of complaints having a link to the COVID-19 pandemic.

2 “Honouring the voices and experiences of Long-Term Care Home residents, caregivers and staff during the first wave of COVID-19 in Ontario”

Patient Ombudsman | COVID-19 Special Report 2 | August 2021 9 Complaints outside Patient Ombudsman’s jurisdiction

Patient Ombudsman has the mandate to receive and attempt example, a patient may complain about their care in a public to resolve complaints about public hospitals, long-term care hospital and also include specific concerns about a physician homes and home and community care. In spite of this or nurse. In compliance with our legislation, Patient mandate, about 20% of the complaints received by Patient Ombudsman must refer complaints about regulated health Ombudsman each year are about programs and services that professionals to the appropriate regulatory college. fall outside this jurisdiction. Between July 2020 and April 2021, Patient Ombudsman Most of these non-jurisdictional complaints come in by received 743 complaints about programs and services outside telephone to Patient Ombudsman’s call centre. The formal its jurisdiction including 213 complaints that were clearly written complaints Patient Ombudsman receives about related to the COVID-19 pandemic. Eighty-five percent of the programs and services outside its jurisdiction are often part of COVID-19-related complaints came into the call centre and the complex complaints that involve multiple providers. For remaining 15% were included in formal written complaints.

Infection Prevention at a Primary Care Clinic The complainant had an appointment with his family physician about the lack of physical distancing in the waiting area but and when he arrived at the clinic, he was concerned to see a came away feeling his concerns would not be addressed. The crowd of patients waiting in the clinic corridor. The Patient Ombudsman Early Resolution Specialist referred the complainant contacted the clinic office to raise his concern complainant to the local public health unit.

Patient Ombudsman | COVID-19 Special Report 2 | August 2021 10 Most of the complaints were related to the roll-out of the A number of these complaints related to decisions about the vaccination program with a spike in complaints in March 2021. rollout of the vaccination program at the local public health Patient Ombudsman received over 60 calls from people who unit level. Neither Patient Ombudsman nor the Ontario were confused and often frustrated about the extension of Ombudsman has oversight of the administration of local the interval between first and second doses of the vaccine. public health unit programs or services, resulting in a gap of Other complaints were about access to primary care during external oversight. the pandemic, visitation and infection prevention and control (IPAC) in congregate care settings like retirement homes and assisted living facilities, and IPAC in workplaces.

Regardless of whether a complaint falls within Patient organizations including local public health units, the Ontario Ombudsman’s jurisdiction or not, our Early Resolution Ombudsman, the Retirement Homes Regulatory Authority, Specialists listen and assist complainants before re-directing professional regulatory colleges and government ministries, their concerns to the appropriate oversight organization if primarily the Ministry of Health, the Ministry of Long-Term there is one. Patient Ombudsman assisted people with COVID- Care and the Ministry of Labour,Training and Skills related complaints with over 240 referrals to other Development.

Patient Ombudsman | COVID-19 Special Report 2 | August 2021 11 Visitation restrictions in a retirement home

The complainant called to express her concern that she was access to their loved ones who were confined to the not able to visit and provide support to her mother who building. As complaints about retirement homes are not lives in a retirement home. Despite the updated guidance within Patient Ombudsman’s jurisdiction, the complainant that permitted visits by family caregivers to resume, the was referred to the Retirement Homes Regulatory manager at the home was continuing to deny families Authority.

Gaps in health care oversight Patient Ombudsman continues to be challenged responding to writing this report, it was not without issues. Patient complaints due to gaps in third-party oversight for a number Ombudsman received a number of complaints related to local of health care services. The pandemic has further amplified vaccination programs and there were limited avenues to these gaps, most obviously for programs and services offered address these complaints. Communication issues were a key through local public health units. While Ontario’s COVID-19 driver of these complaints. vaccination program has largely been successful at the time of

Patient Ombudsman | COVID-19 Special Report 2 | August 2021 12 Hospital-related complaints

While the first wave of the pandemic was largely The hospital-based complaints that Patient Ombudsman defined by a crisis in Ontario’s long-term care homes, received during this time were often linked to hospital the second and third waves of the pandemic capacity issues and the unique vulnerabilities of many patients and their caregivers are reflected in Patient Ombudsman’s impacted all sectors of our healthcare system. complaints. The stories we heard were intricate, personal, and highlighted a sense of powerlessness felt by patients and their Public hospitals were affected with patient volumes caregivers. Patients and caregivers told us that they found that overwhelmed Intensive Care Units, necessitated themselves at odds with their care teams, individual the construction of field hospitals, and contributed to healthcare workers, and a system that imposed restrictive and extreme fatigue and ultimately burn-out among seemingly unfair policies. Caregivers shared their distress with health care workers. Patient Ombudsman over restrictive visitation protocols and confusing or inadequate communication. Health human resources in hospitals were affected Patient Ombudsman received 1,740 complaints about public responding to demands to redeploy care teams to varied hospitals from July 1, 2020, to April 30, 2021. Of those care settings. Several specialized pediatric care hospitals complaints, 527 or 30% were directly related to the COVID-19 even delivered care to adult patients as other acute care pandemic. Of the other complaints (1,213 complaints in total), settings became overwhelmed. it is probable that the pandemic had impacted the patients’ In early 2021, COVID-19 vaccine campaigns in Ontario saw the experiences in some way or another. swift implementation of many hospital-led COVID-19 The peak in COVID-19 related complaints to Patient vaccination clinics on hospital grounds and in the communities Ombudsman about hospitals occurred in March 2021. they serve.

Patient Ombudsman | COVID-19 Special Report 2 | August 2021 13

Visitation Patient Ombudsman received 159 complaints related to prevent hospital cases from spreading to the broader visitation in public hospitals. To keep patients and staff safe community.3 from COVID-19, public hospitals restricted visitors. In some Where visitors were permitted, they were required to meet cases, hospitals would only permit one essential visitor per eligibility criteria established by the hospital. Visitors would patient for a fixed period of time, in others there was a often have to pre-register, complete COVID-19 screening at complete ban on all visitors. The rationale given by hospitals entrances, and adhere to strict IPAC requirements once inside. for visitation restrictions was to prevent community cases of Caregivers shared their distress at having to communicate COVID-19 from triggering outbreaks in the hospital and through layers of PPE and not being allowed to touch their parent or spouse or person they loved.

3 Impact of Hospital Visitor Restrictions during the COVID-19 Pandemic: Munshi L, Odutayo A, Evans GA, et al. Impact of Hospital Visitor Restrictions during the COVID-19 Pandemic. Science Briefs of the Ontario COVID-19 Science Advisory Table. 2021;2(31). https://doi.org/10.47326/ ocsat.2021.02.31.1.0

Patient Ombudsman | COVID-19 Special Report 2 | August 2021 14 Unlike Ontario’s long-term care homes which received status not having a substantive impact on hospitals loosening detailed directives from Ontario’s Chief Medical Officer of access restrictions to patients. 4 Health (CMOH) about visitation, public hospitals were left Many of the complaints to Patient Ombudsman were about largely to develop their own policies at the institution-level. hospital patients who were uniquely vulnerable. It was As such, visitation policies and the resulting restrictions varied common to hear about frail, elderly patients or other patients from hospital to hospital and even from unit to unit within a with diminished physical and cognitive capacities not having hospital. Patient Ombudsman also saw inconsistency in how access to their family members or caregivers in hospital. restrictions were applied by different staff members. Caregivers, when they had access or were able communicate by Caregivers and some patients reported to Patient Ombudsman telephone or video-conferencing, shared stories of loved ones that they felt there was often no opportunity to appeal such that were confused, frightened and alone. We heard stories of policies. patients in physical and chemical restraints, leaving caregivers In complaints related to wave 3 of COVID-19, we learned of uncertain that the patient’s care needs were being met. caregivers disclosing they had been vaccinated and that their

Inconsistent visitation policy A complainant shared that his father was an intensive care on numerous occasions based on inconsistent interpretations unit patient at the hospital and passed away after several from various staff. His mother was often confused as to why weeks. The complainant continuously escalated concerns to the rules changed constantly around visiting her husband. The Patient Relations and Hospital Management regarding their complainant also shared that staff were not timely in visitation policies, and lack of translation for informed consent disclosing his father's evolving condition. The complainant (the complainant shared that his father and mother speak emphasized that this is particularly important for family limited English). He felt the visitation policy for the critically ill members when they are being denied visitation. was inconsistent, his mother was denied access to his father

4 COVID-19Directive #3 for Long-Term Care Homes under the Long Term Care Homes Act, 2007 Issued under Section 77.7 of the Health Protection and Promotion Act (HPPA), R.S.O. 1990, c. H.7 https://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/docs/directives/LTCH_HPPA.pdf

Patient Ombudsman | COVID-19 Special Report 2 | August 2021 15 Patient Ombudsman heard complaints about patients with ones were receiving appropriate palliative care and pain diminished physical or cognitive capacity, being left in soiled management at the end of life. diapers, developing bed sores, or losing personal property Some caregivers shared their anguish of not knowing what such as assistive devices (glasses, hearing aids and dentures). quality of care their loved one received before they died Complainants spoke of uncertainty over whether their loved having been barred from visiting them in the hospital.

Impact of visitation restrictions on vulnerable patients Patient Ombudsman received a complaint from a caregiver months. He shared with Patient Ombudsman that his mom’s whose mother has been in the intensive care unit for multiple mental health had deteriorated to the point of severe weeks. The complainant shared that their other siblings had depression and that she would plead with medical staff daily been designated as essential visitors and were allowed to visit to see family. He feels that he posed no more risk to his one at a time, with limitations. The complainant was denied mother or the hospital than the two designated visitors. He access by hospital staff as the patient (mom) already had two felt that the management team were dismissive and showed designated visitors. He had not seen his mom in seven no sympathy. He felt that his mom was slipping away.

In some instances, families made the difficult decision to discharge their loved ones against medical advice because they felt the patient would be safer at home than alone in hospital.

Health inequities and visitation The COVID-19 pandemic has shone a light on health equity who could not fully communicate in English. Their caregivers and how many communities are not included in healthcare were concerned for their loved one as they did not have planning and service delivery discussions.5 Patient someone to communicate and translate for them. Ombudsman heard stories about elderly immigrant patients

5 , Addressing health inequities within the COVID19 public health response https://www.publichealthontario.ca/- /media/documents/ncov/he/2020/12/covid-19-environmental-scan-addressing-health-inequities.pdf?la=en

Patient Ombudsman | COVID-19 Special Report 2 | August 2021 16 Lack of accommodation for a young man living with Down Syndrome An Early Resolution Specialist helped a caregiver of a young from the hospital was to minimize COVID transmission. The man living with a disability. The caregiver disclosed their complainant was in distress over what her brother’s brother is living with Down Syndrome and was recently experience in hospital would be. She shared she was willing to admitted to hospital. The complainant is the essential take all the necessary precautions such as COVID testing, caregiver and regularly accompanies him to all healthcare screening and wearing appropriate Personal Protective appointments. She shared that her brother has the mental Equipment (PPE) to gain access. Patient Ombudsman capacity of a young child and cannot advocate for himself. reconnected her with Patient Relations at the hospital to Since her brother is an adult in age, the hospital refused to discuss her unique circumstance. allow her to accompany and visit her brother. The rationale

We heard from caregivers of patients living with disabilities, partners who were unable to support their pregnant partner including those living with a diagnosed mental illness. Support during labour. persons and service animals traditionally permitted in hospital Many of these complainants shared dismissive attitudes of for appointments were not allowed to accompany the patient. some healthcare workers towards patients in labour, that their Patient Ombudsman received a cluster of complaints from negative experiences were deemed insignificant in the context pregnant patients and their partners who shared labour of a pandemic. These patients shared feelings that because experiences that led to anxious deliveries and the distress of they did not have COVID-19 they had no right to complain.

Poor communication in a pandemic Patient Ombudsman received 73 complaints where a COVID-19. Patient Ombudsman also received a handful of breakdown in communications between hospital staff and complaints about patients who were possibly exposed to patients, families, and/or caregivers were the primary issue. COVID-19 by other healthcare workers who had tested We received complaints of patients and family members not positive. The common thread to these complaints was that the being informed of COVID-19 outbreaks on some hospital units. patients and families affected were not informed initially by In a few instances, we received complaints of patients having hospital staff. They ultimately became aware of possible risk to share rooms with other patients that tested positive for exposures to COVID-19 from other patients which was later confirmed by hospital staff.

Patient Ombudsman | COVID-19 Special Report 2 | August 2021 17 No one to advocate for patient with Alzheimer’s Patient Ombudsman’s call-centre received an urgent call from family are not allowed access because of a visitation-ban. the adult son of a patient unsure where to turn. He was upset Despite multiple calls to the hospital the family has not as the family did not know what was happening to their 90- received any updates on their dad’s care in 10 days. The family year-old father living with Alzheimer’s. He was admitted to is upset about the lack of communication from the hospital. hospital with COVID-19 symptoms. The complainant and their They do not even know if their dad is dead or alive.

Patient Ombudsman’s call-centre received numerous calls can cause psychological distress to both the patient and from caregivers who did not know what was happening to caregiver.6 their loved one. Clinical staff often did not have time to Some complainants revealed an inconsistency of provide satisfactory updates. While some innovative methods communication on the term ‘hospital visitors’ and ‘essential of communication were explored, such as the use of tablets caregivers’. Policies related to visitation shared by family and video conferencing to promote communication, these members and caregivers would often be discordant to written were inconsistently used. Complainants also shared with information on hospital websites causing confusion once they Patient Ombudsman the limitations of virtual forms of arrived at hospitals where they were denied entry. communication. It is noted that virtual or ‘remote’ forms of communication with loved ones who are isolated and alone

6 Cattelan J, Castellano S, Merdji H, et al. Psychological effects of remote-only communication among reference persons of ICU patients during COVID-19 pandemic. J Intensive Care. 2021;9(1):5. https://doi.org/10.1186/s40560-020- 00520-w

Patient Ombudsman | COVID-19 Special Report 2 | August 2021 18 In some instances, public hospitals made significant strategic Ombudsman received a group of complaints about the closing decisions that would impact care to a group of patients and of a complex continuing care unit and how the decision was caregivers. These decisions were not always clearly communicated to families. communicated to patients and caregivers. Patient

Complex Continuing Care Unit Relocated Patient Ombudsman worked with a group of concerned loved one. The new care setting proposed by the hospital was families of patients who were residents of a complex in a different city and posed challenges for regular visits for continuing care (CCC) unit in a large hospital. A decision was some family members who provided care. Patient made to close the unit at one site and transfer the patients to Ombudsman urged the hospital to recognize the significant another location. The pandemic accelerated the hospital’s barriers faced by these families including an increased level of timeframe considerably. The families shared they received systemic barriers (based on race and income disparities) as it confusing messages from the hospital on the transfer of their relates to access to health and transportation equity.

Discharge/Patient transfers/transitions in care Complaints about poor communication also appeared Other complainants reported feeling pressure to accept throughout most of our cases on discharges/patient transfers choices in long-term care homes that were not close to home and transitions in care (49 complaints in total). or were not homes they would have chosen. Many patients Some complaints reflected caregivers’ fears about sending were discharged to assisted living or other congregate care their loved-one from hospital to long-term care. They were settings to wait for long-term care home placement. fearful that their loved one would contract COVID-19 in long- Some complainants expressed concern that patients were term care and that those homes may not be safe. Some being discharged too early to ‘free-up’ space in hospitals for complainants referenced concerns of localized outbreaks in COVID-19 patients. long-term care homes.

Patient Ombudsman | COVID-19 Special Report 2 | August 2021 19 Quality of Care During this period Patient Ombudsman received 64 Complainants often expressed empathy for over-worked staff, complaints signalling quality of care concerns. Of these however, they felt the pandemic affected the quality of care complaints many parents and caregivers shared experiences they or their loved one should have received. where they questioned the level or quality of care a patient Specifically, caregivers expressed concerns about toileting and received. In a few extreme cases some complainants felt that changing of diapers for incontinent patients and concerns their loved one may have died because of poor care. about skin care, including wound care for pressure ulcers.

Lack of dignity and uncertainty with grandmother’s quality of care Patient Ombudsman received a complaint from a caregiver rules”. When she returned to collect her grandmother’s about her grandmother’s experience at her local hospital. She belongings, she shared that her clothes were soaked in urine was concerned that her grandmother had had a stroke and and that mold was forming on them. The granddaughter was that no one was assisting them or taking their concerns concerned over her grandmother’s care as she would have seriously. After a long wait, staff in the emergency department had to have been left in her adult diaper for a significant told her that her grandmother had not suffered a stroke and amount of time for the urine to have leaked through her they would be seen eventually. She was able to finally obtain pants. The granddaughter ultimately learned from her family help from one nurse to toilet her grandmother. After her doctor, not hospital staff, that her grandmother had indeed grandmother was admitted to acute care the granddaughter suffered a stroke. was told she had to leave after an hour because of “COVID

Patient Ombudsman | COVID-19 Special Report 2 | August 2021 20 Sensitivity/Caring/Respect Twenty of our COVID-19 related and 79 of our non-COVID-19 Complainants felt their concerns were often dismissed by care complaints were about hospital staff lacking sensitivity, care teams or other hospital staff. Akin to our quality-of-care and respect towards the complainant. complaints, some patients and caregivers expressed levels of sympathy and understanding for hospital staff who are front- line workers in the height of a pandemic.

Infection Prevention and Control Forty-seven complaints to Patient Ombudsman were classified Some complaints involved allegations of COVID positive with concerns related to infection prevention and control patients sharing rooms or wards with COVID negative patients. (IPAC). Prior to the COVID-19 pandemic it was rare for Patient Patient Ombudsman received one IPAC-based complaint from Ombudsman to receive such a high volume of complaints on a whistleblower who was a staff member concerned that their IPAC concerns. hospital was not following appropriate IPAC measures to keep IPAC-related complaints were about busy, crowded waiting staff and patients safe. The healthcare worker was particularly areas and other spaces with insufficient physical distancing, concerned about the unique challenges in some mental health outbreaks in hospitals and concerns that appropriate IPAC units where it can be difficult to manage compliance with measures were not being followed by staff. mask wearing, hand hygiene protocols and physical distancing.

Patient Ombudsman | COVID-19 Special Report 2 | August 2021 21 Access and delay Patient Ombudsman received 24 complaints about access or many chronic health conditions expressed a now fractured admission and 16 complaints about delay of care/treatment. relationship with their local hospital. Common to these complaints were stories of extended The complaints also included patients unable to access to waitlists for specialized clinics, the cancelling or postponing of specialized mental health services, and in one instance, a treatment and notifications of additional surgical delays. caregiver of a youth who was told the patient must attend the One complainant to our office expressed frustration after adult mental health program ‘due to COVID-19’. being discharged from hospital as their gallbladder surgery was cancelled after the provincial directive to cancel all elective surgeries was issued7. The complainant who lives with

Care delays caused by the pandemic The father of an adult daughter with breast cancer shared Patient Ombudsman, the two-week pause on treatment had with Patient Ombudsman his concerns about his daughter’s extended to two months. The complainant did not agree with delayed treatment. His daughter has had a lengthy cancer this decision as the cancer centre does not actively treat journey involving chemotherapy, radiation, multiple surgeries COVID-19 patients and the risk of his daughter’s cancer and hormone therapy. Her cancer treatment now requires returning was high. Ultimately the patient was able to meet preventative chemotherapy. The hospital informed her that with the head of oncology to discuss an appropriate preventative chemotherapy would be postponed for two treatment plan. weeks because of the pandemic. At the point of contacting

7 Ontario orders hospitals to halt non-emergency surgeries as COVID-19 patients fill ICUs https://www.cbc.ca/news/canada/toronto/covid-19-ontario-hospitals-elective-surgery-icu-patients-1.5980755

Patient Ombudsman | COVID-19 Special Report 2 | August 2021 22

Complaints about Long-Term Care Homes

In the first few months of the pandemic, complaints Patient Ombudsman received the greatest volume of to Patient Ombudsman about long-term care homes complaints about long-term care homes in June 2020 and increased dramatically. Complaints about long-term complaints about long-term care homes have been generally decreasing in volume since that time. In 2021, the proportion care homes constituted the largest share of of complaints about long-term care homes as compared to the complaints during the first wave, being 44% of the total number of complaints Patient Ombudsman received had complaints Patient Ombudsman received from returned to approximately what we have observed as the March to July 2020.8 This was not the case during the average proportion of complaints prior to the pandemic, period covered by our 2nd Special Report. around 10% of complaints.

Sector-specific trends/themes

The COVID-19 pandemic remains a significant driver of The number of complaints related to COVID-19 and long-term complaints about long-term care homes. From July 2020 to care homes that Patient Ombudsman received during both the end of April 2021, Patient Ombudsman received 404 waves 2 and 3 was comparable to the number of complaints complaints about long-term care homes. Of these, 276 Patient Ombudsman received during wave 1 of the pandemic. (approximately 68%) were related to COVID-19. For public Patient Ombudsman received 239 complaints about long-term hospitals and home and community care, the proportion of care homes between March 2020 and the end of June 2020. complaints related to COVID-19 for this period was closer to one third.

8 PO Special Report #1

Patient Ombudsman | COVID-19 Special Report 2 | August 2021 23

Month-over-month, complaints about long-term care homes significant a decrease in the proportion of complaints about have been decreasing. This has been a relatively smooth long-term care homes. One possibility is that visitation, while decrease, except for an increase in October 2020, which likely still significantly restricted, generally remained open for reflects the release of the 1st Special Report and in February designated essential caregivers in long-term care homes. Also, 2021 which reflects an increase in COVID-19 outbreaks in long- Patient Ombudsman received many fewer complaints from term care as well as a period of heightened visitor restrictions staff members and whistleblowers after wave 1 of the at the peak of the 2nd Wave of COVID-19. pandemic. A ready explanation regarding the lower number of Given wave 1 and wave 2 were comparable in terms of the complaints about long-term care homes received after number of cases of COVID-19 and deaths due to COVID-19 in February 2021 is the success of Ontario’s early vaccination long-term care homes, it is unclear why there was this campaign in long-term care homes.

Patient Ombudsman | COVID-19 Special Report 2 | August 2021 24

There was a shift in the subject matter of complaints from the parameters that the homes put on visits, the level and first wave of the pandemic compared to what we have frequency of approvals needed (for example, having the home observed in waves 2 and 3. The greatest number of complaints administrator need to approve visits daily), the equity of about long-term care homes related to the visitation homes’ policies, and the potential harm not being able to visit restrictions in place for the sector. From July 2020 to April was doing to their loved ones. 2021, 38% of complaints related to visitation. The proportion Similarly, 11% of the complaints we received related to of complaints related to visitation has remained roughly the restrictions and the isolation of long-term care home same from the first Special Report. residents. Patient Ombudsman heard a number of complaints Complainants continued to be frustrated by restrictions which that described the toll that the restrictions on visitation had limited access to their loved ones in long-term care homes. taken on complainants’ loved ones, including depression, They were dissatisfied with the limits of scheduling, the weight loss, decreases in cognition, impacts on ability to

Patient Ombudsman | COVID-19 Special Report 2 | August 2021 25 manage daily activity and quality of life. Despite restrictions the proportion of complaints related to infection prevention and isolation being a complaint subject in our database prior and control (24% fewer complaints), staffing shortages (22% to the pandemic, only 1% of complaints were flagged in this fewer complaints), communication (13% fewer complaints), way in March-June 2020. This significant increase is likely due and personal protective equipment (11% fewer complaints) to the caregivers realizing the impact the isolation had had on when compared to the data in our first Special Report. This is their loved ones as visits resumed in Fall 2020. likely due in part to better access to IPAC training and support, The Long-Term Care Homes Act, 2007 includes a right to some better supports for staffing beginning during Wave 2 receive visitors and a right to the 24-hour presence of family and improved access to PPE from summer 2020 onward. As and friend where a resident is dying or very ill in its Bill of noted, Patient Ombudsman also received fewer whistleblower Rights. However, these rights were not fully respected or complaints and these complainants were more likely to raise promoted during the pandemic. There are limited recourses these issues. for individuals who feel that there has been a breach of the While not a major source of complaints, Patient Ombudsman Bill of Rights as these rights are deemed in the legislation to be also saw an increase in complaints about courtesy and respect contractual in nature and there is no body designated to (Sensitivity/Caring/Courtesy/Respect) from 0% to 4%. These address or provide direction to homes with respect to these complaints were about issues like rude or disrespectful staff, rights in particular. receiving verbal abuse, and seemingly capricious decisions. Complaints about infection and prevention and control (IPAC), Given the extreme stress the pandemic has caused for long- staffing shortages, poor or lack of communication and term care home staff, it would not be surprising if compassion personal protective equipment (PPE) remained substantial fatigue on the part of staff played a role in these complaints. sources of complaints. However, there was a large decrease in

Patient Ombudsman | COVID-19 Special Report 2 | August 2021 26 Resident/caregiver stories Patient Ombudsman heard many stories of the impact that significantly impacted their mental and physical health. Many visitation restrictions had had on caregivers’ loved ones in caregivers expressed having lost significant time with their long-term care homes. The loss of social contact has had a loved ones and seeing someone in a profoundly different profound impact on many of these residents and has condition when visiting restrictions were lifted.

The effects of isolation The daughter of an elderly long-term care home resident The family had video calls with the resident where her mother spoke to Patient Ombudsman about the isolation her mother cried the entire call, believing she had been abandoned and suffered during the second wave of COVID-19. Her mother not understanding the reasons that visits had stopped. was unable to walk unassisted. Prior to the pandemic, her Once visits were permitted again, the family told us that they husband had visited every day to help with her care and to struggled to get access to frequent COVID-19 testing that was keep her company, but this was no longer permitted. The needed. They also noted that only indoor visits were daughter told us her mother had become severely depressed; permitted and could not take their loved one outside. Visitors sleeping for hours during the day, skipping meals, losing were barred again when a staff member tested positive for weight and being prescribed anti-depressants. COVID-19.

Lack of visits and a decline in dad because of isolation A complainant contacted Patient Ombudsman about their months on their video calls. They told us that their father is elderly father, who has dementia as well as significant physical only eating a fraction of the amount of food he did before the limitations. The family told us that before the pandemic, they restrictions and is only able to have a short video call whereas had visited him at least an hour daily and they had he could speak for over an hour before the restrictions. supplemented his care with private providers. When visits were re-initiated by the home, they were limited As soon as the restrictions were announced, the family was to 30 minutes, once a week and the home informed families concerned about the impact of the isolation would have on and caregivers that they would not be able to support both their father. They observed significant declines over the virtual and in-person visits.

Patient Ombudsman | COVID-19 Special Report 2 | August 2021 27 Targeted approach to visitation restrictions During the peak of the second wave, a long-term care home At the time, the home administrator communicated the took a strict approach to visitation and barred all essential restrictions to residents and families, they did not have the caregivers and external visitation to the home until after all dates for the resident vaccinations and had advised families residents and staff received COVID-19 vaccinations. This that the restrictions may last three weeks prior to being impacted 152 essential caregivers. reassessed. Luckily, vaccinations occurred at the home within one week of the communication and visits were re-instated the following day.

Ongoing separation A daughter received notice that her mother tested positive for COVID-19. The daughter told Patient Ombudsman that she COVID-19 in her long-term care home. The home moved her was not able to visit her mother in an area with active COVID- mother to a different floor to ensure COVID-19-positive residents 19 cases because of her work. were cohorted and isolated to prevent spread of the disease. The daughter was confused about the various things that she Luckily, her mother recovered and suffered no lasting illness. heard from the home that did not seem to be consistent with After several weeks, the daughter asked that her mother be other guidance she received about COVID-19 and the risk of returned to her room. However, the home would not do so transmission after several weeks of no longer being ill. until the outbreak had ended and there were no more cases of

Patient Ombudsman | COVID-19 Special Report 2 | August 2021 28 Complaints about Home and Community Care

Each year, approximately 800,000 people receive • appropriate use of PPE, and home and community care through Ontario’s Home • respect for socially distanced treatment whenever possible. and Community Care Support Services organizations Complaints about HCCSS typically make up less than 10 (HCCSS).9,10 In addition to providing home care, the percent of all complaints received by Patient Ombudsman. HCCSS organizations also coordinate access to long- Between July 2020 and April 2021, Patient Ombudsman term care homes and make referrals to other received 210 complaints from 188 unique complainants about home and community care, seven percent of all complaints community services. received. Sixty (29%) of these complaints were related to the COVID-19 pandemic. While considerable attention has been paid to the impact of COVID-19 on Ontario’s long-term care homes and hospitals, The nature of the complaints received by Patient Ombudsman there has been relatively little focus on the impact of the mirror the factors noted by the Home Care Ontario survey.12 pandemic on home and community care. In the survey, patients reported feeling safe when their care was consistent, delivered safely, and they received regular The results of a survey conducted by Home Care Ontario and communication. The COVID-19 related complaints to Patient the Ontario Community Support Association, associations that Ombudsman were most frequently about lack of access to represent home and community care providers, indicated that adequate and consistent levels of care that was often related 93% of respondents “felt safe to receive care from their home to worker shortages, primarily personal support workers. health care provider”. The top reasons cited in the survey for People also expressed concern when they felt adequate patients’ feeling safe were11: infection prevention and control measures were not in place • consistency of caregivers or when they did not feel they had the information they • frequent communication

9 On April 1, 2021, the home and community care coordination role of Local Health Integration Networks began operating under a new name, Home and Community Care Support Services. 10 Ministry of Health, Health Data Branch Web Portal, Healthcare Indicator Tool (HIT) CSV Datasets 11 Home Care Infection Prevention and Control Practices (IPAC): Caring for Ontarians Safely at Home during COVID-19, Home Care Ontario, Fall 2020 12 Home Care Infection Prevention and Control Practices (IPAC): Caring for Ontarians Safely at Home during COVID-19, Home Care Ontario, Fall 2020

Patient Ombudsman | COVID-19 Special Report 2 | August 2021 29 needed about how their care providers were working to keep them safe.

Patient Ombudsman | COVID-19 Special Report 2 | August 2021 30 Home care patient concerns about COVID-19 risks The complainant receives personal support services in the agency, she requested that the agency limit the number of morning and the evening coordinated by the Home and workers involved in her care. She also questioned if the Community Care Support Services organization. She had agency was taking appropriate steps to minimize the risk of complained to the service provider agency about the number contracting COVID-19 from her care providers. The of different personal support workers (PSWs) providing her complainant reported that the manager at the agency care and the risk this posed during the pandemic. Her PSWs dismissed her concerns and told her she was over-reacting. had informed her that they were provided with a maximum of Patient Ombudsman assisted the complainant to connect with five surgical masks each week meaning that they wore the the patient relations representative at the Home and same mask to care for many patients each day. Some of them Community Care Support Services organization so that they were purchasing masks at their own expense so that they can assist her to resolve her concerns with the service could use a fresh mask for each visit to keep their patients and provider agency. themselves safe from COVID-19. When she contacted the

Some complainants also expressed concern that home care patients and their caregivers were not given higher priority or sufficient assistance to access COVID-19 vaccinations.

Patient Ombudsman | COVID-19 Special Report 2 | August 2021 31 Interruptions to long-term care home placement Eleven of the 60 COVID complaints were related to long-term care homes to relieve capacity pressures. Others expressed care home placement, both from the community and from concern about initial placements or transfers between long- hospitals. Caregivers for high needs, at risk patients in the term care homes that could not proceed because of COVID-19 community reported that they felt disadvantaged by the outbreaks or because the homes did not feel they could priority given to placing patients from hospitals into long-term manage the required 14 days of isolation following placement.

Impact of COVID-19 on long-term care home placement

A complainant called Patient Ombudsman to express concern Another complaint called Patient Ombudsman to discuss about how COVID-19 was affecting her father’s placement in a challenges with the placement of her 95-year-old father in long-term care home. The Home and Community Care Support long-term care. Her father is mobile with a walker but suffers Services organization (HCCSS) had offered her father a bed in from advanced dementia and wanders. She reported that her one of the homes he had selected, but the placement could father is being refused authorization for placement because not proceed because the home was experiencing a COVID-19 his wandering behaviour would interfere with the long-term outbreak. She was concerned that the delay would affect her care home’s ability to isolate him for 14 days following his father’s priority on the waiting list, and she had not received admission. She expressed frustration since there are no any clarification from the HCCSS. Patient Ombudsman COVID-19 cases in her community and she did not understand contacted the patient relations representative at the HCCSS the need for her father to be isolated. Patient Ombudsman who confirmed that the father’s status on the waiting list helped the daughter to connect with the HCCSS to discuss her would not change because of the delay. In addition, the HCCSS concerns. offered to reassess the father to determine if he needed more in-home support while he waited for the bed.

Patient Ombudsman | COVID-19 Special Report 2 | August 2021 32 Family Managed Home Care As noted in our first report, between July 2020 and April 2021, health care settings, families were concerned about the risk to Patient Ombudsman continued to hear from a small number their vulnerable children. The most frequent solution of families who receive care through the Family Managed proposed by the families was to hire family members to Home Care program. Family managed care is a relatively new provide care, a practice that is only permitted in the Family program that provides direct funding to enable patients or Managed Home Care program policy in the most exceptional their substitute decision makers to hire care providers or circumstances. Some families expressed that they felt these purchase home care services for defined patient groups, exceptions were not granted consistently or fairly during the including medically complex children. Because many of the pandemic. care providers engaged by the families also worked in other

Contingency planning for families receiving Family Managed Home Care The parent of a child with complex needs who requires required precautions to provide care. They were aware that constant care contacted Patient Ombudsman to complain others on Family Managed Home Care who lived in rural areas about administration of the Family Managed Home Care around her municipality had been granted an exception to the program. Although approved for the program, the family had normal policy and were able to hire family members. She did stopped services during the pandemic for fear that the home not understand why the same exception was not available to care workers might bring COVID-19 into the home. The family families that lived in municipal COVID-19 hot spots where the was exhausted, and their stress could be relieved if they were risk of infection was higher. able to hire a family member that they trusted to follow all

Patient Ombudsman | COVID-19 Special Report 2 | August 2021 33 Recommendations

Visitation In its first Special Report, Patient Ombudsman recommended risk to introducing COVID-19 to a health care setting than are a change in approach to visitation in respect of the long-term staff. care homes. While visitation restrictions were relaxed Part of the issue regarding visitation policies is a lack of following the first wave in long-term care homes, visitation identity in established care organizations and pathways. It restrictions were often a primary measure following an appears that this resulted in the systematic exclusion of outbreak in the second and third waves of COVID-19. essential caregivers as they were outside the system. To Significant barriers still remain to residents connecting with address this, it is critical that essential caregivers be defined their loved ones. and provided a role in legislation. Visitation has also been significantly restricted in public Through the complaints that came to the office, Patient hospitals, with each hospital determining their own Ombudsman has seen the effects of isolation – lasting health restrictions. Based on the complaints Patient Ombudsman impacts; significant decreases in quality of life; and significant received, there was significant inconsistency in visitation emotional distress for patients, residents, their caregivers and policies among different hospitals and even within the same loved ones, and health sector organization staff. hospital. Patient Ombudsman recommends that the government The pandemic has demonstrated the extent to which legislate a right to visit for patients in public hospitals and caregivers, families and loved ones have been sidelined as residents in long-term care homes, with a forum to appeal essential elements of patient care and experience. Despite the restrictions that are put in place.13 Despite the rights in the commentary of health sector leaders and ministry guidance, Long-Term Care Homes Act, 2007 Bill of Rights, there are access to patients’ and residents’ loved ones was not limited avenues to redress complaints regarding visitation in sufficiently supported or resourced to allow it to occur. long-term care homes currently. Patient Ombudsman has not seen evidence that suggests visitors who are properly screened, educated and with access Importantly, Patient Ombudsman acknowledges that there are to appropriate personal protective equipment are more of a circumstances where restrictions are permissible and

13 This would be an important recourse even in outside the context of a public health emergency. Patient Ombudsman receives many complaints about restrictions, often for occupational health and safety reasons (For e.g., see PO Annual Highlights Year 2: https://patientombudsman.ca/Whats-New/Annual- Highlights/Year-Two. While such restrictions may be reasonable in the circumstances, there is inconsistency across health sector organizations in their approach to visitation restrictions, how to address appeals, and with respect to enforcement through things like No-Trespass Orders.

Patient Ombudsman | COVID-19 Special Report 2 | August 2021 34 appropriate to address significant risks to safety and security; Such risks and circumstances will likely be fluid and health however, any restrictions on visitation should be: sector organizations should ensure that any restrictions put in • No more than necessary to address the risk; place reflect situations as they evolve. To the extent possible, restrictions on visitors should be time limited or regularly • Based on evidence; reviewed. • Proportional to the risk a visitor poses; and • Allow for exceptions on compassionate grounds.

Communication during a public health emergency As Patient Ombudsman has seen consistently throughout its Public hospitals should have communications plans at the now five years of operation, communication remains a key ready to communicate policy changes that affect patients and deficiency across all the health sector organizations that we caregivers. This includes frequent, consistent and clear oversee. This has become especially apparent during a public communications about what a policy requires of patients and health emergency. Shifting policies, unclear expectations, caregivers and also information about how patients and explanation of changes in patient status, identification of risks caregivers can clarify the way the policy impacts their and options when those risks materialize all require particular circumstance and whether there are ways to comprehensive and clear communication. accommodate those circumstances. Between July 2020 and April 2021, Patient Ombudsman saw a Similarly, long-term care homes should have communications number of examples of poor communication including: plans in place to communicate significant policy changes that • Health providers not providing a rationale for their affect residents and caregivers. decisions or offering avenues to seek out more Home and Community Care Support Services organizations information if needed; should ensure that patients and caregivers receive frequent, • Health providers expediting significant changes to the care consistent and clear communications from their own they provide with limited or after-the-fact communication organizations and their contracted service providers about: to substitute decision-makers and loved ones; • What is being done and what they can expect in terms of • Inconsistent communications and communications infection prevention and control measures to ensure their providing incorrect information about serious issues like safety. COVID-19 infection status; and • Who to contact if they have any concerns about lack of • Failure to accommodate disabilities, language challenges compliance with these measures. and cultural differences in strategic communications.

Patient Ombudsman | COVID-19 Special Report 2 | August 2021 35 It is also important for all health sector organizations to to understand the most effective methods of communicating engage with the patients, residents, clients and caregivers that with them. they serve to understand their communication needs and also

Home and Community Care Although the number of complaints to Patient Ombudsman • Maintain frequent contact with patients whose care plans about the impact of COVID-19 on the experience of home and are affected by the COVID-19 pandemic to ensure that community care patients and their caregivers is relatively they are receiving adequate care and risks are mitigated to small, these recommendations are intended to address the the degree possible. most frequent concerns we heard. • Review their agreements with families who participate in Home and Community Care Support Services Family Managed Home Care to ensure that they contain organizations should: adequate contingency plans that consider risk • Ensure that their contracted service providers, and any management in the context of a pandemic. Clear criteria sub-contractors that they may engage, have appropriate and guidelines are needed to ensure that exceptions to the infection prevention and control measures in place to normal policies are addressed fairly and consistently. minimize risk to patients and their caregivers.

Patient Ombudsman | COVID-19 Special Report 2 | August 2021 36 Long-term support for healthcare workers Following our 1st Special Report, Patient Ombudsman received staff of other health sector organizations, we know that many additional complaints from long-term care home staff about other workers were deeply affected by the pandemic. It is their experience during wave 1 of the pandemic. These stories imperative that the healthcare workforce be supported, speak to the trauma that long-term care homes staff endured including mental health support, and the working conditions and the impact that these events have had on their lives. improved. While we did not hear of similarly traumatic events from the

A staff member’s story A staff member described how the home she worked in lost She told us about the residents dying and being gone so 40% of its staff after a COVID-19 outbreak. She described how quickly. She told us about being scared to come back from much more time it took to be screened, to don and doff PPE time off, not knowing how many residents would have died and care for residents individually and about how she had while she was gone. She told us of her having to place the contracted COVID-19. She told us that there was not enough residents she had cared for in the hours before in body bags staff or time to care for residents and that she had to let and waiting for the funeral home and having to do that again residents know that it would be a long-time before the next and again. staff member saw them, some alone in a room without even a radio or television.

Patient Ombudsman | COVID-19 Special Report 2 | August 2021 37