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Next Steps in COVID-19 Response in Long-Term Care and Retirement Homes September 14, 2020 12:00 – 1:00 P.M

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Next Steps in COVID-19 Response in Long-Term Care and Retirement Homes September 14, 2020 12:00 – 1:00 P.M Webinar Series: Next Steps in COVID-19 Response in Long-Term Care and Retirement Homes September 14, 2020 12:00 – 1:00 p.m. ET cfhi-fcass.ca | @cfhi_fcass Tanya MacDonald, Dr. Kieran Moore, Medical Theresa Miller Program Director, Officer of Health, Kingston, Providence Manor Resident CFHI Frontenac, Lennox & Addington (KFL&A) Public Health Krystal Mack Dr. David Barber Dr. Pierre Robichaud 22 • Learn from the approach used in Kingston to prepare and prevent outbreaks in LTC facilities SESSION • Offer concrete strategies for organizations to prepare for future OBJECTIVES outbreaks • Share next steps to participate in the LTC+: Acting on Pandemic Learning Together program cfhi-fcass.ca | @cfhi_fcass 3 COVID and long-term care and retirement homes: the Kieran Moore, MD, KFL&A experience CCFP(EM), FCFP, MPH, DTM&H, FRCPC Medical Officer of Health, CEO KFL&A Public Health Professor of Emergency September 14, 2020 Medicine, Queen’s University Program Director, Public Health and Preventive Medicine, Queen’s University Healthy People, Healthy Places Overview • COVID in LTC homes • Ontario’s approach • KFL&A: background • KFL&A pandemic approach • Next steps • Key messages 5 Government of Canada COVID-19 Situational Awareness Dashboard 6 How Canadians contract SARS-CoV-2 GIS Hub is provided by Esri Canada available here 7 Number of COVID-19 Affected Long-Term Care Homes across Jurisdictions in Canada (shown as a percentage of total) Canada 5801 1125 Quebec 2215 568 Ontario 1396 436 New Brunswick 468 2 Saskatchewan 402 3 British Columbia 392 39 Alberta 350 58 Manitoba 261 5 Nova Scotia 134 13 Newfoundland & Labrador 125 1 Prince Edward Island 39 0 Northwest Territories 9 0 Yukon 5 0 Nunavut 00 Source: REIMAGINING CARE FOR OLDER ADULTS page 7 Total Homes Total Affected 8 Number of COVID-19 Resident and Staff Cases and Deaths in Long-Term Care Homes across Jurisdictions in Canada Jurisdiction Resident Cases Staff Cases Resident Deaths Staff Deaths Alberta 558 304 117 0 British Columbia 320 184 97 0 Manitoba 4 2 2 0 New Brunswick 16 10 2 0 Newfoundland & Labrador 1 0 0 0 Northwest Territories 0 0 0 0 Nova Scotia 265 123 57 0 Nunavut 0 0 0 0 Ontario 6576 3275 2052 8 Prince Edward Island 0 0 0 0 Quebec 10275 6079 4455 8 Saskatchewan 4 4 2 0 Yukon 0 0 0 0 Canada 18019 9981 6784 16 Source: REIMAGINING CARE FOR OLDER ADULTS page 7 9 Ontario Orders, Directives, Memorandums for Long Term Care homes 12 March 30 March Ministry LTC Memo 13 March CMOH Update Directive #3 • Begin active screening of all staff, CMOH Memo • Active screening all staff, essential visitors, residents, new and returning visitors, residents twice daily admissions • Only allow essential visitors • Staff and resident cohorting • Follow Ministry of Health guidance for respiratory outbreak CMOH Directive #3 CMOH Directive 1 No short-stay absences Limit number of staff • Use appropriate PPE for all HCWs working in multiple locations 12 March 22 March 10 Ontario Orders, Directives, Memorandums for Long Term Care homes 15 April 21 April April 26 Release of the COVID- 19 Action Plan for Ministry Memo Ministry Memo protecting LTC • Increase testing in LTC homes • Local Ontario Health Regions lead local • Begin proactive surveillance of LTC efforts to plan and support needs of • Aggressive testing screening homes LTC and surveillance • Manage outbreaks • Redeploy health care workers from hospitals Minister’s Directive Ministry Memo • Hospitals temporarily stop • LTC in outbreak receive assistance from transferring patients to LTC • Deployment of hospital hospitals, Public Health Agency of and retirement homes staff to LTC Canada, the Canadian Armed Forces or other federal organizations 17 April April 24 11 Ontario Orders, Directives, Memorandums for Long Term Care homes 26 May 10 June CMOH Directive #2 CMOH Update Directive #3 • Gradual restart of services carried out by • Gradual resumption of visitors health care providers • Active screening of all staff, visitors and residents Ministry Memo • All staff at LTC routine surveillance testing , every Ministry of LTC two weeks • Launching an independent commission into • Surveillance testing of residents in “red” or Ontario's long- term care system “yellow” homes September June 9 12 Ontario Health Recommendations 13 Government of Canada COVID-19 Situational Awareness Dashboard 14 In the news… April 28 April 23 May 20 15 Kingston, Frontenac, Lennox, and Addington Health Unit 16 KFL&A: 27 Senior Homes 11 long-term care homes (LTC) 16 retirement homes (RH) 3000 residents 17 COVID-19 in Senior Homes Residents & Staff 1 Case 0 0 COVID-19 in Staff Hospitalizations Deaths 18 Ontario Public Health Standards 2018 • Prevention • Detection • Management • respiratory infection • gastroenteritis 2018 Outbreak Protocol available here 19 Pro-active preparation • Pre-existing strong relationships between Public Health and senior homes • Communication, collaboration, cooperation, coordination 20 Proactive preparation Yearly updates with LTC/RHs to prepare for influenza, outbreaks, and education about infection prevention and control (IPAC) 21 Proactive preparation IPAC Nurse dedicated to working with LTC/RHs throughout influenza season for many years 22 Proactive preparation September 2019 Influenza Preparedness Workshop and Report (released August 16th, 2019) Hosted by: KFL&A Public Health, Hastings Prince Edward Public Health, and Leeds, Grenville and Lanark District Health Unit 23 Proactive preparation 2019/2020 Table Top simulation exercise for influenza outbreak Homes and providers stepped through an outbreak scenario and discussed possible responses 24 KFL&A Public Health Regular Communication • Support and consultation Long-term Care and Retirement Home • Advice on outbreak management and Nurses infection prevention and control (IPAC) Medical Directors Administrators • Link with acute care for clinical support 25 During the Pandemic Weekly teleconferences with senior homes and medical directors 26 During the Pandemic Augmented inspections in senior homes Inspector + nurse teams inspect all senior homes for IPAC adherence • 4 rounds of inspections • IPAC checklist for each round with additional requirements as COVID-19 progressed • Supervised by IPAC lead 27 Inspections of LTC and RH Pandemic declared Started early!! March 11th, 2020 March 10-13 Round 1: Visited ALL homes 31 repeat visits to 19 homes (assessed as not well prepared) 28 KFL&A PH pandemic response actions for Early Lockdown March 17th LTC and RH • Restriction of visitors Pandemic declared • Non-essential appointments March 11th, 2020 canceled • Active screening of staff and any visitors Round 1 inspections March 10-13 29 30 Inspections • Round 2 – April 3-10 – Phone assessment with home-grown checklist • Round 3- April 24-May 4 – In-person visit with new home-grown checklist – Focused on hand hygiene and PPE • Round 4- May 21- June 24 – In-person visit to all homes – Public Health Ontario checklist 31 Inspection checklists components Main entrance/visitors Care area/residents Testing • Signs posted • New residents screened • Symptomatic • ABHR at reception • Residents monitored daily people tested • Symptomatic residents isolated • Essential visitors only • At least 4 • ABHR/PPE available at point-of- testing kits • Visitors screened care available Admin Staff • Substitute decision-makers • Knows how to use PPE identified • Knows when to isolate (symptoms, • Clear medical directives travel, contact) • Environment reconfigure to • Signs are posted in staff areas (eg, promote social distancing break room) • Staff can list at least 2 resources for reliable information about COVID-19 32 Inspections: progressive enforcements Public health Warnings and orders for homes specific timeline with continuous Fines to rectify issues (Health Protection and Promotion Act Section 13) 33 Universal testing • May 4-15 in LTC homes • Provincially mandated • Tested all asymptomatic residents and staff • No cases 34 Community initiatives Community control of COVID has contributed to low rates in senior homes: • Early expanded testing – No travel requirement – Atypical symptoms • Businesses closures • Guidelines around social distancing • Community compliance • Public Health run assessment center 35 New program: LTC+: acting on pandemic learning together 6 key areas: • preparation • prevention • people in the workforce • pandemic response and surge capacity • planning for COVID-19 and non-COVID-19 care • presence of family 36 • Update IPAC standards and training Preparation • Meet with regional partners to co-design response plans for outbreak scenarios • Secure PPE supply and management • Leverage third-party assessment and guidance to ensure IPAC adherence 37 • Test regularly Prevention • Create contact tracing protocols • Universal masking • Optimize care models • Reduce outside care providers coming into the home • Manage how often residents need to leave for care • Reduce the number of people who are waiting in hospital who need long-term care 38 • Stabilize and reinforce – staffing People in – working conditions – psychological health and safety the workforce • Limit staff to working in only 1 higher risk environment • Provide supports to make this possible • Increase capacity through training and recruitment • Understand and mitigate community- transmission risks 39 • Plan where to turn for assistance if there is an outbreak? Pandemic response • Plan for surge support for every home and surge capacity • Integrate surveillance methods to identify where surge capacity may be needed • Reduce
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