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 • ’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 2215 568 Ontario 1396 436 468 2 402 3 392 39 350 58 261 5 134 13 Newfoundland & Labrador 125 1 39 0 9 0 5 0 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 the risk of cross-infection in the case of an outbreak involving residents

40 • Stabilize clinical leadership and ensure Plan for back-up COVID-19 • Ensure all residents have access to high and non- quality primary health care that does not require them to leave the home during an COVID-19 outbreak care • Arrange for access to needed specialty care • Have up-to-date, person-centred, integrated care plans in place • Have palliative approaches to care embedded in the home’s processes and culture

41 • Recognize and support family caregivers as essential partners in care • Develop policies regarding family presence • Consider harm reduction approaches to support Presence of family presence family • Ensure appropriate infrastructure, supplies, and policies are in place • Create alternate plans to ensure family caregiver care and services normally provided are not compromised if family caregivers are not permitted in the home

42 Plan for COVID-19 and Influenza • Protocols for testing for COVID-19 and influenza

• Plans to prevent coinfection of COVID-19 and influenza

• Cohorting residents based on symptoms and/or pathogen

• Have areas that can be used as designated cohort units

• Have staffing capacity to cohort staff to separate units

43 Key messages for Local Public Health working with LTC/RH

1. Be proactive and operational , keep a low local community rate of transmission

2. Develop relationships with all institutional and community players (hospitals, homes, primary care) before the crisis

3. Communicate, collaborate, cooperate

44 Revised Outbreak Management Guidance resource available here

PHO resource available here 45 Questions?

46 Theresa Miller

4747 Panel Discussion

4848 Dr. Kieran Moore, Medical Officer of Dr. Pierre Robichaud, Medical Director Health, Kingston, Frontenac, Lennox & and a practicing at the John Addington (KFL&A) Public Health M Parrott Centre

Krystal Mack Dr. David Barber Administrator, Providence Manor Assistant Professor, Department of Family Medicine, Queen’s University; Medical Director, Providence Manor 4949 1. Was there anything unique about your institution that helped you prepare for and respond to the pandemic?

5050 2. What were the unintended consequences of the policies released?

5151 3. How are you preparing for the fall? Any early lessons learned?

5252 Engage with residents/family partners

Complete the self-assessment tool & set goals Now What? Register to join LTC+ via our online portal for access to LTC huddles as well as possible coaching and seed funding.

Continue to learn & share via the virtual learning series to improve care cfhi-fcass.ca | @cfhi_fcass 53 Mark Your Calendar September 24, 2020 2:00PM ET Next LTC+ Huddle The New Brunswick Experience

October 19, 2020 12:00PM ET Virtual Learning Series #3: Prevention

cfhi-fcass.ca | @cfhi_fcass 54 QUESTIONS?

Visit our website for more information

Email [email protected]

cfhi-fcass.ca | @cfhi_fcass 55 THANK YOU

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