Northwood review calls for more infection control expertise, increase system support

Experts who reviewed the COVID-19 outbreak at the Northwood long-term care facility in Halifax say the province needs a more robust response to infection prevention and control and that the overall system needs more support.

On Monday, the provincial government released the 13 recommendations stemming from the Northwood review, although it is not releasing the actual report. It also released a report looking at infection control in general across the long-term care system.

Those recommendations include having specific plans for Northwood and other homesfor how and when to respond to staff shortages, and having a monitoring plan in place so warning signs are caught quickly and support can be provided. Although the COVID-19 response team from the Halifax Infirmary was brought in to help at Northwood, it was well into the outbreak before that happened and only after staffing levels at Northwood dropped dramatically.

"Without enough staff you can't do things like sequester staff to a certain ward to limit cross spread between different units or different floors," said Dr. Chris Lata, the head of the division of infectious diseases at Cape Breton Regional Hospital in Sydney. Lataand Lynn Stevenson, a former associate deputy health minister of British Columbia and registered nurse, performed the review.

"You can create a beautiful plan, but if you don't have the people or the expertise to operationalize it then it doesn't amount to much," said Lata.

COVID-19 sickened345 residents and staff at Northwood,and 53 residents died. The site was quickly overwhelmed by asymptomatic spread. Initially, a 30-bed COVID ward was created, but it proved not nearly enough. Eventually, residents who recovered from the disease were moved offsite to a hotel to free up space.

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The review recommends Northwood's occupancy remains reduced and calls for the Health Department to look at issues related to shared bathrooms and ventilation in the building. There are currently 110 fewer residents at the site than before the pandemic.

Health Minister Randy Delorey, meanwhile, committed to doing away with any rooms at long-term care sites in the province with more than two residents. In the case of Northwood, however, he could not say how many beds would remain permanently closed.

"We know that 30 wasn't enough for a major outbreak at a facility of that size and complexity, but what the final number should be we'll have to dig a little deeper."

Darlene Metzler lost her father, Gerald Jackson, to COVID-19. He lived in a triple room at Northwood. She was pleasedto hear rooms with more than two people would become a thing of the past, but said more needs to happen.

"I personally won't be satisfied until they're one person, one bathroom," she said in an interview. "I think these seniors deserve that kind of dignity. I have my own room. I have my own bathroom"

Officials from Northwood said they would take time to review the recommendations before speaking publicly.

In the case of Northwood, specifically, the recommendations note a need for better cleaning and more support for cleaning staff throughout the site. Although it was happening during the outbreak, it was less of a priority than other things.

There also needs to be a better communications plan for residents and their families in the event of restricted visitation. Although the reviewers spoke to some families who felt well informed, others said they struggled to get information.

Stevenson said a key question that must be settled heading into a potential second wave is if it's possiblefor families to safely come into a facility, which wouldhelp prevent residents from feeling isolated and forgotten.

"I don't think we're saying they should be [allowed in], but we're saying it certainly needs to be considered."

Delorey said other recommendations his department is working on immediately include:

• establishing a mobile infection prevention and control expert team in each of the four health zones that will go to sites dealing with outbreaks;
• getting each zone a resource person dedicated to supporting long-term care homes, as well as additional occupational health and safety resources;
• ensuring staff can get tested and back to work as quickly as possible to help reduce staff shortages.

The minister announced $26 million for this year to work onthe recommendations and an additional $11 million to be used in the subsequent two years. Some steps will happen quickly while others, which include possible changesto legislation, will take longer.

Linda MacNeil, Atlantic director of Unifor, the union that represents most of the workers at Northwood, said she was pleased to have the review results and, in particular, that they highlighted the importance of housekeeping staff and the need to support them.

But MacNeil said other items, especiallywhen it comes to working conditions, ratios and pay and benefits for care staff, are things health-care unions have been drawing attention to for years.

"And it's just infuriating that it takes, unfortunately, a pandemic to highlight areas where it needs attention. It needs attention immediately."

Delorey was vague about what steps his department was taking to address workplace conditions.

Issues with care hours and ratios, in particular, were identified by an expert panel on long-term care almost two years ago and in various reports before that. Delorey said a review is happening now to see how those issues are addressed in other jurisdictions, although previous reports have already done such scans.

Linda MacNeil said it's also time for Northwood to get either an expansion of its existing complex or approval for an additional site elsewhere. Officials with Northwood have been in talks for years with the province about adding additional floors.

"The need is there," said MacNeil. "That's quite clear."

A more general review of infection control within the province found that many long-term care homes lacked the formal expertise necessary, or their designated person on site was juggling multiple jobs and often did not have formal training. Enhanced training is something the department has also agreed to remedy.

Opposition politicianssaid little in the information released Monday came as a surprise. Members of the Progressive Conservatives and NDP both said it's time for the government to put more money into long-term care.

"The evidence is clear," said Tory Leader Tim Houston. "The need is there and the government should act."

Last month, the Tories released their own blueprint for how they think the sector should be improved. And like the Tories, the NDP said any such efforts need to include more staff and more single rooms.

"We maintain that one person in a room is safer than two," said Dartmouth North MLA Susan Leblanc."Let's just do it and make sure people are safe and healthy."

Although the Liberal government has announced plans in recent years to build more than 100 new long-term care beds, no new beds have been constructed since the party came to power in 2013.

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