Updated as of 5:40 a.m. on Monday, November 16
Health care workers from across the spectrum are putting their expertise at work at Cedarcroft Place Retirement Residence in Stratford to try to stem the spread of COVID-19.
As of Sunday, there were 42 cases of COVID-19 in residents and 18 in staff. The update was provided by Dr. Miriam Klassen, Chief Medical Officer of Health for Huron and Perth. There has been a total of four deaths.
Doctors, nurses, paramedics and public health officials are all involved in getting the care that the residents need.
Two doctors were in the retirement home on Saturday and two more were in the home Sunday to assess residents.
Dr. Paul Gill is the lead physician for the pandemic team in Huron and Perth.
"Our response yesterday (Saturday) focused on identifying the acute medical needs and resulted in five patients who were COVID positive being moved out to other centres and five who had acute medical needs that were moved out as well but were COVID negative," said Dr. Gill.
There could be more residents to move to help staffing ratios at Cedarcroft.
And because it is a retirement home, Cedarcroft needed some support in bringing health infrastructure including oxygen supplies and medication. That has been done with the help of Perth County Paramedics and local pharmacies.
The paramedics team has also been a key in transferring patients.
Lily Goodman is the CEO at Cedarcroft and says they are implementing a plan to communicate with families.
"Today we are setting up a hotline for the families to have a centralized point of communication. Out intent is to staff the number 24 hours a day," said Lily Goodman, CEO of Cedarcroft. "From 9 a.m. to 9 p.m. our plan is to get back to families within an hour. From 9 p.m. to 9 a.m., we will get back to families within four hours."
The hot line number is 519-273-0030.
"We want to thank the community for the outpouring of support," added Goodman.
She says staff at the home that were in isolation started to come back this weekend. And support has also come from hospitals outside of the Huron Perth Healthcare Alliance, including Wingham and Goderich.
Huron Perth Public Health also recorded questions and answers through a media conference on Sunday. They can be read below. Dr. Miriam Klassen is the Medical Officer of Health for Huron and Perth. Andrew Williams is the CEO of the Huron Perth Healthcare Alliance. Dr. Paul Gill is the lead physician for pandemic team in Huron and Perth. Lily Goodman is the CEO at Cedarcroft.
Q1: Why shouldn’t people with COVID stay in one place and people without COVID stay in another? Why spreading them out to different hospitals? Dr. Klassen: The preferred approach with any outbreak in a congregate setting is to keep the residents in the home to receive care and support and minimize introducing infection into other settings However, when residents are not able to be cared for in the home due to staffing capacity, decanting is the next step and executed based on system capacity. In an outbreak, implementing outbreak measures puts more stress on staffing Therefore, with Cedarcroft, in the interest of keeping residents safe, this decanting is happening As well, there are continued efforts to put resources into the home for the remaining residents and to prepare for receiving transfers back to the home when the situation is stabilized Thank you to the HPHA, medical communities, and southwest LHIN for making this happen
Q2: Should people be worried that someone with COVID is now in their community’s hospital? Where did COVID patients go? Dr. Klassen: Any hospital that has accepted a person with COVID-19 has the capacity to receive COVID positive patients; they have been preapring to receive COVID patients. There is no risk to the greater community. Andrew Williams: All of the hospital facilities have all of the right protocols in place to accept COVID patients – that has been a major focus for all of our hospitals. COVID positive patients are being cared for in the appropriate and safe ways and staff are trained and aware.
Dr. Gill: Our physicians have been matching the care needs of residents to the hospital sites they will be transferred to – skill sets needed are being communicated and matched. Mike Adair (Perth Paramedic Services): Protocols and processes are in place and being followed to ensure the safety of everyone involved in a transfer.
Q3: What is the threshold to meet to decide if a resident should be transferred to a local hospital? Dr. Gill: From a clinical perspective, it is fairly complex; there is not one single metric. Discussions happen between the clinical and the patient about: the goals of care, symptoms, desire to be transferred, whether care needs can be met in the home, whether there is the right infrastructure in the home to support the person’s medical needs, what care supports will have to come into the home to support the person The timing of a transfer is dependent on a multitude of fators. Our efforts are to ensure that we increase the staffing and support to the home to provide care in-place with highest quality of support possible. When infrastructure supports aren’t available, they may need to be transferred. Higher risk residents, even if they are negative and asymptomatic, may also need to be transferred to better match their needs Some decisions may be based on staffing capacity not solely on patient needs and staffing continues to be challenging across Canada. When staffing is stabilized, the intent is to move people back in to the home when they can have a high quality of care.
Q4: Is there a limit to how many you would transfer on a daily/weekly basis? Dr. Gill: It depends on where we can get highest quality of care for the person. We let system partners know that we have a care need and ask partners if they can accommodate it. Some have created bed supply or upped their staffing to create a bed. Partners have been willing to create capacity. Andrew Williams: HPHA has a daily lens on all beds across the region – we know capacity of sites and we reach out. All hospitals knew we were looking at this and started to free up beds. We are grateful to our home care agencies (the southwest LHIN) who are helping free up beds in hospitals to receive Cedarcroft residents.
Q5: Is this outbreak and response precedent setting? Andrew Williams: This is the first time this type of response was needed locally. Across the province and during every outbreak of this nature, the same lens has been applied. There would have been movement across organizations, ensuring staffing. So this is the first time here locally but not across province. We are all tracking lessons learned to build on successes and learn from challenges.
Q6: Previous outbreaks, such as the one at Greenwood Court, seemed to be more contained; what’s gone wrong this time? Jeff Renauld (Administrator – Ritz Lutheran Villa/West Perth Villa, Mitchell Nursing Home – Huron Perth Pandemic Community Lead): Key difference between this and the outbreak at Greenwood Court is that Greenwood is attached to a long-term care setting. There are distinct differences between long-term care homes and retirement homes; long-term care homes have significantly more resources to respond to outbreaks. Dr. Klassen: One of the risk factors is the incubation period of COVID-19, which is 14 days. This longer time period makes it challenging. Another risk factor is that this is a high-risk population in a closed community, and with this particular home, many residents stay past the point of being transferred into a long-term care home, so their needs can be higher. Another risk factor is the increased demand on staffing. During this “second wave”, more facilities and hospitals are up and running at full capacity so there is more strained capacity.
Q7: Are staff at Cedarcroft working at other jobs potentially infecting other people in the community? Lily Goodman: From the beginning of the pandemic, our company has implemented standards that are higher than what government has implemented; I implemented single-site working for a long time. At this facility, we are paying extra money to our staff to ensure this happens. It’s common for people to work at two different locations, but this hasn’t happened in our buildings during COVID. Andrew Williams: A major focus has been on infection prevention and control (IPAC) and putting the right practices in place. A challenge we all face is when we bring new staff in, they may not have comfort level necessary with IPAC. HPHA has deployed an IPAC specialist who is doing on-site training with new staff to ensure they are following the right protocols to be safe and comfortable with the supports they have.
Q8: Are you concerned about staff coming to work at Cedarcroft from other hot-spot locations? What precautions are we taking? Dr. Klassen: For long-term care and retirement homes, there are regulations in place to not allow healthcare staff to work in more than one healthcare facility – that’s where the risk is greatest. In terms of staff who may commute to work to another community, the real foundational piece is the proper IPAC training. If staff are doing the daily screening, universal masking, wearing proper PPE in consistent and proper manner, then that can be done safely. Lily Goodman: There is an intesnse protocol in place for people coming into building. We’re not sure how the virus came into the building – it could have been a family member or visitor; but we do active screening and are strict about it. The proper PPE plays a huge role in stopping the spread.
Q9: Given these transfers are temporary, what needs to be done for residents to safely move back to Cedarcroft? Andrew Williams: We need to stabilize staffing – ensure we have the right complement of staff for residents who are there and any that would be returning. We also need to be on top of the outbreak – that is the key focus of public health. The care needs of individuals need to be appropriate before they go back. Yes, this is temporary measure, and we recognize that this Cedarcroft is their home and we want them in their homes, but safely. Many things to check off before they go back. Dr. Klassen: We continue with daily outbreak meetings with the facility to assist them in containing the outbreak. Next key activity is to complete third round of prevalence testing on staff