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"A true measure of any society can be found in how it treats its most vulnerable members."

Mahatma Ghandi

At the September 28th BC Covid update, BC Health Minister Adrian Dix announced that in order to increase the in-hospital capacity with 1500 surge beds for impending COVID and influenza cases, patients would be “decanted” from B.C hospitals into long term care facilities.

The definition of ‘decant’ is the slow pouring of one liquid from its’ original container to another container. It’s a term used to refer to liquids, not human beings!

What Minister Dix is speaking of are patients in hospitals listed as ALC or “Alternate Level of Care”; patients who are no longer ill enough to be in an acute care hospital, but not well enough to go home to live independently. 

Each of these “ALC” patients has made a unique contribution to society. Each one deserves to be cared for and protected by Public Health, and not referred to as a substance to be “decanted.” 

In addition, there are myriad problems with Minister Dix’s plan. 

The reason these “ALC” patients are still in the hospital is that there are often very lengthy wait times for long term care facilities in B.C. Some of these facilities may have physical beds but no staff to care for the residents. This situation has worsened during the pandemic, with many staff currently sick with either COVID or with Long COVID. 

In many instances, families have been told they have no choice but to take their “ALC” family member home and look after them while awaiting a bed in a long term care facility. This is extremely difficult for working families who cannot afford to take time off work to care for unwell family members. 

In some instances, health authorities contract private nursing companies to provide care for “ALC” patients at home. There are reports that this can lead to disastrous consequences, with poorly trained nursing staff and poorly cared for, neglected residents who are abandoned each evening in their beds, with no one to help them during the night. Other times, home care workers call in sick, but the patients’ families are not notified.

The pandemic has brought to light the woeful state of many long term care facilities, struggling with inadequate ventilation, poor infection control policies, and underpaid, overworked staff. The staff often have limited paid sick days, which provides an incentive for them to work when they are sick. 

It is no surprise that out of the 17,875 Worksafe BC claims for COVID as of September 30 2022, the number one industry for claims registered is health care and social services. At 9,213, this represents over half of the total claims. Long term care workers account for 4,325 of these claims.

"As multiple commissions and research studies make clear, any efforts to overhaul long-term care must recognize that the conditions of work are the conditions of care, and include basic standards for care, occupational health and safety, and staffing."

Linda Silas, nurse and President of the Canadian Federation of Nurses Unions and Pat Armstrong, Distinguished Research Professor Emerita at York University in Toronto

There is no greater example of unsafe work and caring conditions than the disastrous outbreak at Little Mountain Place from November 22 2020 to January 29, 2021. With 116 beds in this long term care facility in Vancouver, 72 staff and 99 residents were infected with COVID. 41 residents died.

It conjures up images of what occurred in Québec in spring of 2020. Residents in long term care facilities sat in their faeces and urine, unfed and uncared for due to lack of staff, who were either too sick or too scared to come to work. Some of these residents died of dehydration, not COVID. Even the bodies of deceased residents were neglected, left unattended for days.

Why not prevent the need for hospital surge beds before we have another wave? 

I have worked as a doctor in long term care for many years. WalkIng down the corridors of the long term care homes, there are the smiling faces of the current residents and the ghosts of all the past residents that used to be behind those doors but are no longer with us.

Visiting weekly, you come to know the residents really well and become attached to them and their families. It is a bittersweet relationship because you know that your time with them is limited by the inevitable. You also develop close knit relationships with the staff that care for these residents.

This is why it is devastating when COVID outbreak occurs, causing residents and staff to become very ill and some of them to die. Many facilities have already had at least two, three, or more outbreaks during the pandemic. Although vaccinations and Paxlovid have decreased the number of deaths in long term care, outbreaks continue, as well as deaths.

It’s maddening that many of these deaths could have been prevented by simple measures based upon current scientific evidence about COVID-19.

Let’s start with expanded COVID PCR testing so that we actually know how much COVID is in the community. This could be augmented by capturing Rapid Antigen Test results from the community, as they do in parts of Australia. 

Two and a half years into the pandemic, much of the public is still unaware that the virus spreads through the air. How can people protect themselves if they don’t understand aerosols? Too little attention has been paid to indoor ventilation and air filtration, let alone indoor air quality. Let’s make hospitals, LTC homes, schools, public transport COVID safe by changing the air frequently and cleaning it. 

With RSV, COVID and Influenza all spreading at the same time, bringing back indoor mask protections would limit the impact on our fragile healthcare system. 

New residents should always be screened prior to arrival at the LTC facility even if asymptomatic. Asymptomatic transmission has been known to the scientific community since at least 2020. Nursing and other care staff should be provided N95 masks to wear to protect themselves and also prevent transmission of the disease because one nurse often cares for all the patients in one wing and one care aide looks after multiple patients. 

Patients with COVID infection should be isolated from non COVID infected patients by more than a curtain! Improving the ventilation of the LTC facilities including installing MERV 13 filters and placing HEPA filtration units in resident’s rooms when there is an outbreak would also lower transmission.

But instead of taking these simple steps to prevent vulnerable seniors from dying, provincial health leaders have chosen a smoke and mirrors approach, and just hide how many BC seniors in long term care have died from COVID-19.

In BC, COVID-19 deaths began with seniors at the Lynn Valley Care Centre in North Vancouver. It then became clear to the B.C.government that the public cared about deaths of seniors in care homes. Initially, when COVID infections occurred in long term care homes, an ‘outbreak’ was declared regardless of the number of cases, and when seniors died as a result, their deaths would be listed as “Deaths in Long Term Care Outbreaks.” 

Now, in some health authorities, ‘Outbreaks’ are no longer being declared in long term care homes. In the B.C. CDC Situation report, it is highly suspect that Vancouver Coastal Health and Northern Health have not had a single outbreak since January 20, 2022.

If outbreaks in long term care are no longer being recorded, then even if dozens of seniors die of COVID-19 while in care, they did not officially die in a COVID-19 outbreak in a long term care home.

Instead, the seniors who die in these homes would be listed as deaths from COVID-19 according to their age group. As a result, we do not know and may never know how many BC seniors died and are still dying from COVID-19 outbreaks in long term care homes.

Management theorist Peter Drucker said that "what gets measured gets improved". Three years into this pandemic, public health seems to be taking a different approach: "what doesn't get measured alleviates our obligation to improve".

And so here we are, with plenty of evidence-based tools to contain COVID-19, and yet long term care is still unsafe, both for residents and for health care workers.

The author of this piece has chosen to remain anonymous.