Nurses urge dedicated funding for infection prevention and control to combat wave of COVID-19 outbreaks in long-term care homes

Ontario’s Long-Term Care COVID-19 Commission released today its second set of recommendations, with a distinct sense of urgency about the COVID-19 situation. RNAO continues to meet with the Commission and inform their work. At our last meeting on November 20, we thanked the commissioners for issuing interim recommendations. In their first release, October 23, the commissioners called for a comprehensive human resources strategy that addresses the full range of staffing issues. That letter was an urgent call to action. Today, the Interim Recommendations focus on leadership and accountability, performance indicators (including staffing levels), restoring comprehensive inspections, improving compliance and enforcement of care standards, and improving infection control measures. This latter point, infection control, is the focus of my blog.

IPAC is a critical issue in long-term care (LTC) homes at all times and more so in the midst of a pandemic. With the rising death toll and insufficient nursing and other resources, IPAC is even more important. RNAO issued today a report and a media release (text follows) with a survey on this life-and-death matter. Please RT this tweet.

As the number of long-term care (LTC) homes fighting outbreaks of the COVID-19 virus increases, the Registered Nurses’ Association of Ontario (RNAO) is demanding the government mandate and provide the necessary funding and nursing expertise to ensure homes are able to contain and prevent further infections.

RNAO conducted an online survey of Ontario’s 626 LTC homes in November to obtain information about infection prevention and control (IPAC) measures. The survey was open for five days. Of the 246 homes that responded to the survey, only 15 per cent have a staff member fully dedicated to IPAC. The remaining 85 per cent of homes reported their IPAC staff had other duties that occupied their time, including 65 per cent being the director of nursing, which is a heavy administrative role. Half of the homes surveyed did not have a formal position description for the IPAC lead. Thirty per cent indicated their IPAC staff had no formal training. And, close to 80 per cent of homes indicated they had to rely on a variety of external sources and services to bolster their IPAC program.

In the midst of an aggressive resurgence of the virus with outbreaks in more than 115 homes (as of  Dec. 3, 2020) and more than 2,300 residents losing their lives to COVID-19 since the pandemic began, RNAO is once again urging the government to make staffing, clinical supports and best practices in infection prevention and control measures top priorities.

The report released today outlines six recommendations government must heed:

1. IPAC should be enforced as a mandatory role in long-term care, with specific full-time equivalent (FTE) requirements depending on the size of the home. This requirement should start with a base of 0.5 FTE for homes with up to 50 beds. Homes with 51 to 150 beds should be funded and allocate one (1) FTE. Homes with 151 to 200 beds should be funded and allocate 1.5 FTE. Homes with 201 to 250 beds should be funded and allocate 1.75 FTE; and those with over 251 beds should receive funding for two (2) FTE.   
2. All IPAC roles must be supported by a standard position description, which clearly outlines the role, expectations, accountabilities and resources, and reflects recognized IPAC standards.
3. All staff in the IPAC lead role must be provided with time and funding to achieve formal and/or specialty education in IPAC.
4. All LTC homes must be given immediately the funding and directives to fulfill the requirement of a registered nurse (RN) or a registered practical nurse (RPN) in the IPAC role, which meets the above three recommendations.
5. LTC homes must be staffed to the level of RNAO’s Nursing Home Basic Care Guarantee in order to provide the necessary staff support for safe care and IPAC compliance.
6. A network of LTC IPAC specialists must be developed and supported by continuous quality improvement and best practices’ rapid learning to ensure we build and sustain IPAC capacity within the LTC sector in Ontario.

“We recognize that homes are doing their very best in the midst of this extraordinary and challenging time. They are trying to cope while facing two decades of severe staffing shortages exacerbated by COVID-19. The need to deliver on the four worked hours of nursing and support care preceded the pandemic; and so is the need for a dedicated IPAC nurse specialist. If LTC homes do not receive these resources, residents and staff will continue to suffer,” says RNAO president Morgan Hoffarth. She adds that it’s imperative that the province step up. “Months ago, the premier said he would place an iron ring around LTC homes. We don’t need an iron ring. What we need is the funding and the human resources to provide safe care.” 

“Hospitals are the only sector where emphasis on infection prevention and control has been made a funding priority and it is the result of the tragedies endured during SARS, and the recommendations that came out of the Justice Archie Campbell public inquiry,” says RNAO CEO Dr. Doris Grinspun, who called for the public inquiry at the time. “In LTC, this is not the case, despite the fact it is a requirement under the Long Term Care Homes Act, 2007 and Ontario Regulation 79/10 to have dedicated IPAC staff. It is evident from the results of our survey that this is not funded, nor it is enforced. Given the number of LTC homes that do not have adequate space to isolate residents who test positive for the virus – or other communicable diseases – and since many residents share a room with more than one other resident, infection prevention and control is even more difficult to achieve,” Grinspun adds.

RNAO says Ontario’s Long-Term Care COVID-19 Commission, which issued a report with early recommendations on Oct. 23, highlighted a lack of strong infection prevention and control measures as a contributing factor to the tragic loss of life in LTC homes. The Commissioners’ urgent call to action and statement also said that “Further study, of the ‘Study’ is not necessary. What is required is the Study’s timely implementation.” RNAO agrees and says that time is now.  Please RT our tweet