Tuesday, April 14, 2020

Covid-19, Triage guidelines and nursing home deaths.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Nursing home residents, with Covid-19, may be experiencing discrimination by being denied beneficial life-saving treatment. It appears that some nursing homes are not transferring residents to the hospital, even when treatment is available. Some of these decisions should be considered elder abuse.

The disability movement is also concerned that people with disabilities are being denied medical treatment.

I understand that there are times when the person is nearing death and it is not reasonable to transfer the person to the hospital. I also understand that there are times when the hospital lacks the treatment capacity to accept the elderly person. I am concerned that treatable elderly people are not receiving treatment, even when there is treatment capacity.

I was interviewed by OneNewsNow about an article that I wrote concerning the Covid-19 triage guidelines developed by Dr James Downar, the former chair of the Physicians Advisory Council for Dying with Dignity, a euthanasia lobby group. OneNewsNow reported:
Alex Schadenberg of the Euthanasia Prevention Coalition tells OneNewsNow one of the problems is that if a hospital ICU is near capacity, then certain people would not receive medical treatment.

"Basically if a hospital, due to the COVID-19 crisis, [if] the ICU is full, then anybody who … has a medical condition [and] is less likely to recover, or they're over a certain age, they would simply not be given medical treatment," Schadenberg explains.
But hospitals with a less populated ICU would treat them, and hospitals who are full could transfer patients to facilities that have beds available.
I continued by commenting about my concerns about the growing deaths of elderly people in nursing homes. I stated:
So Schadenberg is mainly concerned about elderly people in Ontario nursing homes

"What we've seen based on these triage protocols is that the decision is not to transfer these people to a hospital, even if they have a significant condition, that is treatable," he reports. "So what you're finding is somebody who's living in a nursing home … if they come down with COVID-19 … they're basically only cared [for] in that nursing home, which is very limiting."
He says that means they are more likely to die.
Chris Aung-Thwin reported for the National Post that Theresa Tam, Canada's chief public health officer stated that:
the spread of the virus in care homes has been at the root of half of the more than 700 deaths across the country.
Covid-19 nursing home deaths is a national problem. Adrian Humphries reported for the National Post that: 
In Quebec, a police investigation is underway after 31 residents at a care home in Dorval died under what Quebec Premier Francois Legault alleged was “gross negligence.”
Pinecrest Nursing Home in Bobcaygeon, Ont., saw 29 COVID-19 linked deaths in its 65-bed home. In Toronto, 22 residents with COVID-19 died at Seven Oaks.
Eighteen residents at Lynn Valley Care Centre in North Vancouver died with COVID-19; 10 at Almonte Country Haven in Ottawa.
And on and on and on, in communities large and small.
Some would suggest that the large number Covid-19 deaths in nursing homes is due to the age or other health condition of those who died. I am convinced that there are other factors.

Some treatment protocols dictate that residents in a nursing home will not be transferred to the hospital, even when the hospital has the treatment capacity to care for them, leaving them far more likely to die.

Many residents or their families have stated, in a health care directive, that they would not want treatment or that they would not want to be sent to the hospital for treatment and that they would only want "comfort care" measures.

Order the Life-Protecting Power of Attorney for Personal Care from Euthanasia Prevention Coalition to protect your life (Link).

It is likely that some of the nursing home residents who died by Covid-19 may have survived with treatment. This is a form of discrimination, agism and elder abuse.

Elderly people need patient advocates. If your parent needs beneficial life-saving treatment that could enable recovery, then you need to demand equal treatment.

These are life and death decisions.


geardoid said...

You are right about a callous attitude in some chief medical officers and triage directives. In Guelph (Ontario) my own mother with symptoms was tested for covid-19 but sent home to my father and brother before receiving results, which took over three days ! The attitude seems to be that if one is positive than there's no point testing their contacts: they all must have it. That attitude means that not all the people in a nursing home will be properly tested and isolated f positive when one of their residents or staff tests positive (or even develops symptoms). The resignation to a probability that all must have it is tantamount to consigning them to succumb and hope for any to prove immune. This callous attitude goes along with a lack of extensive testing and contact-tracing in Canada generally, or ensuring the establishment of quick-response testing centres everywhere. That lack is the reason we are no better on the infection curve than Italy was at this stage, or even New York. Our present rate of daily growth is a factor of 1.06 which is high and exponential, despite all the lockdown measures, as compared to countries like Taiwan, S. Korea and even Iceland and Germany, where contact tracing brought the growth down to something approaching linear (factor of 1) and manageable. Resignation to 'herd immunity' is just a capitulation to 'survival of the fittest' social darwinism.

Unknown said...

Alex, in past years has there been an unusual number of deaths in nursing homes or related to nursing homes during what has been referred to as the flu season? I can't seen why the nursing home restrictions we see now shouldn't be implemented each year.

For me I am high risk for the flu, yes I did get the vaccine this year, and I regularly social distance and stay away from crowds and avoid touching things etc, etc, that's every year. So the staying at home and having my groceries dropped off is news. Herm

Anonymous said...

When my mother was in long term care there was considerable pressure by the care facility at her annual care conference to change her Goals of Care to NOT include transfer to hospital for treatment or life saving measures. I refused and she did benefit from hospital treatment for several issues.
I conclude that a large number of Covid deaths in seniors occur in the non hospital care facilities and may be due to the advance directives.

Margaret Schaeken said...

I think this COVID-19 pandemic crisis highlights how difficult it is to put into words one's end-of-life intentions. How does one actually determine that one is at their end-of-life? What does 'do not resuscitate' actually mean? Under what circumstances can this be applied? Under what circumstances can one legally be prevented from being sent to a hospital and getting the health services there? Do we need a legal code-of-conduct for each senior's residence that would stipulate, among other things, the minimum PSW to resident ratio, the minimum PSW to resident ratio during meal times to ensure residents who cannot feed themselves get fed? We need some sort of verification tool/process to ensure that each resident gets their meals everyday. Similarly with residents receiving their appropriate medications on a timely basis. By what time in the morning should every resident be changed into clean clothing? Should PSWs be salaried? Should PSWs be assigned to only one residence?

Alex Schadenberg said...

Dear Margaret:

It may become necessary to place strict guidelines on nursing homes. There is a tendency in any institution to develop a culture. In some places it is a culture of caring, in others it is a culture of completing the task, but in some places it is a culture of indifference and even abuse. My concern is that throughout the system we have created pressure to deny treatment to people because they have chosen or it has become necessary to have them live in a nursing home. Whether they live in a nursing home or a private apartment, everyone deserves equality and everyone deserves to be care for.

SB from Friends For Life Alliance said...

Re how to decide in advance what treatments you do not want is impossible. The issue is not the treatment, it's whether you can recover with treatment. That cannot be known in advance. So, appoint someone to speak for you and talk to that person about your preferences. Do not sign anything that says you want to refuse specific treatments or places of treatment.

MDoubleH said...

Dear Alex:
I'm speaking from a place of experience, having worked in a number of nursing homes, visited several, and currently have a 95 year old mother living in one. The issue around "care and compassion" vs "neglect and going through the motions" kind of staffing is dependent on a number of factors. A LEADING factor though is the MOH guidelines on what is considered adequate, and how funding is applied by each of the provinces based on these guidelines. Another factor is the mission/ vision/ philosophy of the owners and HOW THEY CHOOSE TO TREAT THEIR STAFF. HOW you treat your staff does spill over and affect how staff treats the RESIDENTS. I'd like to "toot the horn" anonymously for the excellent care my mom receives, and suggest that the way you know if a LTC home is "good" or not is how stable the staff is, and what the staff turn over rate is. Also, how many other health care workers' parents live there and how decisions are made. Do they call every time there is a fall regardless of injury? Do they have an open door policy to ask questions, make suggestions? Do they restrict access or are visits allowed ANY TIME of the day/ night (within reason)? I can assure you that THIS LTC facility has a high score on a number of key indicators that the MOH tracks; though a few of the indicators are "Not great" because of their location and the kind of clientele who tend to go there- they are in the financially depressed part of a medium sized Ontario City, so tend to get folks who have limited choices, limited finances and multiple medical issues. I encourage you to LOOK MORE CAREFULLY at the track record of Nursing Homes across Canada and inquire about the limitations in care imposed by MOH before pointing fingers at individual homes. I also encourage you to consider this: Because of the DEPLORABLE conditions of some and the HORRENDOUSLY high death rate in some LTC facilities across Canada, the public is now more aware or rather CAN NO LONGER TURN A BLIND EYE to the poor conditions of some of them. Nor can they turn a blind eye to the poor working conditions of the staff. I believe that through the sacrifice of those who have already died, some GOOD will come of this. Yes, at a high price; but there you are. Also to let you know that the MOH in Ontario just mandated testing of ALL LTC facility residents regardless of whether they have symptoms or not, so that the most vulnerable may be better monitored and tracked. There has also been an increase in the wages of some health care aides in these facilities, so let's hope that these improvements will have a LASTING impact. Thanks for being a VOICE to raise the issues and questions around how there are/ may be disparities in levels of care based on age and general health status. Best regards. Mary HH

HILDEE said...