MSH partners with community long-term care homes during COVID-19, supporting home staff across the region with education and training
By Nina Dragicevic
Nurse practitioner Hilary Easton with Fatima Noman, infection prevention and control practitioner
It’s in the DNA of health care workers to provide support to the most vulnerable populations. In fact, years before the pandemic landed, MSH was already working closely with long-term care homes (LTCHs) in the community through a nurse led outreach team.
For the past several years, these outreach teams have been supporting LTCHs within the hospital’s catchment area to facilitate enhanced care for residents. So at the start of the pandemic, when the province requested hospitals to step in and help LTCHs, MSH already had relationships established.
MSH’s mobile outreach team plays a supportive role for many of the region’s long-term care facilities, preventing unnecessary hospital admissions and facilitating transfer back when an admission occurs. This is consistent with the hospital’s guiding vision: ‘Care beyond our walls’.”
“For our hospital, COVID-19 has reinforced that vision,” says Cheryl Osborne, patient care director of MSH’s emergency and ambulatory services. “And we’re honoured to do it. The pandemic has brought that vision to life for me like never before. It’s absolutely saving hundreds of lives across the region. Now, in a proactive way, we need to forge new partnerships and work together to fight the second wave. We can’t do it all, and our community partners can’t do it all,” says Cheryl. “We’ve seen that in long term care. When we’ve shared information and resources, it’s made a huge difference.”
The first wave of COVID-19 quickly became an urgent priority for hospitals across the country. And for frontline health care workers, the next few months were a blur.
“Since the start of the pandemic, we’ve been working 18-hour days, seven days a week, here at the hospital,” says Cheryl. “We’ve been one of the hardest-hit hospitals in the province. Right from the very beginning, York Region was one of the busiest areas. We were trying to manage our internal processes.”
By April, Cheryl says it was clear LTCHs were struggling with outbreaks. And while cases dropped over the summer months, they started to ramp up again in the fall, resulting in new outbreaks.
Public Health assigns each LTCH a colour based on pandemic risk: red means the home is in an outbreak crisis; yellow denotes issues that require improvement but are manageable; and green means there may be COVID-19 cases present but the situation is resolving well. Some LTCHs that had progressed to green in the summer months are now turning back to yellow or red.
“We must help homes that are yellow or red — and help them quickly — or transferring patients to hospital will be their only option,” says Cheryl. “That’s not what the patients want, that’s not what the homes want, but without the proper support it will be an escalating situation with no alternative.” Which isn’t ideal for hospitals either, with increased pressure put on already limited resources.
In the spring, MSH rapidly pulled together a comprehensive community response; mobile team of health care professionals were dispatched to LTCHs in need. Cheryl offered to helm the mission, since she was familiar with the LTCH training program. Fatima Noman, medical microbiologist and an infection prevention and control (IPAC) practitioner, was enlisted to support the taskforce. Their work continues on to this day.
When MSH’s outreach team first arrived at the LTCHs, they encountered some concerning behaviour. Home staff were layering themselves in PPE, wearing two pairs of gloves, three masks, multiple layers of gowns — even goggles with face shields on top. It was clear they were anxious.
Fatima describes the staff’s “irrational use” of PPE as a symptom of another, more critical problem: lack of training. “The first thing,” she says, “was to alleviate their fear and give them confidence in proper use of PPE.”
Next came the establishment of a training program built on repetition and consistency, which Fatima believes is critical to ensuring the new learnings stick once the mobile outreach team leaves. “If we teach them once, they will forget it,” she says. “So I developed a ‘train the trainer’ program, and we trained ‘IPAC champions’ in the homes. Right now, in 17 homes, there are 79 IPAC champions that I have personally trained.”
Hilary Eaton, a nurse practitioner, was reassigned from her cardiology unit to pivot from one role to the next. She first went to the hospital’s COVID-19 Assessment Centre, where she spent 10 hours a day screening patients in the triage tent. She was then dispatched to long term care and retirement homes, and within weeks was further assigned to Participation House’s various community homes (congregate settings for adults with disabilities).
“We’re an extra set of hands and we’re new ideas,” says Hilary. “We have experience in an acute care setting and can make it applicable and useable for community settings.”
One week, she drove to an LTCH in Kleinburg that was in outbreak crisis. She would wake up at 4 a.m. to train night-shift staff who were finishing their shifts; she then sat with patients with dementia to gain their trust before swabbing them.
“I absolutely believe in the work we’re doing. Lives are being saved,” says Hilary.
The taskforce spent months in pandemic-affected homes, touring facilities, talking to staff and performing comprehensive risk assessments. They then identified gaps, drafted action plans, prepared customized education materials and personally trained staff.
Then they came back. They performed audits, talked to staff again and updated training in problem spots. They’re continuing to provide support and will continue to do so throughout the duration of the pandemic, as necessary. “Where we’re needed, our teams will keep going back,” says Cheryl.
Initially, this helped to bring LTCHs from red to yellow to green in about six weeks. But with cases rising in Ontario once again, outbreaks are recurring in LTCHs. And they continue to face a number of other challenges, including province-wide staff shortages that COVID-19 has exacerbated. MSH has a mobile outreach team of nurses and nurse practitioners at the ready, to be deployed as needed.
“It’s our goal to help them stand on their own two feet,” says Julia Scott, vice president of clinical programs and chief nursing executive at MSH. “We’re helping them with policies and processes for PPE, hand hygiene, screening — the same things we’re doing in our hospital. And we’re working collaboratively with them through their leaders and IPAC champions.”
MSH is now considered an IPAC hub, and the mobile outreach team will go back into LTCHs to support home staff with education and training, while IPAC champions are continuing with the safety programs developed during the first wave. “We adapt to what’s necessary in a particular home, what their needs are and what the situation is with respect to COVID-19,” says Julia. “Our goal is to build capacity.”
“That’s why we were early to the game; we were involved in LTCHs before the provincial mandate came out for hospitals to get involved,” says Julia.
“We realize we’re part of the system of health in our catchment area. There’s a lot of work ahead, and a lot of uncertainty, however MSH is committed to going beyond our walls and helping in any way we can.”