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Nursing shortages led to COVID-19 at BC care homes: Seniors Advocate

More paid sick leave and a higher number of nurses are two of the recommendations made by BC Seniors Advocate Isobel Mackenzie following her review on COVID-19 outbreaks in care homes.

The province-wide review noted sites that provided fewer paid sick days and had fewer registered nurses were more likely to experience a larger outbreak.

“The level of registered nursing is important because sites that had lower levels of registered nursing had a larger outbreak,” said Mackenzie.

“We need to add more staff to the system because if we increase paid sick leave and staff stay home when they are not feeling well there has to be someone to provide that shift they were otherwise going to provide, so we are recommending that as well.”

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In its report, Mackenzie also told Vista Radio they would also like to see the end of shared room accommodations.

“We looked at sites with multi-shared rooms, the sites that had shared rooms were 24% more likely to experience a larger outbreak.”

In total, 365 outbreaks at 210 sites were examined for the period of March 1, 2020, to February 28, 2021, and found:

• 84% of outbreaks occurred at sites in the lower mainland
• 72% of outbreaks were contained to four or fewer cases
• 75% of outbreaks had no COVID-19 fatalities with an overall case fatality rate of 30% • 87% of outbreaks were experienced in Wave 2 (September 2020 to February 2021)

In addition, in 76% of outbreaks (76%), the first COVID-19 case was a staff member. In 22% of outbreaks, a resident was the first case and there was only one outbreak where the confirmed first case was a visitor.

A site was more likely to have a large outbreak if:

• the first case was a resident (four times more likely)
• the first case was a nightshift worker (five times more likely)
• the first case was a registered nurse or a licensed practical nurse (1.5 times more likely)

Mackenzie and her office noted fast notification of the first case and testing staff within the first 48 hours were more likely to contain an outbreak and 40% of outbreaks that had not tested all staff by the fourth day grew into larger outbreaks.

The report includes seven recommendations that will either be under review or have already been implemented by Health Minister Adrian Dix:
1. Increase paid sick leave for staff
2. Increase the pool of direct care staff
3. Decrease contracting for direct care staff
4. Increase levels of registered nursing staff as a proportion of direct care staff 5. Increase testing scope, timeliness, and frequency
6. Eliminate shared rooms
7. Require staff of long-term care to be vaccinated and provide booster shots to residents

Mackenzie is applauding the province’s move to require all visitors to long-term care facilities to be fully inoculated against COVID-19, which takes effect on Tuesday.

Visitors to acute care centres will have to be vaccinated by October 26th.

“When you look back at the 30% case fatality rate we saw in waves one and two – now we are seeing some deaths in long-term care but as a proportion of cases, they are much, much lower.”

Health Minister Adrian Dix noted Northern Health has the lowest vaccination rates for employees in long-term care facilities.

For example, our health region has a 79% fully vaccinated rate, Vancouver Coastal has the highest rate at 94%.

Mackenzie says more staff would be lost if they become infected with the virus than if they continue to show vaccine hesitancy.

“The staffing argument around the staff we are going to losing by imposing the vaccine mandate we have to balance that against the staff we would lose because of an outbreak.”

Any long-term care workers who refuse to get vaccinated by October 13th will be off work without pay.

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