NATIONALIZE LTC
COVID-19 horrors in Ontario LTCs leave nurses with severe trauma and post-traumatic stress: Report
Margarita Maltceva
POPSTMEDIA
2021-03-31
Working in Ontario long-term care (LTC) facilities affected by COVID-19 during the first wave has left many first responders deeply traumatized as 60 per cent of nurses reported symptoms of post-traumatic stress disorder (PTSD) and other serious mental distresses
Working in Ontario long-term care (LTC) facilities affected by COVID-19 during the first wave has left many first responders deeply traumatized as 60 per cent of nurses reported symptoms of post-traumatic stress disorder (PTSD) and other serious mental distresses
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© Provided by National Post According to the Ontario Nurses' Association survey, nearly 60 per cent of respondents in long-term care reported PTSD symptoms after working in nursing facilities hit by COVID-19 outbreaks.
The survey was conducted by the Ontario Nurses’ Association between September and October 2020 and asked 3,300 Ontario nurses about their experiences working in long-term care homes during the first months of the pandemic. Of the surveyed members, 1,951 responded, some partially, to the survey questions on several issues, including access to personal protective equipment (PPE), low staffing and personal strain.
The findings concluded that 50.7 per cent of the respondents had experienced PTSD symptoms after working in nursing homes that were hit by the COVID-19 crisis. The percentage increases to 60.8 per cent in settings with a larger outbreak.
“This wasn’t like anything they’d ever seen; they felt like they were on a battleground,” said Vicki McKenna, a registered nurse and ONA CEO.
“The death of so many residents was and still is totally overwhelming. You walk into rooms where there are three or four people, desperately ill and struggling to breathe. And there was nobody else to help.”
The survey was conducted by the Ontario Nurses’ Association between September and October 2020 and asked 3,300 Ontario nurses about their experiences working in long-term care homes during the first months of the pandemic. Of the surveyed members, 1,951 responded, some partially, to the survey questions on several issues, including access to personal protective equipment (PPE), low staffing and personal strain.
The findings concluded that 50.7 per cent of the respondents had experienced PTSD symptoms after working in nursing homes that were hit by the COVID-19 crisis. The percentage increases to 60.8 per cent in settings with a larger outbreak.
“This wasn’t like anything they’d ever seen; they felt like they were on a battleground,” said Vicki McKenna, a registered nurse and ONA CEO.
“The death of so many residents was and still is totally overwhelming. You walk into rooms where there are three or four people, desperately ill and struggling to breathe. And there was nobody else to help.”
Long-term care staff in Ontario being hired away by Amazon, airports and film industry, association says
The National Post also interviewed three nurses on their experiences working in homes during the pandemic. On the condition of anonymity for fear of job reprisal, they reiterated the issues highlighted in the report and described how the high strain of working in homes during COVID-19 outbreaks left them traumatized and suffering from PTSD-symptoms.
Two of the three nurses said they also contracted COVID-19 at their workplaces, which further exacerbated the personal impact of the pandemic.
According to the survey results, 30 per cent of respondents reported supply issues with N95 masks in facilities without outbreaks, while 49 per cent of nurses in homes with outbreaks said the same.
In addition, 20 per cent indicated they were prevented from using PPE and 35 per cent of nurses were told to wear the same mask while caring for both healthy and ill residents.
“At the provincial tables, I asked, ‘What is the pandemic supply like? Is it regularly inspected? What is the situation?’ And the government replied, ‘We have a supply and we’re working on it.’ And that was my first clue when I started to feel very uneasy. https://t.co/xdhdbgKeBo pic.twitter.com/ftA52OcDsW— Ontario Nurses' Association (@ontarionurses) March 24, 2021
“There was still a big fight though to get proper equipment,” a registered nurse from Ottawa said.
“We had paper gowns that were disposable and did not cover us properly. We also didn’t have proper goggles or visors. And the masks they gave us were the surgical ones but not the N95s that were special for airborne particles that we needed for protection.”
The report found that outbreaks in the long-term care facilities and, particularly, uncontained outbreaks of more than five residents were linked to higher rates of inadequate supply of N95 masks.
Without proper PPE, many nurses fell sick and had to stay home, leaving facilities largely understaffed.
Half of the survey’s respondents noted that staffing levels in their homes decreased during the pandemic. Nearly a third reported short-staffing issues that occurred several times a week, the ONA report states.
“We had many, many staff and more residents becoming ill and a lot of deaths. I had four (personal support workers) who died because of COVID… We had 160 residents when (the pandemic) started last year,and we were down to 92,” the nurse from Ottawa said.
In May, she also contracted the virus and was hospitalized for a month, staying in ICU for at least two weeks.
Being so close to the edge of death, she said, severely worsened her mental health, resulting in several PTSD symptoms.
“I do have insomnia at times, wake up in a cold sweat, and have flashbacks from the ICU when I get tired. And when I have (occasional) headaches I always think, ‘oh my gosh, I hope I’m not going into COVID again.’ So, the stress of going to work every day and coming home hoping I didn’t bring it to my family still weighs on me. That’s all post-traumatic – you get anxiety because you think you’re getting sick again,” the nurse said.
The severe staff shortages meant that the few remaining nurses had to work ‘crazy overtime hours’ and daily ‘double shifts’ to look after residents and co-workers, McKenna said.
“One of the nurses said to me, ‘some of these residents I’ve known for years and they were dying in front of me. And I had two others in the room dying in front of me,and I couldn’t hold all of their hands at the same time,’” she added.
© Peter J. Thompson An elderly person walks near the crosses placed at the Camilla Care Community long-term care home, which has lost dozens of people due to COVID-19.
A registered practical nurse from southwest Ontario said she was deployed to a retirement home, which was left understaffed after it was hit by a large outbreak last November.
“There was nobody. There were some people that came from (different hospitals), but nobody that worked at the facility at that time was actually there. That’s why we didn’t know where to find anything – we were all new to the facility and I’ve never worked there before,” she said.
After only three night shifts of providing personal and medical care to residents during the “worst of the crisis”, she said she began experiencing PTSD symptoms. She was diagnosed with it three weeks ago and says the impact has been so severe that she could not return to that facility.
“I couldn’t stop crying after being there, knowing what had happened to those people… I was struggling to live with it,” the nurse said. “I don’t feel rested because I have a hard time not thinking about it. I tried to distract myself by doing something, but it’s hard: I watch TV or read but I can’t focus.
She had also contracted COVID-19 resulting in a post-COVID-19 syndrome in which patients experience persistent symptoms post-recovery.
The syndrome has left her with strong fatigue that she “has never experienced before,” as well as headaches and persistent shortness of breath, the nurse said.
“I have to stop what I’m doing and kind of hold on to something to try to catch my breath. And then, this chest pain, it won’t go away. We’ve tried a ton of medications to try to get rid of it… But nothing really stops this pain, and it feels like there’s a belt that keeps tightening around my chest, and it’s burning. And sometimes, it goes into my back,” the nurse said.
A registered nurse from the GTA said she had treated COVID-19 patients in several homes hit by outbreaks and compared her experience to working in a “humanitarian crisis.”
“I have never worked more during this pandemic than ever before,” she said. “I don’t think my colleagues and I have cried more than we ever have.”
Emotionally exhausted, she applied for another job but opted to stay in the nursing sector out of loyalty to her residents and colleagues. “I couldn’t abandon them during a pandemic… I like my patients and working with seniors, and I’ve worked in this sector for 15-20 years,” she said.
A registered practical nurse from southwest Ontario said she was deployed to a retirement home, which was left understaffed after it was hit by a large outbreak last November.
“There was nobody. There were some people that came from (different hospitals), but nobody that worked at the facility at that time was actually there. That’s why we didn’t know where to find anything – we were all new to the facility and I’ve never worked there before,” she said.
After only three night shifts of providing personal and medical care to residents during the “worst of the crisis”, she said she began experiencing PTSD symptoms. She was diagnosed with it three weeks ago and says the impact has been so severe that she could not return to that facility.
“I couldn’t stop crying after being there, knowing what had happened to those people… I was struggling to live with it,” the nurse said. “I don’t feel rested because I have a hard time not thinking about it. I tried to distract myself by doing something, but it’s hard: I watch TV or read but I can’t focus.
She had also contracted COVID-19 resulting in a post-COVID-19 syndrome in which patients experience persistent symptoms post-recovery.
The syndrome has left her with strong fatigue that she “has never experienced before,” as well as headaches and persistent shortness of breath, the nurse said.
“I have to stop what I’m doing and kind of hold on to something to try to catch my breath. And then, this chest pain, it won’t go away. We’ve tried a ton of medications to try to get rid of it… But nothing really stops this pain, and it feels like there’s a belt that keeps tightening around my chest, and it’s burning. And sometimes, it goes into my back,” the nurse said.
A registered nurse from the GTA said she had treated COVID-19 patients in several homes hit by outbreaks and compared her experience to working in a “humanitarian crisis.”
“I have never worked more during this pandemic than ever before,” she said. “I don’t think my colleagues and I have cried more than we ever have.”
Emotionally exhausted, she applied for another job but opted to stay in the nursing sector out of loyalty to her residents and colleagues. “I couldn’t abandon them during a pandemic… I like my patients and working with seniors, and I’ve worked in this sector for 15-20 years,” she said.
© iStockphoto A nurse from Ottawa says she and her colleagues feel tragedy for having lost so many long-term care residents in a short period of time as they have known them for years
Long-standing issues
Insufficient staffing in Ontario nursing homes has been a “long-standing issue” and “existed before COVID,” McKenna said.
“We have been hearing from nurses in long-term care about the struggles that they were having with short staffing even before COVID started. So, we believe – and have been for some time – that there’ve been real, real problems and gaps in the delivery of care in nursing homes,” she added.
McKenna confirmed that the staffing shortages have not been solved and remained an issue even during the second wave of COVID-19. She also said that the LTC nurses are still denied the use of N95 masks.
“We also continue to see nursing homes denying or restricting nurses’ access to N95 respirators, claiming that they are not needed in long-term care, despite the fact that elderly residents experience respiratory behaviours and symptoms that generate aerosols and the high rate of infections among health-care workers,” she wrote in an email.
ONA sent the survey results to Ontario’s Long Term Care COVID-19 Commission, as well as their recommendations of what needs to be changed in the long-term care facilities, including increased funding, staffing, and proper PPE that can protect from airborne viruses.
The commission, in a statement to the National Post, refused to comment on the survey and its recommendations as it is currently writing its own report on the state of long-term care facilities in the province.
Actions to support the Ontario long-term care
According to the Ontario Long-Term Care Clinicians (OLTCC) report released on March 25, the total number of cases in long-term care homes has grown from 3,274 to 15,017 between September 15, 2020, and March 24, 2021. More than 3,892 staff and residents have died during that time as a result of the outbreaks.
However, OLTCC indicated that the infection rate among seniors in LTC is “negligible” and “continues to flatten.”
According to the Ontario Long-Term Care Clinicians (OLTCC) report released on March 25, the total number of cases in long-term care homes has grown from 3,274 to 15,017 between September 15, 2020, and March 24, 2021. More than 3,892 staff and residents have died during that time as a result of the outbreaks.
However, OLTCC indicated that the infection rate among seniors in LTC is “negligible” and “continues to flatten.”
© OLTCC COVID-19 update Ontario Long-Term Care Clinicians provided the data, comparing the total cases of COVID-19 in LTC homes from September 2020 to March 2021.
To support the Ontario long-term care homes, the province has contributed $16.3 billion since the beginning of the pandemic, along with an additional $650 million to improve long‑term care in 2021 and 2022.
The funds, along with other investments, will upgrade the “staffing strategy” needed to “improve working conditions for staff in long-term care homes” and “accelerate and expand education” in the Ontario recruitment and training program.
Over $121 million will be sent to “accelerate the training of nearly 9,000 personal support workers.”
In addition to that, the province is investing $175 million more in 2021-2022 for mental health and addictions services, as well as contributing $8.4 million over three years to place mental health workers in Ontario Provincial Police communications to support those with mental health issues.
Krystle Caputo, the press secretary of the Ministry of Long-Term Care, wrote in an email to the National Post that the ministry is collaborating with the Mental Health and Addiction Centre of Excellence at Ontario Health, along with a number of hospitals, to design services for frontline health-care workers that they will be able to access in their daily lives.
“Improving working conditions is crucial to addressing issues of staff retention and improving the conditions of care for residents,” she wrote.
“Our government is fixing a broken system and making long-term care a better place for residents to live, and a better place for staff to work,” Caputo added.
Ontario is also spending more than $1 billion to assist the administration, distribution and allocation of the province’s COVID-19 vaccination campaign.
With the vaccine rollout, there is a hope that the burden on nursing homes will be eased, said the Ottawa nurse.
“I’m really positive about the COVID vaccine, killing this disease and stopping it from spreading. I think with the big immunization clinics, I don’t think we should have a big third wave.”
However, the nursing population is worried that these “promises,” including increased staffing, will not be implemented as the LTC workers have been asking for them for “decades,” said the nurse from the GTA.
The nurse from southwest Ontario said that the province should take extra steps to improve mental health programs for first responders as the available programs are short-term and target mainly depression and anxiety, while trauma and PTSD-related counsellings are not widely accessible.
“What worries me is that not enough people know about PTSD and how it’s going to affect first responders, which also include nurses,” she said.
“There is going to be a tsunami of PTSD, depression and anxiety in the healthcare system when this is over because people don’t have enough time to do self-care, and we’re not taking care of each other. And I don’t think that there’s enough mental health support out there right now.
To support the Ontario long-term care homes, the province has contributed $16.3 billion since the beginning of the pandemic, along with an additional $650 million to improve long‑term care in 2021 and 2022.
The funds, along with other investments, will upgrade the “staffing strategy” needed to “improve working conditions for staff in long-term care homes” and “accelerate and expand education” in the Ontario recruitment and training program.
Over $121 million will be sent to “accelerate the training of nearly 9,000 personal support workers.”
In addition to that, the province is investing $175 million more in 2021-2022 for mental health and addictions services, as well as contributing $8.4 million over three years to place mental health workers in Ontario Provincial Police communications to support those with mental health issues.
Krystle Caputo, the press secretary of the Ministry of Long-Term Care, wrote in an email to the National Post that the ministry is collaborating with the Mental Health and Addiction Centre of Excellence at Ontario Health, along with a number of hospitals, to design services for frontline health-care workers that they will be able to access in their daily lives.
“Improving working conditions is crucial to addressing issues of staff retention and improving the conditions of care for residents,” she wrote.
“Our government is fixing a broken system and making long-term care a better place for residents to live, and a better place for staff to work,” Caputo added.
Ontario is also spending more than $1 billion to assist the administration, distribution and allocation of the province’s COVID-19 vaccination campaign.
With the vaccine rollout, there is a hope that the burden on nursing homes will be eased, said the Ottawa nurse.
“I’m really positive about the COVID vaccine, killing this disease and stopping it from spreading. I think with the big immunization clinics, I don’t think we should have a big third wave.”
However, the nursing population is worried that these “promises,” including increased staffing, will not be implemented as the LTC workers have been asking for them for “decades,” said the nurse from the GTA.
The nurse from southwest Ontario said that the province should take extra steps to improve mental health programs for first responders as the available programs are short-term and target mainly depression and anxiety, while trauma and PTSD-related counsellings are not widely accessible.
“What worries me is that not enough people know about PTSD and how it’s going to affect first responders, which also include nurses,” she said.
“There is going to be a tsunami of PTSD, depression and anxiety in the healthcare system when this is over because people don’t have enough time to do self-care, and we’re not taking care of each other. And I don’t think that there’s enough mental health support out there right now.
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