Long-term care homes in Alberta brace for COVID-19 resurgence as requirements change

There are renewed concerns about the safety of people living in long-term care homes as Alberta battles one of the highest rates of active COVID-19 cases in the country and simultaneously eases some facility restrictions.

A new order, announced by Alberta's chief medical officer of health Dr. Deena Hinshaw on Sept. 3, comes into effect today and loosens quarantine requirements for new admissions and residents who leave facilities on some outings.

It also allows volunteers to return to care homes for the first time since they were locked down earlier this year.

The order gives operators more discretion to make these decisions based on individual circumstances and on the site's level of risk tolerance.

"To be relaxing quarantine requirements for new admissions, to be allowing more people into our sites … seems to be counter to the risks that we're seeing within the community. We're somewhat bewildered by that," said Mike Conroy, president and CEO of the Brenda Strafford Foundation, which runs five care homes in Calgary.

All five of the foundation's facilities were COVID-free this summer. Now three of them have outbreaks.

"We believe we are entering the second wave," said Conroy, who is concerned about some of the changes. "The most recent order is more permissive in terms of not requiring people to quarantine or test on new admissions [and] allowing volunteers, based on a risk-based approach — I get that.

"But here we are in an environment of increased community prevalence and increased risk with schools opening … and we're being more permissive in continuing care sites, when we know that's the greatest risk to the population given the vulnerability of seniors in continuing care centres."

The requirement that new residents be tested upon admission has been removed under the new order and replaced with links to documents that recommend testing — a move that has sparked confusion.

Conroy said the Brenda Strafford Foundation will continue to conduct asymptomatic testing for all new admissions regardless.

"The most recent positive resident case we have at Cambridge Manor was discovered based on asymptomatic testing on admission. We admit and we test and we quarantine for 14 days," he said.

Alberta Health tells CBC News that testing requirement has not changed.

"We are aware that some operators may be confused by the changed wording and [are] working with AHS to follow-up with them to clarify," a spokesperson said in an email to CBC News.

Balancing the risks

When she announced the new guidelines on Sept. 3, Hinshaw said it was about striking an important balance.

"We must always balance the need to protect people from COVID-19 with the need to support the overall need and well-being of those who are being protected," she said.

In a statement emailed to CBC News on Sept. 16, spokesperson Tom McMillan said restrictions implemented in the spring helped limit the spread of COVID-19 in continuing care homes, but took a toll on other aspects of residents' mental health.

According to McMillan, the new guidelines were created "based on a detailed assessment of the spread of COVID-19, as well as feedback from residents, operators and families."

Until now, residents leaving overnight for any reason needed to be in quarantine for 14 days when they returned, with no restrictions for shorter off-site visits.

The new guidelines provide low, medium and high-risk precautions — ranging from twice daily symptom checks for two weeks to a full 14-day quarantine — for short and long outings.

"In some cases, this new approach is actually more protective. The old framework did not require any precautions to be taken in residents who left the facility for less than 24 hours, independent of the activities they engaged in," the statement reads. "The new framework also adds precautions for high-risk activities undertaken in that shorter time frame, while realizing that not all overnight visits outside a facility generate the same risk of contracting COVID-19.

"We will continue to monitor the spread of the virus and the implementation of the new, risk-based approach. If changes are needed in the future, we will make them."

Community response

University of Alberta nursing professor Donna Wilson said she believes more flexibility will be good for residents of care homes.

But she warns vigilance will be key with schools opening and elevated community transmission.

"Nursing home operators have to be overly cautious now … partly because the community is not doing its part. There's a lot of people out there that should be wearing a proper mask and not using the same masks for a month at a time," Wilson said.

"We need to start looking at community standards … [it's] people in a nursing home that bear the price, that get ill and die from it when the community doesn't really fear and respect COVID for being a serious virus."

As of Sept. 16, there had been more than a thousand cases of COVID-19 and 163 deaths in Alberta's continuing care homes.

Looking ahead to the fall, Conroy has identified scenarios that will trigger further restrictions in his facilities — including if Calgary surpasses 1,000 active cases or if the city has 15 or more continuing care outbreaks.

And he's calling on Alberta Health to set its own threshold for bringing back tighter continuing care restrictions province-wide.

"That shift from focus on acute care to continuing care should have happened as a result of our experience in the first wave," he said.