Wednesday, April 29, 2020

Wouldn't it still be better to transfer infected care home residents to hospital?

I have been trying to understand why seniors in long-term care homes who catch COVID-19 are not being transferred to hospitals. Fully 79% of Canada's deaths from the coronavirus have occurred in seniors' homes, so something about the current system is clearly not working well.
Now, it is certainly the case in Ontario, and I imagine in other provinces too, that residents who develop severe illnesses in a care home should be transferred to a hospital by ambulance. However, in practice almost no care homes actually comply with that protocol, and many openly admit it (others do so more sheepishly).
Instead, the infected residents are just "treated" in place, with little or no hope of remission or recovery. Essentially, staff just try to keep them as comfortable as possible until they die, which most of them do within just a few days. Some homes have an infected wing and a non-infected wing, some do not even have that level of segregation. In the meatime, the care home staff are getting infected themselves, and spreading the virus around the rest of the residents. It's almost inevitable, and a recipe for disaster.
The explanation given for this apparently indefensible practice is that the weak and aged seniors that comprise the clientele of long-term care homes - the most vulnerable of the vulnerable - do not do tend to do well in an emergency hospital setting, and are unlikely to survive a visit to the ICU, and particularly not a stint on a ventilator. So, rather than put them through the stress, discomfort and indignity of a potentially overcrowded hospital and the massively invasive intubation procedure, most homes prefer to try and look after them in-house, knowing full well that hardly any will actually survive. Sometimes, the care homes will discuss this with families, and try to persuade them of the wisdom of this course of action (or inaction); sometimes it is just done as a matter of course, merely on the assumption that no care home resident could possibly survive a hospital visit, so there is no point in even trying.
Except that ... thanks to relatively successful measures aimed at flattening the curve, most Canadian hospitals actually DO have capacity for more COVID patients. And we know that hospital staff are much better-trained, and have more and better equipment than care homes. And care homes don't seem to be able to look after the infected patients they have anyway, nor even assure them of a comfortable or dignified end of life (if you are in any doubt about that, you can read any number of accounts in the press, of which this is just an example). And communication between care homes and the families of residents seems to be sorely lacking.
On balance, then, might it not be better to transfer infected care home residents to hospital just as soon as possible, partly to give them at least a fighting chance, and partly to give the care home staff a fighting chance, and to reduce cross-infection within the home. Am I missing something?

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