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Mental health supports brought in for soldiers at LTC homes, commission hears

Conditions in some of Ontario’s long-term care homes during the COVID-19 pandemic were so upsetting that the military immediately brought in mental health supports for soldiers deployed there, a senior officer who oversaw part of the mission told the province’s commission on the facilities.

The potential psychological harm of witnessing atrocities later detailed in a military report was apparent almost as soon as officials walked through the doors, the medical director for the teams sent to the facilities told Ontario’s Long-Term Care COVID-19 Commission.

“As we were walking through…and starting our work within the long-term care facility, we very, very quickly recognized that this had a high risk for either mental health struggles or long-term impacts on our clinicians,” Maj. Karoline Martin said.

“It was — it was very traumatic. It was very devastating to the clinicians to see residents passing away.”

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The report released by the Canadian Armed Forces in late May included accounts of aggressive feeding that caused choking, bleeding infections and residents crying for help for hours, and was part of the impetus for the province to launch the independent commission examining the disproportionate spread of the novel coronavirus within the facilities.

The Forces sent a social worker and padres — spiritual leaders who offer “psychosocial support” — into the facilities, she said.

Shocked by standard of care

Martin told the commission, headed up by Superior Court Justice Frank Marrocco, that the military clinicians who are used to a highly structured workplace were shocked by the standard of care in the facilities.

“They were taken aback because there was a significant deviation from the way that they were used to practicing medicine,” she said.

The long-term care homes had lost roughly 80 per cent of their regular staff, she told the commission.

“When you have 80 per cent of the workforce being either temporary health agency staff or new hires, the understanding of what the culture within that long-term care facility is, what their policies and procedures are for clinical care is very, very challenging,” she said.

“So there was deviation sometimes based on the individual practitioner and sometimes based on a lack of knowledge of what was actually the standard of appropriate care.”

Little supervision, poor documentation

Martin said there were so few registered nurses on staff at the homes that the new hires had very little supervision.

“The theme was there was no oversight to make sure that people weren’t conducting themselves in an unethical manner,” she said, noting that the lack of staffing meant new hires got “barebones” training.

There was also poor documentation of residents’ conditions, she noted.

“We had many, many incidents where we had patients who were immobile or very poor appetite, were not able to feed themselves, and because we’d only seen the first snapshot of one or two weeks or the agency nurses had only seen them for one or two weeks, that was deemed baseline,” she said.

But when regular staff returned, they realized those residents had previously been faring much better, but had seen a precipitous drop in their condition.

Martin said the soldiers also witnessed a shortage of basic supplies, like those for wound care.

“When you have staffing levels at 20 per cent or even 30 per cent, the normal individuals that are responsible to restock those shelves — restock and reorder the supplies — becomes problematic because nobody knows who is actually ordering until there is a shortage of supplies,” she said.

And even when those shelves were stocked, she said, workers had to ask permission to use the supplies — something the military clinicians weren’t used to.

“(They were) sometimes being asked, ‘Well, why do you require this?”’

As Martin wrapped up her testimony, which was conducted behind closed doors on Oct. 29 but was later released as a transcript, Marrocco thanked her and the soldiers who went to the facilities.

“It’s not enough to extend the commission’s thanks to the men and women who did this,” he said. “But it’s very clear that this situation would have — at least in respect of the homes where you were — would have spun out of control if it hadn’t been for your arrival, so thank you,” he said.

Historic mission

Testimony given two weeks earlier by Brig.-Gen. Conrad Mialkowski revealed that this was the first time in Canadian military history that soldiers were sent on such a mission.

“That assistance was unique to our domestic operations history and demonstrated our own agility how to face this challenge,” said Mialkowski, commander of the central joint task force.

Several hundred people were deployed to long-term care homes in both Ontario and Quebec, he noted.

Martin said that initially, those people were all medical technicians and registered nurses. But a second wave of personnel included others with a clinical background: physicians’ assistant, dentists and dental technicians who were all trained in how to care for residents.

Soldiers without a clinical background were also sent to the facilities, she said, and helped with things like laundry and housekeeping so that the clinicians could focus on resident care.

“I think that there is an opportunity to look at creative solutions — be it families, volunteers, et cetera — to do some of those peripheral tasks that really were key enablers to the clinicians to be able to do their job effectively,” she said.