Extending COVID-19 support to seniors beyond hospital walls: Long-term care collaborative outreach

Since the COVID-19 pandemic in Canada took hold earlier this year, a group of physicians in East Toronto began meeting regularly to discuss and plan an integrated community-hospital response to the healthcare crisis.

Dr. Jeff Powis, Medical Director of Infection Prevention and Control at Michael Garron Hospital (MGH), and local family physicians from the East Toronto Family Practice Network (EasT-FPN) have been connecting on weekly calls since early March.

With community spread of COVID-19 increasing, the group identified the need for an integrated pandemic response to support at-risk seniors across East Toronto and, in particular, those residing in long-term care homes.

Many members of EasT-FPN provide primary care to residents in local long-term care homes. Through these calls, the Long-Term Care (LTC) Collaborative Outreach approach was born. 

A focus on infection prevention

At the onset, prevention of COVID-19 spread was the primary focus.

The group helped long-term care homes conduct their own needs assessments to determine key areas of focus and intervention.

Some of the early priorities included screening visitors, accessing personal protective equipment (PPE), helping to identify staffing, access to rapid COVID-19 testing and family and resident supports.  

Dr. Jarred Rosenberg, Geriatrician at MGH, has spent much of his time outside of the hospital this past month supporting the LTC Collaborative Outreach work.

Dr. Rosenberg joined the group and started calling long-term care homes in the community to introduce himself where relationships were not already established.

“There are over 50,000 seniors in East Toronto region,” Dr. Rosenberg says. “Our efforts to support them need to extend well beyond the physical walls of the hospital. They may be in need of help and we know how to help them.”

Managing outbreaks at long-term care homes

When prevention of COVID-19 was no longer possible, the team shifted their focus to helping homes manage outbreaks.

They did this by improving the homes’ ability to care for patients with COVID-19, putting appropriate safeguards in place for the safety of staff and minimizing the spread to other residents.

“We want to help ensure that their staff are adequately protected allow them to care for patients with COVID and those who don’t,” Dr. Rosenberg says.

The LTC Collaborative Outreach's response team includes:

• Family physicians from the EasT-FPN
• Nurses from the MGH Emergency Department’s Nurse-Led Outreach Team (NLOT)
• Physicians from MGH with expertise in infectious diseases and geriatrics
• Infection Prevention and Control (IPAC) team members
• Environmental Services team members
• Nurse practitioner with expertise in geriatrics

“We have very strong infection prevention and control leadership at the hospital. Now that we’ve been able to share that expertise with other organizations, some of that is on-the-ground support like environmental services workers and some of that is knowledge and strategies that we’ve implemented successfully at MGH,” Dr. Rosenberg says.

Facilitating conversations about care goals

The team also recognized the need for residents and families to have proactive discussions about their goals of care.

In March, the team created a video to assist residents of long-term care homes and their families explore their goals of care in the face of a pandemic and encourage them to share their wishes with loved ones.

Regardless of what diagnosis a person is facing or the location a senior is receiving care, Dr. Rosenberg stresses the importance of sharing your wishes with your family.

“No matter where patients are cared for, we work collaboratively to meet their goals of care,” he says. “It’s the bottom line of what we do.”