HOLY FAMILY HOSPITAL COVID-19 OUTBREAK FAQs FOR RESIDENTS/FAMILIES/PATIENTS

On the evening of June 9, 2020, Vancouver Coastal Health’s Chief Medical Health Officer declared an outbreak of COVID-19 at Holy Family Hospital (HFH).

Situation update:

  • As of July 2 at noon, no new cases of COVID-19 have been identified among residents or staff. There have been no new deaths. In total, 41 residents and 16 staff members have tested positive. We offer our sincere condolences to everyone who has lost a loved one. Providence Health Care staff, medical staff and infection control experts are continuing to work with public health around the clock to ensure our long-term care residents and staff are kept as safe as possible. 
  • There are two main programs, separated on two floors, at the Holy Family campus: a 126-bed long-term care facility, as well as a 65-bed inpatient rehabilitation unit. Thus far, there are no COVID-19 cases in rehab.
  • On June 29, 2020, the Medical Health Officer declared that the COVID-19 outbreak for the Holy Family Hospital Rehabilitation facility is now over. Please note, this is only for Rehabilitation and not Long Term Care. Click here for more details. 
  • Residents, patients, families and staff have been notified.  
  • Enhanced control measures were immediately put in place for the entire HFH campus in order to contain the spread and keep residents, patients and staff safe.

NEW: HOLY FAMILY LONG TERM CARE FAMILY PHONE LINE

  • We have created a Holy Family Long Term Care Family phone line at 604-322-2606 to answer your questions and provide support during this difficult time.
  • This line is monitored from 9am-5pm, seven days a week. If you leave a message, one of our social workers will return your call as soon as possible.
  • For families requiring emotional support or needing assistance navigating the health care system, please advise them to contact the VCH LTC Family Support Line at 1-844-824-2219 or locally at 604-875-4953 (please note that the VCH LTC Family Support line cannot provide specific resident status reports). 

VISITING INFORMATION 

A Public Health Order restricts visitors to immediate family members and spiritual advisor of residents who are clinically assessed to be at end-of-life and those that facilities deem essential to a residentꞋs physical health and mental well-being. On June 30, the Ministry of Health announced updated provincial guidelines that will ease the current visitor restrictions for long-term care homes and seniors’ assisted living residences with clear guidance on required precautions. Each facility must develop written plans outlining how they will meet the requirements before visitation changes take effect.

Social visits will only be allowed if there is no active COVID-19 outbreak at the care home/residence. As such, Holy Family Hospital Long-Term Care will not be able to ease visitor restrictions until its outbreak has been declared over.

For more information, you can read the June 30 provincial announcement here.

QUESTIONS FROM JUNE 19 TOWN HALL 

RESIDENT WELLNESS

Do residents have the option to transfer to hospital?
Speaking to the other outbreaks we’ve been through and the lessons we’ve learned, some of these outbreaks, when you get that first case you don’t know if that's the only case in the facility or if there are already several others. And if we are fortunate enough to catch it very early, that first case or first two or three cases will sometimes be transferred out of that facility and brought into acute care for specialised care. This is what we did with this particular case, when we had our very first. But once it became evident that there was spread throughout the facility, the utility of transferring everyone out has gone down. You can imagine, the more people that you transfer who are infectious, you put other institutions at risk and moving through the facility is a risk also. So with this particular case, once we were aware of the extent of the spread, we were able to keep them in place and optimize the care that we had for them and ensure we put into place every measure possible. The transfer of residents from long term care to acute care is always an individual discussion. The physicians and Dr. Ken Tekano in long term care started a program early in March to have serious illness conversations because we know that individuals will have different goals of care and wishes in terms of being transferred to hospitals and leaving their homes. With COVID-19, we know that the majority of individuals will recover and there are those who will have a more serious illness in terms of pneumonia. The treatments available in long term care are very similar to what we would do in acute care in terms of supportive management and there have been protocols that have been established at all our long term care sites to help ensure our patients and residents are comfortable and that we treat their symptoms in a setting where they would have good quality of care and they and their families feel they have the best options. So individual assessment in terms of transfers are discussed. For those who have a more serious illness such as pneumonia, the outcome in the elderly that we know of is unfortunately worse than those who have less comorbidities or who are younger. So that discussion is put into the larger context of what the residents and families think is more appropriate. So individual discussions have occurred for all our residents and this is a dynamic process, so decisions that were established back in March may change and our physicians in long term care are working with our residents and their families to reassess when needed.
Please describe what kind of care is provided to those who are diagnosed with COVID?

These care plans are individualized according to the clinical condition of the resident with COVID 19 disease. 

Is there some consideration being given to boosting or supplementing the general diets of the residents, especially those who are positive, with general vitamins that may have some benefit?

Many of the residents are already on multivitamins and a HFH LTC dietitian work closely with residents and their families to optimize their diets and nutrition. Depending on the course of the illness (for those who are COVID 19 positive), oral intake may diminish and medications including vitamins could possibly be refused by or not be able to be taken by the resident.

Our mom is showing signs of sadness, listlessness and more forgetfulness than usual compared to pre-lockdown. What is in place to deal with this?
Our Rehab department has adjusted their schedules to be available seven days a week to focus on facilitating Resident/Family communication and social engagement of residents.
How are you addressing feelings of frustration, boredom, isolation, depression, listlessness, loneliness, abandonment,etc in COVID + residents with very mild symptoms?
We are doing all we can to address these feelings by engaging residents in social interaction and safe activities. Our Music Therapist, for example, has provided easy radios for many residents that are programmed to the music they prefer.
If this goes on for a long time, are we considering the psychological impact on residents?

Yes, that is why we have  regular outbreak meetings to see what is happening in the facility, what stage we are at, what measures need to be in place and which can be discontinued or replaced with something else. We do relax the measures as appropriate but we have to make sure we don’t relax them to the point where transmission happens again. We understand the measures cause harm as well as benefit and do our best to minimize the impact on residents. 

Seems our loved one is being discouraged from getting out of bed in the morning. Is this because there isn’t enough staff now? When will this be corrected?
We are maintaining staffing to get residents up in the morning. Some residents with COVID-19 are especially tired and do not get up as often or as long as they would normally.
You said weekly bathing is still happening. My mom hasn't been given a shower since this began, which is over the 7 days. When will she get to properly bathe?
Please call the family support line with any specific inquiry and we will follow up with you. Residents who are COVID-19 positive are not being showered/bathed in the tub rooms at this time but are receiving personal care with washing at least twice per day.
Is it possible to have specific aides that are familiar with each resident care for them? They would know the residents' capabilities, what they need, etc.
Our regular staff are continuing to work in their assigned neighborhoods and ensuring that staff coming to assist in the neighborhood are briefed on the residents and their needs.
If a resident does not have COVID-19, are they still getting into their wheelchairs during the day, even if they require a ceiling lift to get in the chair?
Yes, they are getting up if this is their wish. It is beneficial for residents to be up in their chair from the bed and we are encouraging them to do so.
Are 'positive' residents allowed to continue with their regular skype/FaceTime sessions?
Absolutely! There are some limitations as we are getting more requests for assistance with calls now that window visits are not possible for most residents.

STAFFING

Are additional staff being assigned to the site?
We absolutely have brought in additional staff to help our Holy Family staff care for your family members. We asked our acute care staff for their assistance and they stepped up and we have a number of volunteers who have moved to Holy Family in order to help. We’re also in regular communication with Holy Family leadership and Human Resources to ensure that we have staff for as long as they’re needed.
Can I know if the infected (i.e. COVID positive) staff were dealing with my family member or not? Are the same staff caring for both positive and negative residents? 

We have to respect the privacy of both our residents and health care workers.  When health care workers are identified as having COVID-19, they are not working until they have been deemed recovered and non-infectious.  We try to cohort health care workers caring for residents who have COVID-19 whenever possible. However, when staffing levels to not permit this, health care workers will care for residents with and without COVID-19.  While caring for any resident, health care workers are educated on and practice infection prevention and control measures (hand hygiene, use of personal protective equipment) to reduce risk of transmission.  

Have you implemented any special precautions to pre-check staff for COVID-19 before each shift, such as temperature checks at the door?

Prior to the outbreak, we have followed Provincial orders for long term care facility staff to have symptom screen at temperatures checks. 

If there's a staff shortage, will family member(s) be called on to help with their loved ones?
We will not be asking family members to augment staffing shortages. Every effort is being made to augment our staffing to avoid shortages.
Do staff members have the option of not coming to work?
Unless staff are medically unable to come to work, staff are expected to be at work.
Have you considered or are you implementing that staff who provide care at the bedside wear enlarged ID's (ie bigger photo and name in bigger print)?
The “facial recognition” project with photo identification badges is completely voluntary. However, when a staff member is wearing full PPE, other staff and patients report the photo badge is very helpful. There is no designated staff member at HFH on this project, so any HFH staff who are interested in getting a photo badge, please email a close-up selfie with your name and occupation to Indershini Pillay, Professional Practice Leader Speech-Language Pathology: ipillay@providencehealth.bc.ca.
Assuming the extra staff brought in are for the positive cases, what's staff:cases ratio during the day/evening/night?
The extra staff brought in to assist us is for our overall staffing level and not specific to COVID positive residents. The exception to this is that George Pearson deployed staff are working primarily with COVID positive residents. The staff: resident ratios are approx 1:5 on days, 1:7 on evenings and 1:20 on nights. These are overall ratios, not specific to COVID or non-COVID residents.
What happens if a Holy Family staff member gets COVID-19?

All care staff showing any signs of illness have been asked not to come to work. If they are being tested for COVID-19, they are directed to self-isolate until they have their results. If they test positive, they are asked to continue self-isolation as per Public Health’s direction.

Are there enough staff to care for all Holy Family residents during this outbreak?

Yes, we have a Medical Health Officer on site and communicable disease doctors are supporting them. All residents have their own doctors, in addition. Nurses, Care aids and Allied staff continue to be on site   

Do staff have time to get all residents who use wheelchairs into them each morning? Time to help residents to bed for a nap and to get them up after?
We are ensuring staffing levels are appropriate to ensure we can continue to provide the highest level of care to our residents. This includes ensuring residents are able to be moved from their beds to chairs and wheelchairs throughout the day.
Dr. Henry tells us to go outside and get fresh air. Thursday I drove around HFH and most 3rd floor windows were closed. Can staff open them and keep them open?
At Holy Family Hospital, our air-conditioning system works best with the window shut. Our air exchange system brings in outside air to refresh our home so we do not have re-circulation of inside air.
Can I know if a COVID-positive staff member was dealing with my family member or not?
For reasons of confidentiality, as well as it being extremely difficult to know exactly who and when people came in contact with individual residents, we are assuming that all residents in Holy Family are at some risk of COVID. Given the outbreak, we are being very careful to watch for illness, as well as ensuring ongoing use of appropriate protective equipment and cleaning.
As staff are usually wearing masks and/or face shields, do you have a system that ensures that all entering the facility are supposed to be there?
All staff sign in upon the beginning of their shift. Anybody not expected on the site is asked their purpose for being there.

VISITATION

Can family come in to care for loved ones at end-of-life?
We all recognize how difficult the visitor restrictions are on families and certainly we think a lot about this and the difficulty it puts everybody in. We take our guidance from Public Health and there are directions to us about family visitors that we need to follow and in the event that somebody is nearing end-of-life, the medical team at Holy Family would be reaching out to you and they would be during the course of your family member’s illness to talk about how to best support the resident and yourself throughout this process. If what you want is to come in and visit, we can support that to happen and families would be given appropriate protective equipment, they would be supported to learn how to use that well, and be supported while they came in to visit to ensure that they were safe during that visit. My understanding is that with that personal protective equipment, the family would not need to quarantine after a visit.
Can staff who care for both COVID and non-COVID residents, such as Spiritual Health, please visit the non-COVID residents first?
Yes, this is the practice.
Can we have window visits?
Window visits are limited to only those residents who live in the North side neighborhoods who have their own window at ground level. This is to limit travel through our home to get to the visiting windows on the North side.
Can I visit my family member at Holy Family during the outbreak?

Visitor access restrictions are in place at long term care homes across the province to keep residents and staff safe. The only visits permitted are family or spiritual advisors when residents are at the end of life, or for compassionate reasons. These restrictions are in place to protect the health of our patients, clients, residents, staff and physicians. There is no timetable for when these restrictions will be lifted.

We would like to remind families and visitors that we are asking anyone with symptoms to self-isolate for 10 days and use the new provincial self-assessment tool to determine if you need further testing for COVID-19.

Is HFH going to allow visiting once the Provincial Health Officer allows it?
All visitor guidelines are directed by the Provincial Health Officer and we absolutely will be following their orders when they are adjusted.

HEALTH AND SAFETY

What if a resident is COVID-positive and in a shared room?
For residents who are in shared rooms, one of the challenges at Holy Family is that we do have several rooms where they have 4 beds to a room. So this is one of the issues where we have to use all of the other tools in our toolbelt to separate those residents as much as possible. Effectively, we treat those bedrooms as 4 separate rooms. If a resident does test positive, we essentially put all of those residents on what is called droplet precautions which is where we use all the appropriate PPE and make sure that it is changed between patients, make sure we have dedicated staff and make every effort possible that the virus doesn’t make its way around that room. Unfortunately a lot of these things have happened before we’ve found out about the outbreak, and a lot of residents are incubating. Most of those we’ve found by now, but what we would do is watch the other residents very closely which we’re already doing, monitoring their symptoms and we increase the frequency of monitoring the symptoms of those other individuals in the room. We test them for any change whether it be subjective or objective, so any change in behaviour, doesn't have to be a fever or a cough, even a sniffle, even if the resident’s feeling off, we do not hesitate to make sure that we provide the care necessary for those residents.
Refresh us on what safety measures are in place for healthy residents?
We are blessed to be able to work with an incredible team of infection prevention and control practitioners who know Holy Family well and know the people there well and they have been on site since day 1, really supporting the team to bring the best infection control principles to all of the care that is being provided. We look at the use of personal protective equipment and hand hygiene and the flows of traffic through the building and a myriad of other things that they are so expert at doing. This isn’t brand new to them - any time we have an outbreak, it could be flu, it could be a GI virus - this is what these people are experts at doing, so they are bringing that expertise to the site. We’re really lucky to have the Rapid Response Team there as a partner. This was a resource that was provided through Vancouver Coastal Health that allows more people to come to support the staff, so I would think that’s the most important thing. We also are working closely with Crothall, our housekeeping partner, on enhanced cleaning, so they have really increased the cleaning that is happening at the facility. They had done this prior to the outbreak and now there is additional cleaning now that the outbreak is declared. Probably of most importance is that the high touch areas throughout the site are being cleaned every 4 hours. Now it's still really important for people to pay attention to their hand hygiene but we are creating as clean of an environment as we possibly can. We are really using a lot of our intelligence to find the right mix of staffing for the residents, we think it is really important to maintain those strong relationships that we have between the staff and the residents. They are a part of the family. So we want to maintain those but if it is important that we actually realign staff in a certain way then we will do that in order to keep everyone safe. We’re limiting things like communal foods so that we don’t have to be worried about potentially food being able to transmit the virus between people. We have some new personal hygiene products that have been brought in that will limit the exposure of personal waste that is moving through the facility. So there is a long list of things that we are doing for safety. There is also a long list of things we’re trying to do, not just for the healthy residents but for all the residents, to maintain this feeling of home. So that they don’t feel like they are now suddenly in a “hospital” - they know that this is their own place, that they belong here. I know that the radio show continues, I know that the staff are doing everything they can to really keep spirits up and to keep residents happy and engaged and interested. Our residents have relationships with each other and with the staff who support them and we’re trying to maintain those relationships as much as possible. We’re so grateful for the additional assistance of staff who come in from around Providence to assist us, and they’re absolutely essential, but we are trying to ensure our residents see familiar faces as well. So that continues, and that speaks to the things that we consider when transferring a resident - if we know that relocation or moving away from known caregivers is very difficult for many of our residents. Our team - which includes physiotherapists, occupational therapists, our rehab assistants, our social workers and music therapists - are moving their schedules to assure we have 7-day coverage and they are working very diligently to engage our residents as much as possible in a safe way, in communicating with their families and in engaging them in conversation. Our radio show which is overhead has increased in frequency from once a day to up to 3 times a day where there’s music, inspirational poems, and other words of encouragement to our residents and staff. So the connections continue even though, physically, our residents are not able to congregate with each other in the way that they’re used to.
Why aren’t residents wearing masks?
The most important reason that we don’t ask the residents to wear masks is that this is their home and they shouldn’t be required to put that mask on while they’re in their own home. If there's a resident who feels comfortable doing that or that's something they are used to, by all means they can, but for other people who are not familiar with it, it can feel constrictive, it can be annoying, it could even be frightening to people who don’t really understand. So we use the protective equipment of the staff wearing the mask so that they are not spreading droplets to the residents. Staff wear goggles so that if the resident did have droplets the staff are protected. And we think that is the right way to manage that.
Prior to the outbreak, what were the routine safety measures in place? Will these increased safety measures continue in anticipation of the second wave?

Infection Prevention and Control measures that were in place prior to the outbreak included:

1) Health care worker screening

2) Implementation of the Provincial visitor policy to restrict visitation

3) Monitoring of residents for symptoms compatible with COVID-19 and testing 

4) Use of personal protective equipment by health care workers (mask, eye protection, and gloves for all routine care).

5) Hand hygiene

6) Adherence to the restrictions on staff mobility

7) Physical distancing of residents as much as possible. 

How do we prevent airborne transmission to the hallway?

We checked in with Facilities Management and all our heating ventilation, air condition systems take air flow through fresh air, so that infrastructure still allows for good air exchange. Because this is primarily transmitted through droplets and the procedures that occur or the type of interventions and treatments that are provided to residents in general aren’t generating sufficient aerosols to really make airborne transmission a predominant root of transmission. We’ve been able to adjust how we do some things in terms of medication delivery. So for example, for residents who need medications inhaled - medications for respiratory problems - all those have been changed to metered-dose inhalers. Those provide the same effectiveness in treating airway problems as do the other form of delivery, nebulisation of medications. When that's not possible, we identify rooms to move those residents to receive that type of therapy. But other than that type of medical intervention, the predominant root of transmission is through droplet and contact. So the infrastructure that we have in place for air circulation, ventilation and the air conditioning is sufficient in preventing the concerns around airborne transmission.

This may be a new virus but the way that this is transmitted is not new. We know very well how this virus is transmitted, which most of the time is from touching surfaces and touching your face, or people sneezing or coughing within 2 metres. We went through the facility and made sure there was nobody that was on any current interventions that would actually put the virus into the air. There was one individual, and we moved that individual into a private room and there is no recirculation of the air at this time. That individual is still COVID-negative at this time but we did it in a precautionary way in case they were to become positive, and we’re making sure we’re protecting both the staff and the residents of many of those possible risks.

How do you isolate COVID-19 patients? Do they have their own nurse, care aides and house-keeping personnel?

When decisions are made to move residents from one room of HFH to another room, the overall health status of the resident is considered. Moves can sometimes cause more harm.  When moves occur to single bed rooms, all attempts are made to have cohort staff.  When moves do not occur, all attempts are made to cohort staff as well.

The physical infrastructure of HFH cannot be changed and we are left with the reality that in many rooms, residents are sharing the space.  

In the last town hall there was talk on spotting and coaching for PPE use and hand hygiene. Will this be put in place for all LTC sites as it was for acute care?

This has been in place since the outbreak was declared. 

What practices can my relative adopt to reduce the risks? (ex: hand washing prior to meals) What are the most effective practices for LTC setting?

Hand hygiene before meals and after using the washroom.
Avoid touching ones' own face.
Physically distance from other residents as much as possible.

I have heard there are mask and other protective equipment shortages. Is this shortage putting this site and my loved one at increased risk of infection?

We do not have a shortage and we have sources for continued supply.We are not currently facing PPE shortages, however we are actively sourcing alternate suppliers to ensure continuous supply.

SYMPTOMS AND TESTING

Have any COVID-19-positive residents at HFH had severe enough symptoms that require the use of steroid treatment?

Steroid treatment is a decision made between the resident/family and the family physician in consultation with Infectious Diseases as to the appropriateness of this medication. Please remember that this clinical trial was released for public news before any peer review of the paper was done and the results applied to persons hospitalized or in the ICU. It is not known how this would apply to our frail elderly population but in consultation with Infectious Disease and Senior Medical Advisor, this could be used off-label.

Are you able to indicate how many have mild, medium and high risk symptoms, and do this separately for residents versus staff? 

COVID-19 has a range of symptoms and this information could change day by day even if it could be shared with the public. Patient confidentiality needs to be respected.

If a resident became infected early in the HFH outbreak with mild symptoms, can a second, later COVID-19 exposure during this HFH outbreak cause them to become more ill?

No, what we have seen in outbreaks so far is that further exposure does not seem to cause a second illness or worsening, however each resident will still be kept on precautions limiting exposure between residents even if they are already ill. 

I heard that the worst symptoms are in the first 2-6 days, so after that the chances of severe complications are drastically lower, is this correct?

While it is a common pattern for any serious deterioration to be in the first week of an illness, unfortunately some patients can worsen further along in time.  That is why outbreak precautions will be kept on until the last person finishes having symptoms for at least 10-14 days.  Public health will be monitoring the situation extremely closely until it is felt that the last person is cleared of infection.

Does VCH’s decision to not accept any LTC residents with respiratory symptoms into acute care still stand, now that our hospital system was not overrun?

Admission to Acute Care is an individual case-by-case decision based on consultation with family and residents with Goals of Care as a guide. Not all individuals wish to be hospitalized and as best as possible, residents' directives are to be respected. Severe COVID-19 has extremely poor outcomes for elderly, especially frail elderly, and transfers to Acute Care would not necessarily change the outcome as difficult as this is to accept. This is not “ageism” but rather, biological reality and constraints. As we all age, immunosenescence sets in. At this stage of our understanding of the disease, there is no “cure” for COVID 19, only our own immune systems. In the frail elderly, their immune systems are not as robust as in younger populations and hence, results in poor outcomes that are not necessarily altered by transfer to Acute Care.

If a resident has symptoms or tests positive for COVID-19 and is in a shared room, will the other residents in the shared room be automatically swabbed for the virus as well? What happens? 

After the initial mass testing of residents, repeat testing is based on any symptoms and signs that may be compatible with COVID-19.  We are monitoring all residents closely and retesting when there are any concerns.  

If a resident is symptomatic and gets swabbed for COVID-19, which turns out to be negative, but the resident continues to have symptoms, will they be re-swabbed?

Yes. In addition to nasopharyngeal swabs, we also consider talking alternative specimens (e.g. saliva, orophyarngeal swabs, etc).

Have all residents been tested?

The day after the outbreak was declared the Infection Prevention and Control Team, along with the Public Health Team, went into the facility and did mass testing for all the residents. The purpose of that mass testing was to cast a very broad net to identify residents who may have infections who may not be presenting with the symptoms we typically see in younger, healthier individuals, because COVID has many different manifestations. It’s very challenging to identify our frail elderly residents who may have symptoms. So we attempted to do testing for all residents.

During that first day, we were unable to collect testing on some residents because of residents' awareness of what was happening and the difficulty in explaining to some residents how the testing would be done. So on subsequent days our team went back to the facility to complete testing. There was still one resident who refused testing. In terms of whether residents will be tested again, the way we’ve been approaching this is based on symptoms. So when residents develop symptoms, no matter how mild the symptoms may be, we are repeating testing and that is why we’re identifying additional cases.

Is there a waiting period for a COVID-positive person after they test negative? Do they need to self-isolate? Can they still transmit the virus?

After a person has confirmed COVID-19, they are followed closely and determination of recovery is under the authority of Public Health.  There are clearance criteria that are used and once someone is deemed recovered; they are no longer at risk of transmitting the virus.

Have any residents been re-tested since the announcement of 22 residents positive?

Yes, retesting is done to identify any new resident cases. 

Isn't it better to test all of staff and residents in other facilities before another outbreak?

Mass testing is reserved for outbreaks. Mass testing in facilities without outbreaks is not indicated. 

If my loved one was exposed to an infected person (staff, doctor or resident) do they get tested?

The Communicable Disease Control team at Vancouver Coastal Health is working with the staff at Holy Family to identify anyone else who may have been exposed and taking steps to protect the health of all residents and staff. 

Testing of all residents and patients at Holy Family is now underway.  

If my loved one tests positive, what happens next – do they get transferred to another facility or hospital, are they kept in isolation?

If your loved one tests positive you will be notified and we will take steps to ensure they get the care they need. Your loved one’s health-care team will work with you to make that decision based on their condition.

Who has tested positive at Holy Family?

Even in an outbreak, all staff and residents retain a right to medical privacy; we are not able to provide the identity of the person who tested positive.

I heard that the worst symptoms are in the first 2-6 days, so after that the chances of severe complications are drastically lower, is this correct?
While it is a common pattern for any serious deterioration to be in the first week of an illness unfortunately some patients can worsen further along in time. That is why outbreak precautions will be kept on until the last person finishes having symptoms for at least 10-14 days. Public health will be monitoring the situation extremely closely until it is felt that the last person is cleared of infection.
Have you seen instances in other long term care facilities where the symptoms in an elderly individual have been mild in the first 14 days, but have flared up to something more severe after the 14 days?
At PHC, Holy Family Hospital is our first COVID-19 outbreak in long term care. We work closely with Public Health to control the outbreak. In those who have mild disease in the first 14 days, it is unlikely that they will have worsening symptoms that become more severe. However, the disease progression is relatively new knowledge. How it applies to different contexts is still be investigated.

COMMUNICATION

How are residents being updated?
Our clinical team is caring for our residents every day and communicating with those residents in ways that are appropriate to them. Many of our residents are able to understand what is happening and we want to make sure they have the information they need and why things are happening. Some of our residents are more confused and we just focus on their care and how they’re doing and worry less about telling them the overall picture. So it is an individualised approach. We also ensure the family members are communicated with immediately once we have a positive result and we also are working very diligently to ensure families are able to talk to their resident through FaceTime, phone calls, Zoom or Skype, whatever works best in order for the family member and the resident to be able to communicate together about what is happening.
What is the best way to get information?
We acknowledge that challenge and we’ve tried to work at a new and better system. We have a new central line that will be put into place tomorrow morning, the number is 604-322-2606 and this will be answered by a team of social workers who will either be able to answer your questions or refer you to the appropriate person. If you leave a message, it will be checked between 9am-5pm, 7 days a week. In addition, if there is any change in your residents status you will hear from your physician or from a nurse about the status of the resident.
What personal info can family get about their COVID-positive loved one?

Information about a resident is only shared with their permission and if they are not cognitively intact enough to give consent, this information is given to the substitute decision maker (SDM) who can then share the information with the rest of the family.

For up-to-date information on their clinical condition, you can contact the HFH LTC RN at the usual number and it will be forwarded to RN Family Consultant who will answer your questions or forward them to the attending nurse if she is unable to do so. The family physician will call you as needed as well.

For other inquiries, please call 604-322-2606 and the Social Worker will assist you.

How will you keep families informed of the outbreak situation?

Holy Family Hospital will communicate proactively with families during this time to keep them updated on any changes to the situation.

For families with outstanding questions, requiring emotional support or needing assistance navigating the healthcare system, please contact the VCH/PHC LTC Family Support Line at 1-844-824-2219 or 604-875-4953. Please note that the VCH/PHC LTC Family Support Line cannot provide specific resident status reports. For information regarding a resident in the home, please contact Holy Family Hospital at (604) 321-2661.

I want to talk to my loved one about the outbreak to reassure them. How can I communicate if I am not allowed into the home?

Please contact the facility to see how we can set up communication with your loved one. Please be patient if you have trouble getting through and rest assured we will try to connect you as soon as possible.

We understand isolation is a significant issue among the elderly and particularly during this pandemic period when many new policies are in place for everyone’s protection. We are working on creative ways to get you in touch with your loved one that will not compromise their safety, or the safety of other residents or staff. Please contact the site for more details on what you can do to reach your loved one.

Because of language barrier, a good number of residents don't know, aware of the current situation, any chance to have the memo/ notice in different languages?
We have had difficulty getting updates translated as they would be out of date by the time they are translated. We have a family member who is offering to assist with translation of daily updates into Chinese. Her contact details are in the daily HFH update.

TRANSMISSION OF COVID-19

Can the virus spread through the residents' clothing? Are the positive cases’ clothing laundered together with the negative cases?

Laundering clothing is not a route of transmitting the virus that causes COVID-19. 

Is the outbreak in one area of the residence or is it spread throughout?

The outbreak involves all of HFH residential care.  HFH acute care (rehabilitation program) is also part of the outbreak but no cases have been identified in HFH acute care (rehabilitation program)

In order to provide a maximum amount of isolation; wouldn’t it make sense to put the Covid-19 positive patients and medical staff in one “wing”?

Given the physical layout of HFH LTC and the number of residents with confirmed COVID-19 and their overall health status and comorbidities, this is not possible. 

What behavioural factors played a role in this current outbreak, when the risks and protocols for community transmission were known?

SARS-CoV-2 is a coronavirus that is easily transmitted.  This is reality that the world is dealing with.  Health care workers and health care systems have the best intentions and always strive for best practices for preventing transmission, but the reality is that there will always be gaps.  

If resident became infected early in HFH outbreak with mild symptoms, can a second, later Covid exposure during this HFH outbreak cause them to become more ill?
Based on the current understanding of COVID-19, there have been no documented cases of re-infection in those who have had confirmed disease. While this may be a possibility, re-infection has not been reported. However each resident will still be kept on precautions limiting exposure between residents even if they are already ill.

CLEANING PROCEDURES

Are there extra housekeepers available to increase the cleaning measures? 

Yes.  

When the outbreak is over, will cleaning/disinfecting rules be eased? 

During the outbreak, we have instituted enhanced cleaning/disinfecting procedures. When the outbreak is declared over, the cleaning/disinfecting will revert to routine procedures which are in place at all PHC long term care facilities. 

Are the bathrooms/bedpans in each of the rooms being cleaned more often?

Yes.  

Dividing drapes/curtains in between residents could carry the virus since COVID-19 lives at least 2 to 3 hours on a surface. How are these being kept clean? 

Hand hygiene by health care workers is being used a measure to reduce transmission from surfaces that cannot be easily cleaned/disinfected.

Does the ceiling lift gets wiped off for each patient’s use before and after use?
All shared resident equipment is cleaned and disinfected after each use. Staff are ensuring that they are cleaning their hands before contact with shared items, wearing gloves and cleaning their hands after contact.

OTHER

Do we know how the virus got into Holy Family?
First, we want to acknowledge that all the staff are doing the best they can at all times and we do have a lot of faith in PPE (personal protective equipment) and we know that people know how to use it, but people are not perfect. The virus gets into the facility one way or another from people coming into the facility and there is still a degree of community transmission of COVID. It is very low which keeps the risk low, and given the number of long term care homes we have in Vancouver, on a daily basis, people are doing a fantastic job. But every now and then someone can make a mistake, we can never know exactly where that was, but the best thing we can do at this point is to make sure we put those measures in place to take care of it. The other important benefit of this is that it makes us look at all of our approaches in terms of making sure everyone has optimized all of their infection prevention and control practices. So this is unfortunate, but I will say that these things do happen and we can’t eliminate COVID, which is why it is considered a pandemic, so we just have to manage the best we can and always try to improve our safety protocols so they are the best they can be.
Where are you finding the space?

There are many shared rooms at Holy Family and one of the challenges is that we don’t have that physical separation. Where possible, we have moved residents into private rooms, and where it isn’t possible, what we do is we use the infection prevention and control tools to separate those individuals as much as possible. The other thing we do if we can’t physically cohort residents is that we also cohort the staff. We do have separate staff that are working with COVID-positive residents and they are different than the staff who work with the COVID-negative residents and all these steps cumulatively help us to minimize the spread between these individuals. For the most part, where it is possible, we certainly are reviewing daily at our huddle to make sure we’re looking at the layout of where the residents are and if it's necessary, we do move residents to a limited degree so long as that provides benefit.

With the infrastructure though it may seem that moving is the best thing, for some residents it’s not because of the complex nature of the illness. This is not the only thing that affects the health of residents at Holy Family, so each case is assessed and looked at regularly to see the risks and benefits before decisions are made.

The positive residents and staff - which HF wings/neighbourhoods were they residing and working in?

Due to patient confidentiality, this information cannot be shared but COVID-19 is throughout the care home and we continue with the practices of PPE, strict hand hygiene and other measures that were in place since late March. Public Health is doing its investigations now and when more information is available that can be shared, updates will be given.

If my relative moves back to my home, is VCH still providing 'home care support'? If yes, what are the risks of transmission?

Applications would be made with Care Home Consultant and there are steps to be taken to ensure the safety and well-being of the resident and the family taking the residents home. For more information, please contact the Social Worker.

From VCH’s website: 

In response to COVID-19, the Ministry of Health has created flexibility in the policy on Temporary Absences from Long Term Care (LTC). This change allows residents to leave their LTC home for a maximum of 90 days in a calendar year.

Additional information about temporary absences from long-term care during COVID-19:

Information and Consent - Temporary Absence from Long Term Care

Temporary absences from long-term care workflow

Move or stay in long-term care 

What age range are the positive residents? Is death inevitable for most of them ? How many residents and staff are at their end of their lives because of covid?  

Although COVID-19 infection is very serious in the elderly, it is not always fatal. Many do recover. Age ranges and stages of infection are confidential information that cannot be shared - sorry, but we will do our best to give you as much information as we possibly can. We are working together as a team at Providence and giving our utmost to help you and your loved ones navigate through this storm. We thank you for your support and understanding during this very difficult time for all.

Will you provide a map as the outbreak continues in the facility outlining (generalized) room locations of COVID-positive patients to be updated daily?

To respect the privacy of residents, maps of the room locations of residents cannot be provided.

Families can communicate with HFH staff to determine where their family member is living. 

Based on the current rate of infection at Holy Family, what is the projection of anticipated cases of Covid-19 in this facility over the next month?

Outbreak durations are difficult to predict. In general, outbreaks are declared over after 2 incubation periods with no new cases.  Public Health has the authority to declare the conclusion of the outbreak. 

To our decision makers at all levels: are we to understand that we do not have the resources to address these outbreaks in a more considered manner?

BC’s response to this global pandemic has been effective on a majority of fronts. The health care system had to make a lot of changes very quickly in March to get BC ready to address COVID-19 and to protect our population. The challenge hasn’t been as much about a shortage of resources but, rather, ensuring all the myriad resources we have available are brought together in a comprehensive and timely manner, and that our response is as coordinated and integrated as much as possible. We believe we’re doing that with the Holy Family Outbreak. Our resources currently deployed at Holy Family to address resident care and safety include Public Health, Infection Prevention & Control, Staffing and HR, Occupational Health & Safety, Facilities Management, Risk Management, Housekeeping, PPE Supply Chain/Stores, Nutrition Services, Protection Services, Spiritual Care and many more. We’ve brought in extra staff to assist with the provision of care and to continue to meet the needs of our families, and we’re working closely with our health partners, such as Vancouver Coastal Health authority. The outbreak at Holy Family is a fluid and changing situation and we’re focusing all our resources to mitigating the spread and ensuring as quick a resolution to the outbreak as possible.

When will the outbreak be declared over? How is a care home determined to be COVID-free? 
In general, outbreaks are considered concluded after two incubation periods without new cases. The incubation period for COVID-19 is considered to be 2 weeks. This means that it will take 28 days without new cases before the outbreak can be concluded. These are the general approaches and ultimately Public Health will make the final decision.
What are you doing to prevent further spread?

Enhanced control measures were immediately put in place for the entire Holy Family campus in order to contain the spread and keep residents and staff safe. 

Extensive organizational, infection control and public health supports continue to be in place to help staff and leadership address resident and family needs and ensure staff safety and wellbeing.

Residents, and staff who develop any symptoms of COVID-19, however mild, will receive the care that they need and guidance from the Medical Health Officer.

Providence has also proactively implemented the following outbreak procedures and precautions:

Staffing levels: Management staff is on site seven days per week. Staffing levels are being maintained to provide resident care.
Personal protective equipment: All staff will continue to wear appropriate Personal Protective Equipment (PPE) in order to protect residents and staff at all times.
Limiting to work at one location: Staff currently working in long-term care at Holy Family will not be working at any other facility during the outbreak.
No visitor policy —Visitors have been limited to family, and spiritual care providers, for compassionate reasons at the end of life.
Restrictions to movement: Staff and resident movement in the facility has been restricted. Social/physical distancing measures are in place; all residents are eating meals in their rooms, with staff supervision
Enhanced cleaning: We continue to have enhanced cleaning frequency to high touch areas such as the side rails, tables and elevator buttons. This should reduce the risk of transmission of virus from objects.
No group activities and non-essential services: There continues to be restrictions to group activities, and non-essential services.
Symptom monitoring & testing: Regular screening of all staff and residents.
Outside food: Families may continue to drop off food at our front doors. We ask that it be a single portion and in a disposable container.

During this time, Providence has also deployed experts to the home as part of our rapid response team which includes clinical nurse educators, infection prevention and control experts, screeners, and those people dedicated to addressing quality to answer questions from staff, residents, patients and family, and provide active checks of symptoms with staff and residents. Through these teams, sites are also connected with emergency supplies and additional personnel if needed.

Further measures for infection control may be implemented at the direction of Providence Health Care and the Medical Health Officer.

Can the COVID-positive residents go to acute care?
To discuss care needs in case someone contracts COVID, we would advise families to discuss goals of care with one of the physicians looking after residents at Holy Family. In brief, because there are no specific drugs or therapies for COVID, as well as unclear benefits from sending frail elders to hospital with COVID, goals of care including transfer need to be discussed with a resident's medical provider.
Mom has a new person in her room. Are they running out of room to put the infected people?

Room changes occur for many reasons.  At HFH we have capacity for 126 residents.  

How many residents in total are there in Holy Family LTC?
We currently have 116 residents living at HFH.
How will the outbreak affect services and activities at Holy Family?

We recognize the stepped up outbreak response precautions could delay the delivery of some services, including meals, but continue to actively explore ways to prevent that from happening. There will be no common meals for residents at this time. Rehab activities can continue, but not as group activities.

If we have concerns, or if the outbreak gets bigger, can we remove our loved one from Holy Family?

Yes. There are no restrictions on removing a resident to your home. There are restrictions on moving them to another facility, and there is a restriction on bringing the resident back into this facility. Residents removed from the facility will not be able to re-enter until we and the health authorities are absolutely positive there is no risk in doing so, which could be an extended period.

Who can we contact if we have questions or concerns?

For families with outstanding questions, requiring emotional support or needing assistance navigating the healthcare system, please contact the VCH/PHC LTC Family Support Line at 1-844-824-2219 or 604-875-4953. Please note that the VCH LTC Family Support Line cannot provide specific resident status reports. For information regarding a resident in the home, please contact Holy Family Hospital at (604) 321-2661.

 

Click here to download a Chinese-translated version of the Q&A portion of the Town Hall. 

QUESTIONS SPECIFIC TO LONG-TERM CARE

An outbreak of COVID-19 has just been announced at my loved one’s long-term care home, Holy Family. Should I be concerned?

We have been working closely with Vancouver Coastal Health Public Health Officers and Providence Health Care Infection Prevention and Control to contain the outbreak at Holy Family and keep your family member safe. That is our priority. We have put outbreak control measures in place. This could mean a delay in the delivery of some services due to the stepped-up response to the outbreak.‎

Staff are practicing good hygiene and proper use of PPE to help keep everyone safe.

Why aren't residents wearing masks?
The most important reason that we don’t ask the residents to wear masks is that this is their home and they shouldn’t be required to put that mask on while they’re in their own home. If there's a resident who feels comfortable doing that or that's something they are used to, by all means they can, but for other people who are not familiar with it, it can feel constrictive, it can be annoying, it could even be frightening to people who don’t really understand. So we use the protective equipment of the staff wearing the mask so that they are not spreading droplets to the residents. Staff wear goggles so that if the resident did have droplets the staff are protected. And we think that is the right way to manage that.
Can family come in to care for loved ones at end-of-life?
We all recognize how difficult the visitor restrictions are on families and certainly we think a lot about this and the difficulty it puts everybody in. We take our guidance from Public Health and there are directions to us about family visitors that we need to follow and in the event that somebody is nearing end-of-life, the medical team at Holy Family would be reaching out to you and they would be during the course of your family member’s illness to talk about how to best support the resident and yourself throughout this process. If what you want is to come in and visit, we can support that to happen and families would be given appropriate protective equipment, they would be supported to learn how to use that well, and be supported while they came in to visit to ensure that they were safe during that visit. My understanding is that with that personal protective equipment, the family would not need to quarantine after a visit.
What is the best way to get information?
We acknowledge that challenge and we’ve tried to work at a new and better system. We have a new central line that will be put into place tomorrow morning, the number is 604-322-2606 and this will be answered by a team of social workers who will either be able to answer your questions or refer you to the appropriate person. If you leave a message, it will be checked between 9am-5pm, 7 days a week. In addition, if there is any change in your residents status you will hear from your physician or from a nurse about the status of the resident.
Does VCH’s decision to not accept any LTC residents with respiratory symptoms into acute care still stand, now that our hospital system was not overrun?
There was no policy at any acute care hospital to refuse LTC residents admission for any reason, including respiratory symptoms. Admission to Acute Care is an individual case-by-case decision based on consultation with family and residents with Goals of Care as a guide. Not all individuals wish to be hospitalized and as best as possible, residents' directives are to be respected. It is recognized amongst physicians that COVID – 19 is particularly serious in elders , with higher mortality. There is no proven treatment to alter the course of the illness. Treatment is entirely supportive in nature. This supportive treatment can be very effectively and compassionately provided in our care homes, and is preferred and recommended by our medical staff. Whether a resident recovers or succumbs to COVID – 19 is not dependent upon where they receive care, rather is a reflection of their physical capacity to overcome the virus.

QUESTIONS SPECIFIC TO REHAB

What precautions are being taken to ensure the outbreak does not spread to other parts of Holy Family? (e.g. from long-term care to rehab)

Testing of all residents and patients is now underway. There is no crossover of staff between rehab inpatients and rehab outpatients / clinic areas and there is no crossover between the long term care and the rehab parts of the hospital. Outpatient rehab clinics are postponing all in-person appointments until further notice. 

Rehab patients who want to be discharged to home can do so, but there will be no transfers from rehab to long term care. Rehab treatment will continue, but no group activities.