Part 3 of our series featuring Dr. Naheed Dosani, Palliative Care Physician and Medical Director, Region of Peel COVID-19 Homeless Response. This episode focuses on Long-term care and COVID-19 response.
Part 3 of our series featuring Dr. Naheed Dosani, Palliative Care Physician and Medical Director, Region of Peel COVID-19 Homeless Response. This episode focuses on Long-term care and COVID-19 response.
OMA Podcast Episode 18: Long-term care and COVID-19 with Dr. Naheed Dosani
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Voice Over: In this podcast the Ontario Medical Association looks at current health issues that are on everyone’s mind. Spotlight on Health gives you the straight talk. We’re Ontario’s doctors and your health matters to us.
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Anne Marie Flanagan: I’m Anne Marie Flanagan. I’m the Director of Media Relations and Social Media for the Ontario Medical Association.
Dr. Naheed Dosani: I’m Naheed Dosani, and I’m a palliative care physician.
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Flanagan: If you’ve got a family member in a long-term care home, is it really a good idea to take them out?
Dr. Dosani: There’s a huge tension. One one hand, taking people home, it can create a sense of safety—avoiding outbreaks, and I totally get the nature of that— but as a palliative care doctor who provides care in long-term care and in home care as well for people with serious illnesses, what I’ve heard is, “I’d love to take my loved one home, but the home care is not enough to support my mother,” or “that would mean I have to take time off of work, and I can’t afford to take time off of work.”
And so while I understand the desire to get to that debate, there’s probably some rooted issues we need to talk about first that may help us in answering that debate in the sense of: how much do we value the elder members of our community? By the way we invest in long-term care and the way we’ve established our long-term care facilities, I would say that, if you look at the raw investment, I don’t think we value this population very much. And it’s not right. And it’s everything from the nursing ratios in our long-term care facilities, where nurses are caring for—one nurse for 32 patients, in some cases one nurse for 64 patients—to how we’re paying people who work on the front lines in long-term care.
These are often individuals who often deserve a higher wage than they’re actually getting and are often coming from racialized communities as well, so there’s some equity issues around that.
And this flipping over to home and community care, we need to think of an emboldened home and community care system. Our home care system, in a province like Ontario, is really a patchwork, makework system that is not really a coordinated, synchronized system with different geographies, and overlaid maps, and service providers. It’s very confusing for people. And so we need a rehaul and a rework of home care.
What we could potentially benefit from a rework of both of these systems, long-term care and home and community care, is, hopefully it doesn’t happen ever again, but if we ever have to have this debate again we’re not talking about: should you take a loved out, or should you keep them in. You’d have faith and confidence in the system within which they’re in.
I bring those factors up today because I get why people are worried about this now, but we need to think about this for the future too.
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Flanagan: What do you see as the long-term impacts of COVID-19, both from a health perspective as well as from a system perspective?
Dr. Dosani: One of the things that probably needs to get talked about a little bit more, but I’ve seen some conversation around it, is around the trauma, loss, and grief that so many are experiencing. As a palliative care doctor, it breaks my heart to see and hear of many of the patients I care for and their caregivers not being able to be connected, particularly as they approach end of life. But not just that, just when people are receiving care. Technology can help with that sometimes, but all the unprocessed grief and trauma that people are experiencing, when someone dies, for example. I mean, how can you get closure if you can’t be physically connected to the processes associated with death and dying?
But it’s not just the people we care for, it’s ourselves. So I worry about health workers who are pedal to the metal, stepping up, doing the right thing to serve our communities during this crisis, and maybe not absorbing as much as they probably should to be able to cope with that. And I think there might be some long-lasting mental health impacts on our communities, our work communities, and we’ll need to support each other around that.
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Flanagan: We’re in a situation where, for obvious reasons, a lot of non-essential surgeries, treatments, have been postponed so that the system and doctors can focus on the COVID situation, but the reality is that’s going to create a bit of a backlog and potentially longer wait times.
Dr. Dosani: We are so focused on flattening the curve, and we talk about the COVID curve but we’re not talking about the next curve that comes up which is going to be all the backlog of surgeries and clinical care that needs to be provided, all of the people who are maybe staying home right now and would normally be in the hospital but are trying to deal with what they’re dealing with at home. Then there’s the next wave which is the mental health of people in our communities and our health workers may be unravelling some of the experiences they had during COVID.
There’s been some good depictions on social media about what these curves look like, but to realize this is a multi-wave issue. It’s not just the one wave we keep hearing about in the news. There’s a few curves that have to be discussed, and these issues could have long-lasting effects for people. And I anticipate that the kind of mainstream palliative care we’ve been calling it for this conversation that I was providing prior to the pandemic will really change, and I will be providing mainstream palliative care to people who probably are receiving that kind of care because they didn’t access the care they needed during COVID.
And so, pandemics like this have very unintended consequences for the health of our communities and the health systems within which we work. The grief and the loss and the trauma of how people have stepped up in this time? Like, I can’t even tell you. It’s been moving. We cannot forget the sacrifice that so many have made to support our communities through this time. We need to be there for them when this is all said and done.
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Flanagan: It’s really interesting how a situation like the pandemic can sometimes change what we do and can bring out the best in people.
Dr. Dosani: We’ve seen a lot of COVID kindness around us, and you think about people who are working in the health field or health workers. This is what we signed up for—responding to a call to action. Like, this is what it’s all about. And we’ve seen such excellent examples of that across the board, and that’s why I’m just so grateful to see so many people sharing their stories from the front lines. This is uncharted territory. We’ve never been through this. It’s really amazing to see.
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Voice-over: This podcast is brought to you by the Ontario Medical Association. It is produced and edited by Jodi Crawford Productions. This podcast is not intended to provide medical advice for specific situations and is for general educational purposes only. Please consult your doctor if you have symptoms or questions about your health.
For more information, please visit our website at oma.org.
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