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HEALTH CARE PROVIDERS WEEK
Lessons learned: What has the pandemic taught us about long-term care for seniors? BY PAT REDIGER
It is no secret the pandemic has highlighted the systematic challenges for seniors and long-term care facilities in Canada. Saskatchewan has fared relatively well, but the Saskatchewan Union of Nurses (SUN) points out there are lessons the province can learn from harder-hit jurisdictions where COVID-19’s impact has been far more tragic. “The pandemic has shown how essential—and sometimes underappreciated—our long-term care health care providers are. The current system, which is plagued by chronic understaffing, heavily relies on families, informal caregivers, and volunteers to compensate for the insufficient resources,” said SUN president Tracy Zambory. Seniors, particularly those in long-term care, are the most at-risk population for COVID-19. More than three quarters of Canada’s deaths from the virus have been among long-term care residents. Even facilities not experiencing outbreaks are affected by the pandemic. Necessary safety precautions, such as restrictions on activities and visitors, have taken a toll on residents’ psychological and emotional well-being. Saskatchewan has coped relatively well with COVID-19. Most long-term care facilities in the province are operated by and bound to the single public health authority. Zambory said that having a fairly integrated public health system is advantageous in these types of situations, ensuring more consistent standards of care.
Seniors, particularly those in long-term care, are the most at-risk population for COVID-19. Tracy Zambory, president of the Saskatchewan Union of Nurses, is calling for greater investment in Saskatchewan’s public long-term care system. PH OTO: G E T TY
“Our province’s geographical location and lower population density is also on our side. It gave the Health Authority more time to put measures in place. The people of Saskatchewan have also taken those measures seriously, keeping case numbers relatively low,” explained Zambory. “The impact of the virus on seniors is interlaced with community transmission. If the public keeps following safety precautions then that will help keep the most vulnerable protected.” She cautioned, however, that the public system in Saskatchewan is unfortunately not as strong as it could be. “Care standards and physical infrastructure are being increasingly neglected, while the private care industry is being encouraged and subsidized to pick up the slack, shifting costs onto individual
seniors and families,” said Zambory. The pandemic has called the trend towards privatization of long-term care in Canada into question. Ontario, which has one of the highest percentages of for-profit longterm care homes in the country, has also seen the highest COVID-19 fatalities and mortality rates occur in these facilities. “When you prioritize profits over people, the quality of care suffers. Lower staffing levels, higher rates of hospitalization for residents, and even higher mortality rates are the inevitable outcomes of running long-term care like a business,” said Zambory. “What we have witnessed in Ontario is an important lesson for Saskatchewan and a wakeup call for the rest of Canada to eliminate forprofit from long-term care.
Most long-term care facilities in the province are operated by and bound to the Saskatchewan Health Authority. This system has helped ensure more consistent standards of care in Saskatchewan, as compared to provinces with higher percentages of for-profit long-term care homes. P HOT O: GET T Y
It is clearly compromising the safety of our country’s seniors.” Zambory added that greater investment in Saskatchewan’s public long-term care system is desperately needed, noting the current approach is affecting the rest of the health care system. Many hospital beds are given to “Alternate Level of Care” patients who are waiting for a longterm care placement. This is increasing waiting times in our emergency rooms and is a difficult environment for the fragile elderly. Staffing is another area of concern stated Zambory. In the early days of the pandemic, there was a public health order that mandated the cohorting of staff—requiring staff to work only in one facility to reduce the chances of staff spreading the virus between facilities. “This was the right thing to do, but raises the question: why are so many people who work in long-term care forced
to cobble together a living by working at multiple facilities?” said Zambory. “We’ve known for years that a stable workforce benefits patients, providing for continuity of care, and a consistent care team for families and physicians can collaborate with. Now, because of COVID-19, we also know that consistency for workers is also important for infection control.” After the death of Regina long-term care resident Margaret Warholm in 2013, investigations revealed systemic issues in the sector. In 2016, the provincial auditor recommended the Ministry of Health consult with the then-12 health regions and stakeholders to map out the care needs of current and future residents. The auditor also urged the government to identify and report on the factors that affect quality of care, and recommended that government develop and make public a strategy to address those needs. Zambory said
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that hasn’t happened yet. Zambory said she believed this conversation needs to be expanded to a national level: “We need consistent standards applied to all Canadian jurisdictions according to the principles of the Canada Health Act. There also needs to be targeted federal funding, and evidence-based, mandatory safe staffing models. This is how equitable standards of care will be maintained.” The more the public understands the needs in long-term care, the more demand there will be on decision makers to properly address these needs, said Zambory. “It is easy for those of us who do not currently experience or depend on this system to look away. If any good comes out of the pandemic, it will be a new sense of how connected we are. It will lead us to re-evaluate our priorities when it comes to seniors’ care.” For more information, go to makingthedifference.ca.
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HEALTH CARE PROVIDERS WEEK Pharmacists’ role expanding during pandemic BY WENDY LIVINGST ONE
Many goods and services became unavailable early this year due to the COVID-19 shutdown, but it was vital that crucial health care remain accessible. Pharmacies moved quickly to ensure that they were able to provide their patients with medications, counselling and other services in a safe manner. “Like every other health care provider out there, they shifted and pivoted as safely and as consistently as possible,” said Dawn Martin, CEO of the Pharmacy Association of Saskatchewan (PAS). “They worked very quickly to get protective equipment and barriers in place, and they provided services such as deliveries of some medications for patients who couldn’t get in, were afraid, or had health risks.” Adding to pharmacists’ determination was their standing in many locations throughout the province. “Often, in rural and remote communities, pharmacists might be your only health care provider in that area,” said Martin. Patients in remote areas are not the only ones who benefit from the unique role that pharmacies— partially due to their ease of accessibility— play in the health care system. Patients visit pharmacies to have prescriptions filled, to purchase over-
the-counter medications, and to access many other services provided, so they may see their pharmacists up to 10 times more often than they see other health care providers. Saskatchewan pharmacists’ expanding authority allows them to administer injections for the contraceptive Depo-Provera and many vaccinations, including certain types of pneumonia and influenza, and for travel health. More than 50 per cent of the province’s flu shots are now administered by pharmacists. They are also trained to prescribe medications for certain minor conditions such as bladder infections, diaper dermatitis, oral thrush and canker sores. “That is certainly not a role they take lightly,” said Martin. “They can identify when it’s not minor and get that patient into an appropriate care pathway. These are highly, highly trained professionals, and they are available for longer hours— often your bladder infections are not happening between 9 and 4.” Providing counselling is also a key component of the pharmacist’s role. In addition to their long-standing access to patients’ medication history, pharmacists can now access recent lab results to assess and then discuss outcomes. This is particularly important for some patients, especially many seniors, who may have been
Dawn Martin, CEO, of the Pharmacy Association of Saskatchewan PH OTO: S U PPL I E D
on multiple medications for many years. Counselling can now be done by telephone or virtually for those who are unable or reluctant to visit the pharmacy. “Pharmacists go through all their medications, checking dosages, making sure they are all working the way they should be and that patients are taking what they should. Pharmacists understand 20,000+ medications. If patients have any questions or concerns, they are all addressed as well,” said Martin. “Virtual appointments have been really important in order to continue that service, particularly for vulnerable seniors who may not be getting out and about right now because of the pandemic or, as winter approaches, even less so.” PAS’s recommendations for the upcoming winter months include continu-
The Pharmacy Association of Saskatchewan urges residents of our province to continue to follow public health guidelines such as wearing a mask in public and having a flu shot. P HOT O: SUP P LIED
ing to follow public health guidelines such as wearing a mask in public and having a flu shot (due to the pandemic, be sure to make an appointment first). Martin stressed the importance of addressing mental health concerns. “We are all struggling during this time, and I think the really important thing is for all of us to reach out to family, friends, or to health providers—pharmacists, physicians, nurses, public health folks—anybody available to make sure you get the help
and support you need during this time. We are in a perfect storm with advancing flu season and all of the usual things that that brings, and then layer in a pretty scary pandemic situation… Don’t suffer in silence,” she said. To help ease the burden on other sectors of the health care system, as many as 100 pharmacies are prepared to administer COVID-19 tests if this is deemed to be a benefit to the health system. Depending on the location, this could require modifications or additions to their exist-
ing facilities so that those being tested could be physically distanced from other patients, similar to when flu vaccines are administered in malls or other store fronts. “If we are asked to do that, we would need to stand up and do it, because it’s important for the system and important for our patients, and certainly patients want it,” said Martin. “I think the COVID challenges have highlighted pharmacists’ role—what they can do already and what they could do more of.”
BridgePoint Center adds new digital services and re-introduces residential programs BY T OM EREMONDI
Like so many other services this year, the BridgePoint Center for Eating Disorders coped with delivering services in the midst of a pandemic and ensuing public lockdown. Located in Milden, 110 km southwest of Saskatoon, BridgePoint offers a variety of services for eating disorders and disordered eating. “BridgePoint is a residential eating disorder recovery centre, the first and only of its kind in Saskatchewan. We were actually the first of its kind in Canada when we opened in 1997,” explains executive director Carla Chabot. A non-profit, provinciallyapproved facility that works in partnership with the Saskatchewan Health Authority (SHA), she says “BridgePoint participants come from all across the province and access our programs free of charge. The center will also occasionally see paying participants from out of province.” Operating in Milden’s former hospital, Chabot says “BridgePoint is centrally located, so it’s easy for people to access and find tranquility in a confidential, remote site.” At the core of its philosophy is a community-based, face-to-face recovery model, Chabot notes. “Eating disorders thrive with isolation and secrecy, so it’s important for this demographic to find connection in community. Essentially, they take a break from their regular lives and obligations to come here and focus solely on their recovery programming.” Par ticipants initially spend four days in retreat at BridgePoint and then can select recovery modules that vary in length from seven to 30-day stays. That model was necessarily altered due to COVID-19 but not suspended, Chabot reports. “ The pandemic
Residential stays and face-to-face programming are at the heart of BridgePoint’s recovery model.
forced us to look at how to provide our programming virtually. We had to pause all of our residential programming but, because of our contract with the Health Authority, we had to pivot and dive into offering virtual care.” Chabot says staff at the center worked hard to mobilize programs that could be offered online. “Initially, when we were working on our backend to establish an electronic mental health
a virtual retreat where they could come and spend two days online with us.” The interest in this was huge from the moment it was available. “We started the virtual retreats in June and were pleased to find that we could replicate that connection in community online,” Chabot says, noting another advantage to the virtual programming. “It ‘opened up our doors’ to participants who had not been able to attend our program in the past because of issues such as work commitments, lack of access to child care, or lack of mobil-
ity. Even people who were medically unstable were able to jump online and access our programs.” B r i d g e Po i n t o f f e r e d that virtual programming through the summer and early fall. Its re-open plan was approved by the SHA on October 1 and residential programming was relaunched on October 15. “We’re fully operational,” Chabot says, “but, instead of having 15 participants on site, we’re limited to eight. That allows us to provide social distancing with participants in their own rooms. So, we’re hoping to have the
platform, we provided publicly accessible Facebook live groups as a way to bridge the gap.” Following that, she says “BridgePoint worked in partnership with other similar groups from across Canada to launch an e-learning platform. BridgePoint was able to provide videos and other resources in a self-guided format but we supplemented that by creating a virtual group room. It allowed us to welcome participants to
funding to offer the online programming as well. We were able to do that before because, by not opening for a few months, we had the capacity and rechannelled funding. As a non-profit and a charity, we would now need to find the funding to continue to offer virtual programming. We would love to be keep these options going.” Seeing about a hundred participants every year, Chabot adds that the virtual programming also would help BridgePoint with its growing wait list. For more information, visit bridgepointcenter.ca.
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Community MRI services now available in Saskatoon Mayfair Diagnostics Saskatoon is the first to offer community magnetic resonance imaging (MRI) services to Saskatoon and surrounding areas. T his ne w MRIonly clinic opened its doors and began serving local patients in August of 2020. It’s the second Mayfair Diagnostics location in Saskatchewan; the first opened in Regina in 2011. In Fe b r u a r y 2 0 2 0 , May f a i r w a s aw a r d e d the contract to deliver publi cly-f unded, community-based MRI ser vices in Sask atoon by the Saskatchewan Health Authority (SHA), as part of the SHA’s Request for Proposal (RFP) process which also ren e w e d May f a i r ’s c o n trac t to continue providing MRI services in Regina. The Saskatoon clinic will help improve access and lower wait times to MRI ser vices for residents in central and northern Saskatchewan. “We have a great local team in place and I look for ward to working with the Saskatoon health care community to support our new neighbours and colleagues in Saskatoon,” s ay s S a s k a t o o n c l i n i c manager, Kevan Tayler. The new Saskatoon clinic is located across the street from St. Paul’s Ho s p i t a l , o n t he fi r s t floor of 210 Avenue P South in Saskatoon. Mayfair Diagnostics Saskatoon operates six days a week, offering MRI services by ap-
Mayfair Diagnostics Saskatoon provides community MRI services at their MRI-only clinic across from St. Paul’s Hospital. S U PPL I E D
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a patient is wearing upon arriving for the appointment is not a surgical mask, clinic staff will provide the patient with one. Mayfair Diagnostics Sask atoon offers MRI exams as a publiclyfunded, communitybased service under contract with the Saskatche w a n He a l t h A u t h o r ity and as private pay exams. Patients receiving public e xams will be referred to the clinic through the Saskatchewan Health Authority, while patients opting for
private pay exams will require a referral from their doctor. An MRI is often ordered when more detail is needed or the cause for symptoms is unclear on other types of medical imaging. An MRI scan creates images by exposing hydrogen atoms within the body to a magnetic field which controls the direction and frequency at which these hydrogen at o m s s p i n . A ra d i o f requency pulse is then directed toward the area of the body being exam-
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HEALTH CARE PROVIDERS WEEK
Pandemic changes role of volunteers with SHA BY JENNIFER JACOBY-SMITH
Everyone knows that health care is a team effort. It’s nurses and doctors, lab technicians, x-ray techs, and many more professionals that keep the health care system functioning and meeting the needs of Saskatchewan residents. In a time of crisis—such as a global pandemic—this is especially true. In addition to nurses and doctors, lab technicians and other professionals that keep the health system running smoothly, there is a small army of volunteers at each Saskatchewan Health Authority facility who offer support to visitors and clients. They visit long-term care homes, work in gift shops, provide transportation to medical appointments, and even deliver Meals on Wheels. Unfortunately, the global pandemic has made it difficult for volunteers to fulfill their role. As the COVID-19 pandemic hit and everything shut down in March, services were curtailed to reduce traffic in hospitals and reduce the risk of spreading the virus in long-term care homes. Meals on Wheels, however, provides an essential service. The program delivers nutritious meals to senior citizens or other clients who could benefit from a daily meal to help them maintain their indepen-
As the pandemic shut everything down in March, the Saskatchewan Health Authority realized that many of their volunteers were over the age of 65. That left a huge void when it came to deliver meals for their Meals on Wheels program. P H O TO : G E T TY I M AG E S
dence. The program delivers over 200 meals each day just in Saskatoon, but Meals on Wheels volunteers deliver meals to clients across the province as well. “When the first public health order came out and the recommendations were that all volunteers over the age of 65 were asked to step back to provide safety to them-
selves and to those in the community, we lost—I have generalized to say—about 90 per cent of our volunteer base for Meals on Wheels,” says Bernie Doepker, director of Volunteer Services for Saskatchewan Health Authority. Initially, SHA staff members who were unable to do their regular jobs because of elective surgeries being cancelled, for example, were able to fill in and deliver meals. The program also had to revamp how meals were delivered. Personal protection equipment and hand sanitizer were provided to each volunteer (at a time when finding it wasn’t easy). In addition, delivery persons began to leave meals on tables outside of people’s homes or hung on their doorknobs in order to maintain social distance of two metres or more. Clients then receive notice of the meal delivery with a knock on the door or a phone call. Meanwhile, SHA put out a call for volunteers across the province. Many of their volunteers actively recruited in their communities to fill the void. “We just had a great response across the province of people stepping forward,” says Doepker. In fact, over 1,000 people registered as volunteers—despite the fact that so little was known about what the next few months were going to bring.
As businesses shuttered and schools closed, Shauna Wimpney felt the need to do something. As a drainage expert for the agricultural industry, Wimpney normally works from home. “I say I’ve been training for a pandemic, because nothing changed for me at work. I work by email. I work by phone,” she says. With her parents and in-laws in good health and her children safely at home she says she realized, “I have it pretty lucky that nothing changed for me personally.” Determined to give back, she looked for a way to help out her community and applied to deliver Meals on Wheels. Since March she has been delivering meals one day a week. “That was my little way of helping for the pandemic,” Wimpney says. Sometimes she fills in on other days, but it takes just two hour out of her week. She understands that not everyone is able to help and she’s got an understanding employer that allows her to take her lunch break and other breaks all at once so she can be gone for two hours in the middle of the day. As well, others may have loved ones with health conditions that put them at risk with the virus, so volunteering could be endangering someone in their house. For Wimpey it’s about doing what she can to
support her community, during a time of unprecedented crisis. Not all volunteer services have resumed at all facilities across the province. In order to control the spread of COVID-19, traffic is still kept to a minimum in some facilities. Some services provided by volunteers may not return until the pandemic is over. “We have reinvented some of our positions into doing virtual visits in long-term care homes, or doing virtual support, or even letter writing,” says Doepker. “And we are looking at different ways we can re-engage volunteers and recruit a younger demographic until we are able to find a vaccine or to find a treatment plan that will work for this disease.” Every request that comes in to volunteer services goes through a risk assessment to be sure they are not jeopardizing the health or safety of their volunteers or clients. “It’s really hard on our volunteers because this is where they contribute to their communities and facilities across the city and the province. And the value they add to all of our programs is surely missed by our health providers in all programs,” says Doepker. In the meantime, Meals on Wheels will continue being delivered, thanks to the many brand new volunteers in communities across the province.
What is being done to make health care better for Saskatchewan patients? BY ELIZABETH IRELAND
Quality improvement is an important part of our province’s health care system, but what happens to the process when a pandemic is taking place? Tracey Sherin is chief executive officer of the Saskatchewan Health Quality Council (HQC). Since 2002, the Saskatoon-based organization’s mandate has been to accelerate improvement in the quality of health care in Saskatchewan. With its own board of directors, HQC operates independently from the provincial government and employs approxi- Tracey Sherin, CEO, Saskatchewan mately 45 staff. Health Quality Council. S U P P L I ED PH OTO In addition to her CEO role, Sherin serves as co-chair of the oversight committee for the Sas- and other stakeholders for specific katchewan Centre for Patient Ori- research opportunities in the provented Research (SCPOR). Although ince. the term may be unfamiliar to the Sherin was previously HQC’s diaverage Canadian, patient-oriented rector of data analysis and research research is the concept that health partnerships, where she led a team research done through partnering of researchers and analysts generwith actual patients and their fami- ating evidence to enable health syslies leads to better outcomes. HQC tem improvements. Sherin earned and SCPOR help to facilitate con- her BSc in microbiology and immunections between patients, families nology from the University of Sas-
katchewan and her MSc in health care and epidemiology from the University of British Columbia. Launched in early 2017, the Clinical Quality Improvement Program (CQIP) is one of HQC’s flagship programs. With COVID-19, the 10-month program is business as usual (virtually of course) and the fifth CQIP cohort is in the recruitment phase right now. CQIP is designed to build the skills and capacity necessary for successful health care improvement work, within the system itself. CQIP is a collaboration with the Saskatchewan Medical Association and the provincial Ministry of Health. Participants are mostly physicians with some other clinicians, such as pharmacists, participating as well. “We believe that the Clinical Quality Improvement Program helps clinicians develop the skills they need to lead improvement in our health system. Evaluations of the program indicate that participants feel that they are wellequipped to lead quality improvement initiatives, and many go on to
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lead new projects. We are also seeing that these improvement tools are preparing participants to adapt to the changes that we are experiencing as part of the COVID-19 pandemic. We have seen 62 clinicians graduate the program so far, with another 20 completing the program as part of our fourth cohort. We are recruiting for Cohort Five, which will be offered fully online so that participants can continue to learn these valuable skills during the pandemic,” says Sherin. Relatively new on the scene are HQC’s BestPractice Panel Reports. These panel reports give Saskatchewan’s family physicians relevant information about their patient population—including demographics, emergency room use, chronic disease and prescription medication rates. “So far, about 20 per cent of Saskatchewan’s family physicians have requested a BestPractice Panel Report to better understand the populations that they serve and to identify areas for improvement. The feedback we have received is that they find the reports useful for
understanding their practice and identifying changes they want to make. Once they have signed up, physicians will receive an update to their report once a year,” says Sherin. As the pandemic enters its eighth month, what impact has COVID-19 had upon HQC’s efforts? “On a practical level, HQC has been able to react quickly and build capacity. We have transitioned many of our program offerings to virtual methods. As a team, we have adapted to working remotely when possible and have modified how we use our office space. We have also implemented safety procedures, such as wearing masks in common areas,” says Sherin. Saskatchewan patients, and their family members, can become involved in the patient-oriented research process as advisers or research partners by going to the Patient & Researcher Connection Site at qi.hqc.sk.ca/scpor-connectionsite. More information on HQC and its programs can be found at www. hqc.sk.ca.