On Sept. 10, almost four years to the day a controversial court case – launched by physician Brian Day – started in the Supreme Court of British Columbia, a judge dismissed the constitutional challenge that Day and other supporters of for-profit health care argued violated the constitutional rights of patients. Day, founder of a private surgical facility in Vancouver  said sections of the BC Medicare Protection Act prevented him from helping patients willing to pay for surgical procedures in the private system if wait times were longer in the public system. He wanted to strike down three provisions in the act: a ban on extra billing; the prohibition on selling private insurance for medically necessary care; and a prohibition on doctors working simultaneously in the public and private systems.

This case started in 2009, but didn’t get to the B.C. Supreme Court until 2016. RNAO issued a statement in 2016, noting it was “an attack on our country's health system, pure and simple. Brian Day believes…that the system exists for him and others to profit from it. Nurses are proud to work in a system that believes universal and equitable access to care is a human right. The path to improving our health system is not through compromising its core values, but instead through increasing universal access. Like all two-tier systems, Day's ideas benefit only a small elite, while substantially diminishing health outcomes for the rest of us.”

In his September ruling, Justice John Steeves rejected the argument that the rights of patients and physicians were violated by limits on access to privately paid surgical services, citing the act is focused on medically necessary services, not the ability to pay for such services.   

RNAO applauds the historic September ruling (available in full HERE) for its support of universal health care as “part of our national identity,” CEO Doris Grinspun said.

RNAO board member Julie Rubel writes a letter to the Waterloo Region Record (Aug 9) about how long-term care residents should be allowed to visit with their loved ones.

It shouldn’t be this difficult to visit a loved one in a long-term care (LTC) home. But this is what Ontario families are experiencing as government protocols are interpreted differently by nursing home operators. It means some can visit up close while others visit metres apart, unable to hold their loved one’s hand.

We know the effects that shutting down LTC homes for months has had on residents. Intended to protect residents, restrictions were indeed depriving them of the love only families can give. Even now, some decline as they are denied the assistance loved ones provide with personal care activities like eating, toileting and exercising.

The looming second wave dictates we rethink how residents are reunited with their loved ones. We need a uniform approach that all nursing home operators are required to follow. Residents should have the right to identify up to three essential family care partners with no restrictions on how often or how long visits last, even during an outbreak. Personal protective equipment should be readily available and communication between families and homes must be regular and clear.

Nursing homes are people’s homes. Residents have a right to see their family. Let’s get this right.

UPDATE: In September, the Ontario government updated the visitor policy for long-term care homes. Essential caregivers are now allowed to visit any time, even during an outbreak, subject to direction from the local public health unit. Each resident can have two caregivers. As of Oct. 7, only essential visitors are allowed to visit loved ones in long-term care homes in Ottawa, Peel Region, and Toronto. Nursing homes in York Region were added to the list Oct. 19.

As an RN at Hospice Niagara, Mahoganie Hines is working on the frontlines during the pandemic to help those in her care have a good death, which includes efforts to ensure loved ones have a chance to say goodbye. This year, due to COVID-19, the number of people who can see their loved ones at the hospice is limited, and only designated visitors are allowed in the facility, one at a time. Hines says she and her colleagues have been helping hospice residents connect with their loved ones through videos, phone calls and window visits. “The family members that maybe aren’t their designated visitor, they can come visit at the window,” says Hines. “We’ll push the bed over to the window, so that way they can see them and that way they can hear them.” Hines has also been prioritizing comfort, including taking more time while giving residents showers and baths, and bringing them outside. “Even if they can’t get up, we can take them outside in their bed, so they can see the sunshine or smell the rain,” she says. (CTV News, May 31)

To prepare for a second wave of COVID-19, RNAO CEO Doris Grinspun is calling on the government of Ontario to adopt several long-term care recommendations by July 31. In an op-ed in The Globe and Mail, Grinspun writes that during the first wave of the virus, there was a lack of early prevention measures and health-risk awareness. “Any preparation carried out was targeted to the already resource-rich hospital sector, leaving the other sectors to fend and fail for themselves,” writes Grinspun, adding there is no time to wait until April, when the results of the recently announced commission looking into how the LTC system responded to COVID-19 delivers its report. Included in RNAO’s recommendations to the government are calls to implement a Nursing Home Basic Care Guarantee that provides four hours of direct care and a richer skill-mix of regulated and personal support staff in nursing homes, ensuring personal protective equipment is fully available to all staff in long-term care and other facilities caring for vulnerable persons. RNAO is also calling for immediate and full implementation of the five-step plan proposed by RNAO for reuniting families in long-term care. In addition, less invasive surveillance testing, immediately isolating residents with the virus, and ensuring facilities have quarantine plans in place and single-occupant rooms have personal bathroom facilities. (The Globe and Mail, July 20)

Brantford General Hospital resumed elective surgeries in June, following months of these being put on hold because of COVID-19. Martin Ruaux, vice-president of clinical programs and chief nurse executive for Brant Community Healthcare System, says the surgeries resumed on a gradual basis, with the most urgent performed first. The plan was to start by working at 25 per cent of normal activity for two weeks, then ramp it up to another 25 per cent every two weeks, Ruaux says. Pre-pandemic, the hospital was performing about 42 elective surgeries each day. Those non-emergency procedures were put on hold on March 15. To resume elective surgeries, hospitals must ensure the number of COVID-19 cases in the community is stable. They must have a stable supply of personal protective equipment and medications, as well as a sufficient number of patient beds and appropriate staffing levels. “Our priority has to be the safety of patients and staff,” says Ruaux. “I’m proud of the way the organization has come through this. We’ve learned a lot that we can use during a second wave.” (Brantford Expositor, June 9)

In Hamilton, nearly a quarter of all COVID cases reported in June – 180 of 747 – involved health-care workers. A job-by-job breakdown shows PSWs bear the highest burden with 57 cases. Nurses are the second-highest with 48. Hamilton Public Health, which released the data, says 82 per cent of infected workers are women. RNAO CEO Doris Grinspun says the data make sense since the majority of health-care workers in Ontario are women. In the case of PSWs, many receive lower wages, are people of colour, and work more than one job, Grinspun adds. This is why workers need to be better protected, not only with better access to personal protective equipment, “but with good jobs that pay well and where people don’t need to be struggling,” she explains. Of the 180 Hamilton health-care workers who tested positive in June, nearly 50 per cent caught the virus on the job, with their case connected to a facility or institutional outbreak. A quarter of cases are community acquired, meaning public health doesn’t know how they got sick. (Hamilton Spectator, June 11)