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Dr. Nathan Stall is a geriatrician at Mount Sinai Hospital. He is also a research fellow at the University of Toronto, with an interest in older adults, people living with dementia and residents of long-term care homes.
Carla Loftus is a clinical nurse specialist in psychiatry at Mount Sinai Hospital. She holds an adjunct clinical appointment at the Bloomberg Faculty of Nursing at the University of Toronto.
Dr. Nathan Stall and a team of frontline staff from Mount Sinai Hospital got the call early in the pandemic: Help provide medical leadership to a long-term care home and its more than 100 residents against a virus that already made its way inside and do it all without ever setting foot inside the building.
By May of 2020, many long-term care homes across the country were in crisis. Ontario had seen 190 outbreaks of COVID-19 in long-term care homes, involving more than 5,000 residents. More than a quarter of those who got sick had died.
In response, the Ontario government issued an emergency order that allowed it to appoint a manager to help long-term care homes struggling with COVID-19 outbreaks. They defined the manager as “any person, including a corporation or a hospital.”
Mount Sinai Hospital was called to action. It was assigned five homes in total; two were long-term care homes where the virus was raging and staff were in crisis mode.
“What happened was catastrophic,” said Dr. Stall, a geriatrician at Mount Sinai Hospital. “I think back to the Pinecrest Nursing Home in Bobcaygeon, how all of a sudden this small town in northern Ontario had an explosion of cases and deaths. That was when we knew this was this was really, really bad.”
The full extent of wave one of the pandemic would only be revealed much later - 80 per cent of those who died in Canada were residents of long-term care homes.
Dr. Stall volunteered to lead the operations for one of the homes assigned to Mount Sinai Hospital’s care. Yet because of the nature of the pandemic, Dr. Stall had to stay out of the home so he could continue seeing patients at Mount Sinai Hospital. Nursing staff couldn’t enter either the risk of infection was too high.
“There were people who were dying from COVID-19,” he said. “And, there were people who didn't have COVID-19, but were decompensating from a mental health perspective. There were others who didn't understand what was going on. There was fear among the staff. It felt like a place that had lost control and it felt like something, you never thought could happen in a place like Canada.”
The team’s first challenge was determining how they could help the long-term care home staff, when they couldn’t enter the care home itself. They had to figure out how to support COVID-19 testing, conduct blood and imaging tests, and determine which room changes to make (separating COVID-19 positive residents from the others), all from a distance.
To do so, they created emote command centre using laptops donated from Sinai Health Foundation. In the first week, Dr. Stall and his team worked with the long-term care home staff who were on-site and triaged more than 100 residents in the span of a few days. Dr. Stall said that’s when the real heroes emerged. “There was one really outstanding and heroic registered practical nurse who worked at the home, and she would go around with our iPad and we would assess the patients virtually with her clinical exam,” he said.
Creative collaboration was critical for success. From their virtual command centre, the Sinai Health team accessed electronic medical records, emailed practitioners involved in the residents’ care, and had frequent conversations with the long-term care physicians who knew them best.
For weeks, they made critical decisions about every patient's care, all without seeing any patients in person. Eventually, when the outbreak was more controlled, Mount Sinai Hospital redeployed some of their own nurses to offer relief to the exhausted staff at the long-term care home.
Carla Loftus, a clinical nurse specialist at Mount Sinai Hospital, was assigned to be Sinai Health’s eyes on the ground. Her department helped coach frontline staff who were being deployed to work inside these homes during the early days.
“I was very eager to put my name down, having seen what it was like there and feeling like these people really need help,” Carla said.
The virtual care model designed by Sinai Health was so effective, teams from across the city began reaching out to learn how they could practice the same approach at their own locations. Dr. Stall would later turn his learnings into a published paper.
“We actually wrote it up and published it in a peer-reviewed journal so that others could learnfrom this,” he said. “I've never been prouder to be part of Sinai Health than during this time.”
After the outbreak was under control, the partnership between Mount Sinai Hospital and the long-term care home continued. For several weeks, Dr. Stall and his staff continued working with the home to address some of the outstanding medical issues and try to optimize the health of the residents who survived.
“It was a really humbling experience to go there and work with the care providers that work in this setting every day and to realize how hard they're working,” Carla said. “The leadership was incredibly dedicated to caring for their residents.”
The piece that Dr. Stall, Carla and their colleagues published in a peer-reviewed journal ends with an acknowledgment:
“The authors of this article would like to acknowledge the heroic dedication, indescribable efforts, and persistent advocacy of the healthcare workers and administrators in the extraordinary nursing home described in this article—it was a true privilege for the hospital to be partnered with this nursing home.”
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