Senior Toronto blog

August 29, 2020

Zoom 101

It’s our new lifeline in the pandemic. Everyone’s using Zoom now to visit with friends and family, go to meetings and take courses. Here are some tips for getting the most out of it:

  • You need a camera and microphone. Most newer computers have them built-in. If you own an older computer that doesn’t have them, you can buy a webcam with a microphone and just plug it in. Be patient: a lot of them have been sold out everywhere since the pandemic began.
  • You have to download the Zoom software, but you don’t need an account. When you get a Zoom invitation, just click on the link they send you, and you’re in.
  • You can test your audio and video in advance at https://zoom.us/test.
  • Try to put a light in front of you, behind your computer. But if there is a bright light on in the room behind you, for example, from a lamp, turn it off.
  • Make sure your whole head shows on the screen.
  • People can see the room behind you, so don’t leave a pile of laundry on the bed or a sink full of dishes.
  • If you don’t like to look at yourself, just don’t! When other people are talking, look at them. When you are talking, look at the little camera light. People watching you will think you’re looking right at them.
  • If you really don’t like to look at yourself, then once a session starts, look for Video below the live screen. Click on the up-arrow, then Video settings, then Touch up my appearance. It gives you a softened, airbrushed look.
  • Watch the time. If there are only two of you, you can go on talking for as long as you want. If there are three or more, you get just 40 minutes for free.
  • Zoom gobbles up a lot of your internet usage. Watch the logs carefully to make sure you don’t go over your limit. You may have to upgrade your data package. You can check your usage in Windows 10 by going to Start > Settings > Network and internet > Data usage.
  • If a group of you will be meeting regularly on Zoom and they want people to take turns hosting, say yes. You can do it, it’s no big deal. There are lots of tutorials, for example here and here.
  • If you do host a meeting, don’t send the invitation too much in advance. The day before would be fine. That will save everybody from having to scroll back through days of emails, looking for the one with your instructions in it. Make it easy to find.

July 30, 2020

What should seniors do now?

At first, it was easy to figure out what to do. Everyone who possibly could went into lockdown and stayed there. We were all in this together. And in Ontario so far we’ve been lucky: our numbers went down and the hospitals were not overwhelmed. But you can’t keep the economy on lockdown and put people’s lives on hold for long, so we’re opening the economy back up and loosening the guidelines. Now the rules are different in every jurisdiction. But the coronavirus is still out there, and for seniors, it’s still deadly. Can we go for a haircut, shop in a grocery store, visit with family and friends? How do we decide what we can safely do?

Most of us are not scientists, and the burden of assessing our own health risk is daunting. Normally our doctor would be walking us through some well-established decision tree, but this is new territory and we’re pretty much on our own. But now some guidelines have begun to appear, so here are a couple of suggestions for deciding what’s right for you.

The risk of dying of the coronavirus is much higher for seniors than for younger people, but it’s not the same for all seniors. It varies with age and health status. So you might want to start by checking out a COVID-19 prognostic tool. It displays the fatality rate for people in your age group with a similar health history. That might help you decide how much risk to take.

Some activities are riskier than others; for example, you’re more likely to catch the virus indoors than outdoors. So now Public Health Canada has produced a guideline for going out safely during COVID-19. It assesses a variety of activities as low risk, medium risk or high risk. Take your pick.

Of course, the level of risk we’re taking when we go out also depends on how well people and businesses are following public health measures. Are staff and customers wearing masks? Are they observing physical distancing? Are they cleaning and sanitizing the premises every day? Do they set aside early morning hours for seniors? Many people, especially the young, are tired of the restrictions, don’t feel they’re in danger, and just want to get on with their lives. Many businesses are desperate to make up for lost time and revenue. There’s a growing feeling that if seniors and other vulnerable people just kept themselves in lockdown until a vaccine appears, then everyone else could pretty much go back to normal. The concept of targeted lockdowns has even been proposed by some MIT economists as public policy, an easy way to keep mortality rates low while minimizing the impact on the economy. I hope our government resists the temptation to follow this path, keeps on testing and contact tracing, and continues to require and enforce physical distancing, masking, and other protections in public places. We seniors want to stay safe and healthy and try to be prudent about our activities, but don’t ask us to isolate ourselves indefinitely from public life.

June 30, 2020

Home care in the crosshairs

Now that we’ve learned the gruesome facts of life in long term care, many of us seniors are more determined than ever to keep out of those hellholes, and age at home with the support of home care. But can we?

Ontario home care is a mare’s nest of stresses and strains. Unlike hospital care, it isn’t insured by the Canada Health Act. It’s a provincial responsibility, and the provinces invest some of their transfer money in it. How much? What’s covered? Good luck finding out. For years it has been administered in Ontario by the CCACs, now the LHINs, and soon it will be the Ontario Health Teams. What coverage you qualify for depends on the funding choices made by your local health agency. What care you get, or even whether you qualify for care at all, depends entirely on where you live in the province. Meanwhile, the demand for home care keeps growing. It’s not just because the population is aging. For years, Ontario has been aggressively shifting health care out of the hospitals and into people’s homes. Advances in technology have made it possible to deliver many treatments at home, such as chemotherapy, intravenous therapy, and mechanical ventilation. But funding and services have not increased to keep pace with these growing needs. The burden often falls on unpaid family caregivers, or, for those who can afford it, private care. If you’re on your own on a low income, you may be out of luck.

And now, while everyone has been preoccupied with the pandemic, along comes Bill 175, Connecting people to home and community care. According to analyses by the Ontario Health Coalition and other advocacy groups, here’s what it does:

  • Repeals the existing Home and Community Services Act and transfers most of it to regulation which can be changed by Cabinet members without ever going to a vote in the Legislature.
  • Dismantles all public governance of home care and transfers it to provider companies, including for-profit companies, which are not accountable to the public. These corporations can contract and subcontract home and community care amongst themselves with no oversight.
  • Makes no provision to ensure or improve access to care or quality of care.
  • Enables private home care to go into public hospitals, and even enables private for-profit hospitals to expand into the newly created tier of unlicensed congregate care.

Introduced without input from advocacy groups, client representatives, or workers’ and health professionals’ representatives, Bill 175 was rushed through first and second reading in the Legislature in early June. The NDP health critic brought forward more than 20 amendments to Bill 175, all of which were voted down. Advocacy groups have staged protests, but the legislation is headed for third reading and royal assent.

It’s a big win for private interests, a big loss for public home care in Ontario, and a big worry for seniors who were hoping to age at home.

May 30, 2020

Can long term care be fixed?

Bug infestations. Old food trays stacked inside residents’ rooms. Residents crying for help for hours. Staff reusing the same PPE for multiple patients, some with coronavirus, others not. Residents force-fed to the point of choking. COVID-19-positive residents allowed to wander through the facility. Key supplies locked away. Residents left lying in soiled diapers. Untreated bedsores. I wonder if Premier Ford regrets calling in the military to assist in five long term care homes overwhelmed by the pandemic. If instead he had just called in a bunch of nursing staff, and they had written a report, he could have quietly tucked it away along with all the other reports that have documented such issues again and again, over decades. But the Canadian Armed Forces report went straight to the Prime Minister, and made the national and even the international news. Conditions in long term care in Ontario have been appalling for a long time, but now that the whole horror show has been so publicly exposed, something will have to be done.

So what should be done? Opinions come with different political slants, but there is a lot of agreement on the basics. There have to be minimum standards for care and staffing, and they have to be rigorously enforced. Homes must be designed so that there are no more than one or two residents to a room, with an en-suite bathroom, and facilities must be available to isolate infectious residents. Staff should be permanent, and their work limited to one nursing home. They should receive wages high enough to attract qualified people to these positions, and benefits, including sick leave. Staff should be trained and competent to serve the complex needs of the elderly in nursing homes. The system must build more capacity to meet the needs of our rapidly aging population. Home care must be expanded too, so that as many seniors as possible can age at home and not have to go into long term care. And somehow the service must be made affordable, so that we don’t create a system only for the rich. What are the chances that all this will finally happen?

The failure is massive and cries out for change, but the obstacles are massive too. Long term care sits at a dangerous crossroads, where sexism, racism and ageism all meet. Long term care staff are overwhelmingly female and racialized, and are chronically underpaid. Our deeply ageist culture dismisses the elderly as disposable and wants long term care to be cheap. Historically we have turned a blind eye to the consequences. But the Armed Forces report has forced us to face those consequences. We don’t like to think of ourselves as cruel and will want to do something to end the abuses and ease our feelings of guilt and shame. But the fix is going to be very expensive. How much sacrifice is our still-ageist society willing to make? Long term care is a provincial responsibility, but health care money comes from federal transfers. The federal government will be very wary of treading on provincial toes. If we’re lucky, maybe they will set some general national standards and attach some new transfer money to long term care. But as it digs out of the pandemic, the federal government will have to face some hard choices about investing more dollars in health care. What would most Canadians pick: long term care or pharmacare? And the Ontario government, over the last few years, has set the stage for exploitation in long term care, with aggressive privatization, minimal standards, and virtually no oversight. The powerful long term care lobby, which makes lots of easy money out of this scenario, will do everything possible to ensure that their lucrative gravy train keeps rolling. They won’t want things to change.

Maybe we need to tweak Ontario’s Medical Assistance in Dying legislation, so that if we reach the point where we need long term care, we can choose MAID instead. It would be a great comfort, now that we’ve learned that ending up in long term care can be a fate worse than death.

April 30, 2020

What’s wrong with public health in Ontario?

If there’s been one bright spot in this pandemic saga, it’s the way it has been managed in British Columbia. They’ve been proactive right from the start, taking a lot of measures early. They recommended against all non-essential travel outside of Canada during spring break. They put in an early measure to prevent health care workers from working at multiple care homes. They flattened the curve while Ontario and Quebec were still struggling with soaring numbers. They quickly coordinated their communication and procedures across the province. And every day, their provincial health officer, Dr Bonnie Henry, steps before the cameras and delivers the latest update calmly, clearly, honestly, and compassionately. In British Columbia, a scientist is leading the charge with integrity and courage. The rest of us can just watch with awe and envy. Because look at what’s been happening in Ontario.

Following the SARS epidemic of 2002 – 2003, Ontario created a stockpile of personal protective equipment (PPE): some 55 million N95 masks, respirators, face shields, needles and more. But the budget covered only the cost of storage. There was no budget to manage, distribute or replace the equipment. When a 2017 auditor general’s report found that most of the equipment had passed its expiry date, the government simply destroyed most of it and didn’t order replacements. So as the coronavirus spread, Ontario was caught short, dependent on a highly competitive, cut-throat, unreliable international market. When we could get N95 masks, they went first to front-line hospital staff. Other front-line workers, like paramedics and long-term care staff, were often left to scramble. Sometimes they were told to use the less effective surgical masks, sometimes home-made masks, and sometimes they were not issued any masks at all. Some had to use green garbage bags as gowns. Now one in seven Ontario residents who have tested positive for COVID-19 is a health care worker. That puts Ontario at one of the highest rates of health care worker infection in the world.

We didn’t have enough swabs, reagents, or lab capacity either, so that may help explain why Ontario’s approach to testing has been so slow and narrow. Insufficient testing has been one of Ontario’s major failures. We persisted in testing only travel-related cases for weeks, long after we had clear evidence of community spread. Later we allowed testing of people in contact with a diagnosed case. But people with coronavirus symptoms who did not meet these criteria were refused a test and told to stay home, so that community spread could not be recorded and tracked. Faced with a lack of capacity and a mounting backlog, Ontario narrowed its criteria even further, restricting testing mainly to sick front-line health care workers and patients sick enough to be admitted to hospital. Additional labs were hastily brought on board, increasing capacity to 13000 a day by the beginning of April, but by then the testing criteria were so narrow, they were down to just over 2500 tests on April 7. That provoked an angry response from Premier Ford, who demanded more testing. So what did they do? They changed the way they count the tests. Instead of reporting the number of patients tested, they simply report the number of tests per day. One patient may receive multiple tests, so now it’s harder to know how many patients there are and it’s harder to track the spread. But Public Health Ontario can look as if it’s ramped up the testing. Before we are ready to ease restrictions, we need to know how much coronavirus is out in the community, being spread by people with mild symptoms or even no symptoms. So we need to do massive testing in the community. Where is the huge army of health care workers going to come from who will do all that testing and contact tracing?

Robust reporting and clear communication aren’t just nice to have. Without them, we can’t move forward safely. In this pandemic, they’re a key to life and death. But Ontario’s public health system has not been up to the job. It is made up of a group of agencies which vary widely in size and sophistication, many of which try to get by on precarious funding. Their Integrated Public Health Information System (iPHS) is antiquated and selective about which data it reports. In frustration, the City of Toronto built their own COVID-19 database, the Coronavirus Rapid Entry System (CORES). Dr Eileen de Villa, Toronto’s public health chief, said that CORES would speed up her department’s efforts to trace people who came into contact with infected Torontonians, and yield better data on the local spread of COVID-19 to share with the public. The new system also tracks test results, hospitalizations and deaths, and uploads information to iPHS. In response to the ongoing nightmare in long-term care, the Toronto Star built a database too, to provide up-to-date information about COVID-19 outbreaks and deaths in long-term care and retirement homes. The Star had found that the data reported by Public Health Ontario vastly under-reported the true number of people dying in these settings, and failed to include any information about where the deaths were occurring, and which homes were experiencing outbreaks. And it’s not just Public Health Ontario that has let us down; it’s the scientific and political leadership too. They have been very slow to respond to the evolving evidence. As recently as early April, Dr David Williams, Ontario’s Chief Medical Officer of Health, announced that asymptomatic nurses and care workers could keep going to work in long-term care, even if they tested positive for COVID-19. It wasn’t until April 14 that Christine Elliott, Minister of Health, reported that she had “recently learned” that asymptomatic COVID-19 carriers can spread the virus. This information has been reported repeatedly in the medical literature since January. Ontarians are being asked to trust the scientists, but we will do that only if they act with scientific integrity.

They say that the COVID-19 pandemic has been a great revealer. In Ontario’s case, it has revealed a fragmented, dysfunctional public health system that has broken down after years of cost-cutting, downloading, and short-term thinking. This pandemic is reminding us what governments are for. What a civics lesson we’re getting. What will we learn from it?

March 30, 2020

Under the coronavirus cloud

The coronavirus pandemic is bad enough, but there’s another one following in its wake. Blatant, unapologetic ageism is going viral too.

It began early, when Canadian public health officials were downplaying the threat by assuring us that the virus affected mainly the sick and elderly. So there might be some losses, but they would be socially acceptable, and it would be business as usual for everyone else. Then the virus began rampaging through long term care homes, exposing all the weaknesses of a poorly regulated and poorly monitored industry. And as the cases ramp up and strain intensive care services beyond their limits around the world, medical staff are now posing out loud the question of who should get the ventilator: the 75-year-old pensioner, or the 30-year-old father of three. Will seniors get extra points if they provide a home for their adult children, or child care for their grandchildren? If we seniors do get turned away from intensive care, what sort of death will we be facing? I can’t imagine that there will be many palliative care beds available for coronavirus patients. Will we just be sent back home, then, to die on the bathroom floor?

Who lives and who dies? Doctors may well be facing that dilemma in Canada soon. I hope that the decisions will be guided by fair, value-neutral ethical principles, using a variety of factors, and not just age. I don’t envy them the task. And I fear for the suffering of those of us who get triaged out.

Stay home. Wash your hands. Keep yourself safe.