Three ambulances pulled up outside the Rosslyn Retirement Residence Friday evening. The paramedics who climbed out pulled on protective gear and breathing apparatuses then wheeled stretchers through the front door.
Their movements were methodical and unhurried, but inside a crisis was unfolding.
Over the next eight hours residents of the home where at least 62 people have tested positive for COVID-19 were transported to hospital. Others found places to stay in the community.
By Saturday the facility was empty.
“It’s been cleared out at this point,” said Dr. Ninh Tran, associate medical officer of health for the city, adding it’s the first time he’s aware of a home in Hamilton being emptied after an outbreak.
“It’s clearly something very significant and given the situation that was arising it was the right thing to do.”
The situation at the Rosslyn, which was described by the director of the city’s emergency operations centre as a “crisis” on Friday, appears to have evolved quickly.
But exactly one month before those paramedics arrived, a public health inspector had visited the home and ordered it to make changes, saying the facility was “inadequately prepared to respond to a case or outbreak of COVID-19.”
That warning proved to be true.
Health officials said 49 residents have the virus as of Friday afternoon. One, a 70-year-old man, has died.
Thirteen staff members have also tested positive. Additional test results are still pending.
Fifty-two people at the 64-bed home have been transported to hospital, according to a statement from St. Joseph’s Healthcare Hamilton Saturday. Tran said two other residents found places to stay with family or friends.
‘Nobody is here today’
The Rosslyn did not immediately respond to an email asking for comment and calls to the home went unanswered Saturday except for a woman who picked up around noon.
“I’m just a cleaner,” she said. “Nobody is here today.”
The public health order for the Rosslyn cited two specific issues: a lack of a sufficiently detailed outbreak response plan and a lack of a written process for in-home isolation of ill residents and/or physical distancing.
It also called for the home to take eight actions including making sure staff were trained on how to use personal protective equipment, developing a plan to isolate ill residents and creating a contingency plan in case of staff shortages.
Dr. Elizabeth Richardson, Hamilton’s medical officer of health, said the home made changes bringing it in compliance with the order.
However, after an outbreak was declared at the Rosslyn on May 10, health officials carried out a second inspection and wrote a new order.
This time the number of issues identified tripled and pointed to several the home was supposed to address under the actions in the original order:
- A lack of faculty staffing contingency plan.
- A lack of a sufficiently detailed outbreak response plan including passive surveillance of residents.
- A lack of written policy and process for in-home isolation of ill residents.
- A lack of a facility plan to implement physical distancing.
- A lack of adherence to proper PPE use based on recommendations from Ontario Health and Public Health Ontario best practices.
- A lack of staff training and education on appropriate PPE use including conducting a point of care risk assessment and use of routine practices to guide staff decision making on selecting and wearing appropriate PPE.
“Staff have not received suitable training on donning/doffing of PPE,” the order, dated May 14, states.
Finding enough people to work in the home also continues to be a problem.
Six staff and one physician from St. Joseph’s Healthcare Hamilton were deployed to the home on Friday to assess patients and help transfer them to hospital.
“We get involved when staffing levels are critical,” explained Johnson.
That struggle is similar to the situation at the Cardinal Retirement Residence, where employees stopped coming to work after an outbreak leaving just a handful of people to care for residents. That outbreak ended earlier this month.
The order goes on to state Tran has reasonable grounds to believe there’s evidence of COVID-19 spread throughout the facility, “inadequate control measures” have been taken to control the spread of the virus and that the home “lacks active and passive screening.”
The new order also added a new action — that the home develop and implement a a facility-specific plan to encourage physical distancing among staff, residents and essential visitors.
“We wanted to ensure that they were continuing to do the things that they were ordered before, as well as all of the good things that are related to an outbreak,” Richardson said of the second order.
Rosslyn only home with 2 orders
The Rosslyn isn’t the only facility ordered to improve infection controls or face consequences. Forty-two other residential and retirement locations were also singled out.
But it is the only site that’s been issued two orders, Tran confirmed.
He said the purpose of the initial order was to be pro-active and identify potential problems, adding the expectations for home in an active outbreak are different.
“What actions are needed before an outbreak and during an outbreak are different that’s why the second order … is a bit longer and is tweaked in terms of the expectations and requirements.”
When asked about the fact some of the issues identified in the second order mirror actions the home was directed to take after the original order, he conceded the question was “fair.”
“It was in compliance at one point and then we, on re-inspection in a different context found that the areas weren’t being addressed again,” said Tran.
“I think there’s a difference between having a plan and on-the ground observations in an outbreak how things are done and not done. That’s why there’s additional findings as well.”
However, that does raise the question of how much confidence the public should have in first 43 orders and reports from public health that they homes they were issued to are now in compliance.
“I think that’s something we have to look at … in terms of how does a home temporarily or at one point get into compliance and then not get into compliance and what changed,” said Tran. “I don’t have a specific answer to that, but I think that’s a point well-noted.”