Page - 457 - in VULNERABLE - The Law, Policy and Ethics of COVID-19

457Privatization and COVID-19: A Deadly Combination for Nursing Homes proximity to other health care workers to turn and position the resi- dent. There is no way this can be done from two metres away. Much of the work of bathing, dressing, changing briefs, and assisting residents to the toilet and the shower is carried out by those variously called personal support workers, health care aides, or care aides, and the like. To supervise them, nurses must know how to do this work and be prepared to assist, especially in these times of very short staffing. Residents regularly cough, spit, and dribble, risking the spread of the virus. There is no guarantee that residents will remem- ber to cough into their arms, blow their nose into a Kleenex, or wash their hands, let alone do it to singing “Happy Birthday” twice. Even if they are able to take these precautions in the morning, they may not remember to do so in the afternoon. Dressing and undressing, and especially changing diapers, exposes workers to physical risks, both because such intimate work can prompt resistance and because workers are so close to the residents. Residents may lash out when dressing or clinical tasks are underway. Exposed to frequent scratching, kicking, punching, spitting, and bit- ing, the skilled work of staff is difficult. The work becomes more dif- ficult and skilled under COVID-19 conditions. With many residents upset and confused by today’s changed conditions, the work becomes even more risky. Resistance and violence are increased, and workers must call on a wide range of skills to calm and reassure residents. Dietary workers, laundry workers, and housekeeping staff also require specialized skills for operating in this care environment. They, too, frequently interact with residents and need to know about their capacities. The need for special cleaning has become more obvious during the pandemic, as it did during SARS, but cleaning is always a critical factor in care for this vulnerable population. Urine and feces, for example, are frequently found on seats, floors, and beds, carry- ing risks. Laundry too can spread infection and requires careful and knowledgeable handling.31 Moreover, it is essential to coordinate these workers with those who provide nursing care. All these workers frequently encounter families seeking infor- mation and help. Moreover, many families provide a considerable amount of care, especially in terms of assistance in eating, dressing, walking, comforting, and advocating, and many receive training to do 31. Pat Armstrong & Suzanne Day, Wash,  Wear,  and  Care:  Clothing  and  Laundry  in  Long-Term  Residential  Care (Montréal & Kingston: McGill-Queen’s University Press, 2017) [Armstrong & Day].