Page - 460 - in VULNERABLE - The Law, Policy and Ethics of COVID-19

VULNERABLE460 off personal protective equipment (PPE)—if available, which it often has not been—alone increases the workload substantially. Changes to workflow are also required during an outbreak, such as ensuring medication administration and clinical assessments are consolidated to optimize PPE conservation. Residents are confined to their rooms, so all medications and meals must be administered in each room, rather than more efficiently in the dining room, for example. In addition, gaps in care created by low staffing levels had often been filled by family members and volunteers, the same families and volunteers now barred from entering due to infection control. Families also create more work as a result of their understandable demands for information. Similarly, volunteers had taken on some of the work involved in keeping residents active, also as a result of low staffing levels. These people too have been removed from the homes, leaving residents without activities. The result can be increased stress, agitation, and violence. While adequate staffing levels are a necessary condition for quality care, they are not the only one. Training for the specific and changing needs of residents in long-term care, especially during a pandemic, is also required. In these times, this includes the use of new equipment and protection for everyone who enters the home. Anyone new to the home also needs information on particular resi- dents in order to protect both the person providing and the person needing care. The work is more complicated if workers without spe- cific training in nursing home care are brought in. Workload is further increased during an outbreak when staff are unfamiliar with the resi- dents, the home, or with other workers as a result of relying on part- time or agency staff. Moreover, part-time staff not only move from home to home, as has become obvious during this pandemic, but they are often without the benefits that would enable them to stay home when sick. Coordination and teamwork are essential in these times of extra work and rising fear. Both are made more complicated by work- ers unfamiliar with the place and people. Physical environments also matter.38 Austerity has meant that many homes have not been redeveloped to meet current health needs. The problem of wards that house up to four residents separated by little more than a sheet has become obvious. Crowded rooms force 38. Pat Armstrong & Susan Braedley, eds, “Physical Environments for Long-term Care” (2016), online: Canadian  Centre  for  Policy  Alternatives  <https://www.policy- alternatives.ca/publications/reports/physical-environments-long-term-care>.