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An interview with alumna Cara Henry: The COVID crisis in long term care

Jun 24, 2020

Cara Henry 

Above: Cara Henry in her full PPE

Cara Henry is part of the “Nurse Practitioners Supporting Teams Averting Transfers” team at Trillium Health Partners in Mississauga. Since the pandemic started, she has been working as a nurse practitioner (NP) with one nursing home.

(This interview has been edited for brevity.)

When did you graduate? 

I graduated with my BScN from the Mohawk/McMaster BScN Consortium program in 2006. Then in 2011, I earned my MSc in Nursing and Nurse Practitioner Diploma.

Where have you worked?

As a nurse, I started out in long term care (LTC), then in palliative care, then in cardiology, before going back to school for my graduate degree. My role as an NP has been in LTC and helping with the hospital transitioning people into LTC from there.

Tell me about your current role.

I am part of the nurse practitioner-led outreach team. We are called NPSTAT. I am based out of Trillium Health Partners. We go into long term care homes. Our mandate is to help prevent unnecessary transfers to hospital. As part of COVID-19 we were trying to figure out how to maximize our availability to homes without creating cross-contamination. Many members of our team got deployed to specific homes. I was deployed to a LTC home about 8 weeks ago. It was during their outbreak. I’ve been there for 40 hours a week ever since.

What has that been like?

It has been a really interesting experience. I have learned a lot of flexibility. Initially I was part of setting up the COVID testing site in the hospital. Then we were trying to develop some remote services for the homes that we can’t get to physically.

Initially there was a lot of fear of the unknown. Things were changing so quickly. My role was a clinical one for the residents, and a mentor or leader for the staff. I made sure staff had PPE and it was easily accessible. I mentored them in proper donning and doffing of PPE. I provided assistance with having difficult conversations with families about their loved ones.

The outbreak at this home is now over. We had 15 patients who tested positive, and 4 who passed away. Everyone else has recovered. There were 4 staff and they’ve all done well.

In your experience, how has the pandemic affected LTC homes? What changes are needed?

I think that it’s unfortunate the pandemic happened, but it definitely put a spotlight on LTC and a lot of the systemic issues I’ve seen in my career, such as the physical layout of some of the older homes. Also, all the homes have slightly different infection control practices. I would love to see something that’s more standardized. And we need to look at the staffing in LTC, better wages for the personal support workers (PSWs) and the nursing staff, and more full time positions so staff are not having to work multiple jobs to make ends meet.

Do we need more nurses going into LTC?

Yes. The scope of LTC has changed so much. Even before I was a nurse, I worked as a PSW in LTC while in nursing school. The type of clientele I faced in 2002 is entirely different than what we are dealing with now. People are living longer with more chronic diseases. There are more specialized skills required to help deal with the residents. I feel there’s a lot of opportunity for growth in LTC and we need more nurses with an interest in LTC and in seniors in general. Registered staff play a huge role in being able to deal with the medical management of those patients. I would love to see more NPs in LTC as well. We deal with the medical piece but we are also able to contribute to plans of care with a unique nursing lens.

What can a NP add to the LTC environment?

I see NPs as leaders in LTC and being able to provide mentorship for staff and build up their capacity and confidence.

What do you personally enjoy in your role?

I have a love for the elderly. It’s hard during COVID because their families aren’t able to visit. For me, it’s been really refreshing to have more time in the home, because I can sit and have a conversation with the residents. During the first few weeks there was no time for that, but as residents started to recover and staff got more comfortable, I came in to help feed breakfast and lunch. I could visit and still do a task that needed to be done.

The province has said they are going to open the homes to visitors. What will happen next?

The homes need to create a plan to accommodate these visits. And if they’re not ready, I think it’s ok to wait until a concrete plan can be devised.

If a second wave happens, are we any better prepared to protect residents in nursing homes?

I feel lessons have been learned. We have a better handle on access to PPE, and the need to isolate residents and adjust cleaning. When everything started, everyone thought the hospitals were going to be overrun. Now we know that LTC needs to be looked at. I feel the resources will probably be more equitably managed should a second wave come. I feel like we are in a better position now.

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