Health unit assists congregate settings with COVID-19 protocol

By Sue Tiffin

The COVID-19 pandemic brought to the health unit’s attention areas in which they needed to develop new or enhance existing relationships with in order to help protect vulnerable groups during the pandemic, including congregate settings like group homes, farms with temporary foreign workers, child care centres and residential and day camps. 

Health promoters with the Haliburton, Kawartha, Pine Ridge District Health Unit Lisa Kaldeway and Sue Shikaze began in April to engage with these settings, and Kaldeway reported on that experience to the board of health meeting on Sept. 17. 

“What we find in all of our health promotion work is that investing some time upfront, in building positive relationships with partners leads to a better understanding on their part of why the issue – in this case COVID-19 protocol – is important and that can increase uptake of the preventative actions public health is promoting or requiring of them,” said Kaldeway. 

She said while some of the settings were occasionally or regularly inspected by public health inspectors, others were not, so hadn’t had much contact with the health unit previously, which presented an opportunity for public health. 

“These settings experience rapid changes due to COVID-19 and many work with vulnerable populations, particularly related to this pandemic, so this provided an opportunity for us to develop new or enhanced existing relationships, and provide support in new ways to help these settings navigate change, including interpretation of regulations and guidelines – we found the guidance documents provided some direction but they cannot cover every situation, so the operators had many questions specific to their settings and clients,” Kaldeway reported. 

Kaldeway and Shikaze, alongside colleagues, provided support in the development of COVID-19 policies and procedures for the organizations, and also in consideration for the secondary impacts of COVID-19 precautions in some settings, for example, she said, mental health impacts on residents who were too young or did not have the cognitive ability to understand physical distancing measures in place between their staff and them, or missing visits with their family during the lockdown.

“Sometimes we were able to troubleshoot alternatives, and sometimes we were just there to empathize and bring this information back to our provincial contacts and networks.”

Outcomes Kaldeway said they were looking for included positive working relationships, increasing an opportunity to work with the organization, better understanding of the regulations, and positive health outcomes for clients.

In the HKPR region, there are 47 group homes operated by 10 agencies with the Ministry of Children, Community and Social Services and the Ministry of Health involved. Group homes serve vulnerable groups such as people with physical and developmental disabilities, people with addictions and mental health issues and youth who have experienced trauma. Most homes accommodate 10 or fewer residents. Additionally, there are six shelters in the region, which were contacted through an ongoing relationship with a social determinants of health nurse. 

“When we first reached out to group home agencies, the initial reaction we heard was ‘thank you,’” said Kaldeway. “They were very overwhelmed with changes and guidance they needed to roll out across multiple homes, and were very relieved to hear from public health and be offered one point of contact.”

Kaldeway said some of the work they did with agencies focused on infection prevention and control practices, plans for managing ill staff and residents, personal protective equipment use, and staffing plans, as well as arranging for optional sentinel testing with homes, in partnership with local assessment centres and paramedicine programs, which had good uptake. 

“As the response evolves and communities have been reopening there have been many questions from group homes, as they try to balance protecting the people they support with allowing for activities that will help their residents’ wellbeing, such as visits and outings with families and friends.”   

In the Haliburton, Kawartha, Pine Ridge region there are 23 farm operations, some with multiple sites, mainly in the Kawartha Lakes and Northumberland County, that hire more than 200 temporary foreign workers arriving between March and September this year.  The numbers range from a farm with one temporary foreign worker to one with 60, with most having smaller numbers. 

A few farms, according to the report, have received or plan to receive transfer workers from other farms in Ontario, while 16 farms also use approximately 87 local workers on site, who don’t necessarily live on the farm. This year, many farmers opted not to accept transfer workers due to concerns with outbreaks at larger farms in southern Ontario. 

From April to August, public health inspectors inspected housing for COVID-19 considerations, and health promoters started contacting farms beginning June 1 to confirm temporary foreign worker numbers and arrival dates and to offer support. The heath unit also called farms with migrant workers in quarantine twice during the 14-day period, completing a short survey to verify practices, provided support with the Section 22 order, and coordinated to offer optional on-site testing for newly arrived workers.   

Child care centres in the region were closed due to the pandemic beginning in March, with a gradual reopening allowed on June 12, with many protocols required, and a full-capacity opening on Sept. 1. Many centres opened later than June and some are still not open, according to Kaldeway. 

In total there are 86 child care facilities in the area, which include licensed child care centres, licensed home daycares and before and after school care. Many are multiple sites run by one agency or operator. 

The health unit reviewed and provided feedback on COVID-19 policies and procedures for child care centres prior to reopening, offering guidance to centres on changes to policy as the response evolved. Kaldeway said she and Shikaze reviewed what she said were “extremely comprehensive” plans laying out plans for screening, cohorting, facility cleaning and disinfecting, physical distancing and management of symptomatic children and staff.   

“As we saw trends of calls and emails bombarding our call centre and inspectors and ourselves, we worked on refining guidance for the centres, on management of symptomatic children,” said Kaldeway. “Each time the provincial guidance was updated over the summer we would see an increase of questions coming in.” 

Recreational overnight camps were deemed not permitted to open by the provincial government, but the health unit is aware of eleven day camps that operated this summer.

The health unit was in touch with all recreational camps and day camp providers, providing guidance as to what was permitted and reviewing ministry guidance to ensure the day camps had plans in place to address procedures such as screening processes and isolation plans for symptomatic children. 

“Some of our key lessons learned from being involved with [all of] these settings was that they really needed our help and support,” said Kaldeway. “Legislation, regulations, guidelines only go so far, and people need specific help for their setting and what they do in scenario A, B and C. So we found that using a health promotion approach that was supportive and solution-orientated helped them feel more confident, helped them in effectively applying the requirements and made them feel like they could move forward, they could face an outbreak and they could contact public health with any questions no matter how small.”  

While a steep learning curve required Kaldeway and Shikaze to be up-to-date on new guidance as it was released, prior to calls coming in, Kaldeway said the work was satisfying professionally, and also personally beneficial.  

“It has been incredibly rewarding to help these settings navigate the pandemic and feel like their first call when they have an issue or they need support,” she said.