OTTAWA — COVID-19 is already causing a crisis as it spreads through nursing homes, but an Ontario researcher warns that the much larger population of elderly patients in home care also faces huge risk from the virus and could overwhelm hospitals if they aren’t protected.

John Hirdes, a University of Waterloo professor who specializes in geriatric health-care, said authorities are “quite appropriately” focused right now on quelling the outbreaks in nursing homes.

But he said home-care patients — which he estimates at about 560,000 nationally, compared to 200,000 nursing home patients — must also be made a priority. Though they are obviously more spread out than nursing home patients, an outbreak in a community could quickly prove devastating to them.

“Many people in home care are only there because they’ve got a family member supporting them,” Hirdes said. “Otherwise they would be in a nursing home because they have comparable health conditions, but the family are what’s keeping them in place.”

He said data on how home-care patients have been affected by COVID-19 likely won’t be clear until months after the fact, but he suspects it’s already strongly present in Canada’s numbers. Federal data shows 94 per cent of COVID-19 deaths in Canada so far are from people aged 60 or older, and 62 per cent are from people aged 80 or older. Half of the deaths are connected to nursing homes.

“I would expect a good number of deaths that have occurred have been among people that are probably home-care clients, because they’re a very similar population (to nursing homes),” Hirdes said.

On Friday, Hirdes and his research team released a “COVID-19 Vulnerability Screener” for Canada that will allow partner organizations (who already use other screening tools his team has developed) to assess patients for being high-risk to the virus.

“It could be used by primary care physicians, by geriatric services, by retirement homes to do some basic screening for vulnerable populations, and that can be fed back to physicians or nurse practitioners to help identify the cases most at-risk and manage them in the community,” he said.

Hirdes said eventually the tool will be available as a web-based application that can be used by anyone, but for now he wanted to get it out the door quickly.

We’re just trying to catch up to the COVID-19 pandemic like a lot of people are

“We got this together in about a three-week period,” he said, adding that his research team (10 PhD students and four staff) has shifted to entirely focus on the virus. “We’re just trying to catch up to the COVID-19 pandemic like a lot of people are.”

Using COVID-19 patient data published by the World Health Organization and combining it with his own data, Hirdes said about 40 per cent of home-care patients and 60 per cent of nursing home patients in Canada are in the top risk category for COVID-19 mortality due to age and underlying conditions such as renal failure, heart failure and liver disease.

“If the home-care folks alone got sick, if they were exposed on enough scale, they would by themselves overwhelm the hospital system,” Hirdes said. “So we’ve really got to protect those people.”

Prime Minister Justin Trudeau said Canada’s death rate has been rising much faster than federal modelling had predicted primarily because of outbreaks in nursing homes, and it was scheduled to be a main topic of discussion in a call with premiers on Thursday evening.

“One of the things we’ve seen over the past number of weeks is a far more severe impact on seniors’ residences and long-term care centres than we had certainly hoped for, or more than we feared,” Trudeau said. “Therefore we need to take more measures to protect our seniors.”

Theresa Tam, Canada’s chief medical officer of health, said governments need to “double down” to stamp out outbreaks in high-risk settings. “If the measure of a society is in how it cares for its most vulnerable, this pandemic has revealed the chink in our armour,” she said.

The situation is most dire in Ontario and Quebec, as more than 100 nursing homes in each province have seen COVID-19 infections, and multiple homes in each province have seen more than 20 deaths.

Quebec has been facing a staffing shortage due to more than 1,200 nursing home staff contracting the virus, and the government has been redeploying staff from hospitals and recruiting physicians to help. It has also asked the federal government for military assistance. Ontario announced an action plan on Wednesday that promised increased testing and the deployment of medical “SWAT teams” made up of hospital staff and other health-care workers.

Hirdes said this is good, but warned against taking away resources for home-care patients, especially at a time when they’re already likely under-supported.

“Three quarters of the care home-care clients get comes from family members,” he said. “Now with social distancing, what’s happening is that we’re down to one family member, probably, providing the care and there’s fewer home-care staff available to provide support.”

He urged governments to look elsewhere, such as staff who provide post-surgical care and staff at complex continuing care hospitals, if governments are redeploying people with experience in geriatric care to nursing homes.

“I would be quite concerned if what we did was to take away personal support workers from these at-risk home-care clients and sent those personal support workers into the nursing homes, and leave the home-care clients behind,” he said.

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