Dementia Care During the COVID-19 Pandemic with Dr. Rhonda Collins M.D.

It was my pleasure to interview Dr. Rhonda Collins M.D. on how the COVID-19 pandemic has affected the care given to seniors in assisted living, independent living, and dementia care. She currently performs many roles, namely:

• Family Physician with a certificate of added competence in Care of the Elderly
• Lead physician of a hospital-based memory clinic for the diagnosis and treatment of cognitive impairment and dementia
• Consultant Physician, Senior’s Mental Health Outreach Program, St. Joseph’s Healthcare, helping patients and families experiencing behavioural challenges of living with dementia
• Chief Medical Officer at Revera, a leading owner and operator of LTC and retirement homes across Canada
• Assistant Clinical Professor, Department of Family Medicine at McMaster University
• Board Member, Ontario Long Term Care Physicians
• Member, Dementia Task Force, ORCA

She is a Past Board Member, Alzheimer Society Niagara.

Hanh Brown:[00:00:00] Today, my guest is Rhonda Collin.

Dr. Rhonda Collins: [00:01:14] Well, first of all, thank you.

Hanh Brown: [00:01:15] Thank you so much for being here.

Dr. Rhonda Collins: [00:01:17] If you could just

Hanh Brown: [00:01:18] take a moment to share with the listeners about yourself, your journey, how you got to serving the elderly and also about your company.

Dr. Rhonda Collins: [00:01:27] Sure. Well, thank you for having me on. I’m always happy to talk about. Seniors and senior living because it’s a passion of mine and it didn’t start out that way.

[00:01:36] But I started getting very interested in dementia. I’m a family practice physician who has care of the elderly added competence, a certificate about a competence from the college of family, physicians of Canada. And I originally got very interested in dementia and the impact that it has on older adults.

[00:01:54] And I went through a special training course. To develop a memory clinic within my family practice. And within the year I had an opportunity to work in a long-term care home as the physician there, because they were looking for somebody particularly for the dementia units. And I went there not expecting to love it as much as I did.

[00:02:16] I thought that I would enjoy it, but I actually, within several months just said, this is. All I want to do. And so I changed my practice to the focusing exclusively on older adults and particularly older adults with cognitive problems, because it is such a challenge for them and for their families. So I have a memory clinic out of a hospital where I see people, um, with memory concerns.

[00:02:41] And I also am a consultant for a seniors, mental health outreach. Program that provides some support for residents in long-term care or people living in the community who have cognitive problems and also some behavioral problems associated with that. So it’s not uncommon with dementia, for people to become agitated or confused and act out in a way that is sometimes concerning to either family members they live with or caregivers.

[00:03:10] And so I provide support in those areas. And then my full-time job is a chief medical officer for Revera. So we own across Canada, the us and UK have a 500 long-term care and retirement residences. And in Canada we operate about 175 of those. So by about 75 long-term care and a hundred retirement residences.

[00:03:30] So I provide clinical oversight and recommendations on how do we improve the lives of our residents living in our senior living sector. Well, God bless

Hanh Brown: [00:03:40] you to have that journey and find your calling, what a blessing to be able to serve in my opinion, the greatest generation. So thank you. So as far as post COVID,

[00:03:53] what is your take of what depend DEMEC has done to the older adults and the older adults with dementia?

Dr. Rhonda Collins: [00:04:00] It’s been pretty devastating on one of the things that I’ve been challenged with over the past several months, as you know, when we went into COVID, there were visitor restrictions put in place, particularly in our long-term care homes. There’s a couple of different sectors here and there’s the community environments.

[00:04:16] There’s the retirement home environment. And then there’s a long-term care home environment. And for your listeners, it’s important to distinguish a retirement residences from longterm care homes. I am. Fan of keeping people at home as long as possible. I think everybody does best in their own environment.

[00:04:34] Sometimes care needs, exceed what can be offered at home. And so long-term care, particularly if somebody has medical needs that need to be attended to, or physical needs that prevent them from having appropriate care within their home. And sometimes cognitive needs as dementia progresses. It can be very challenging to take care of somebody in their home.

[00:04:53] So the long-term care home offers that 24 hour nursing care support to be able to help with mobility issues with medication administration, with medical needs and with cognitive means a retirement residence is much more. Independent. There are some that provide care some additional care, but by and large, they have a tendency to be independent.

[00:05:17] And there are advantages to being in a retirement residence. I worry about people who are living alone and who don’t have a lot of visitors and don’t get adequate amounts of physical activity. So loneliness is a big contributor to cognitive decline in a retirement residence that congregant living environment allows somebody who might otherwise be living alone and may not be eating the healthiest meals or not getting enough physical activity to be able to access those things, the meals that are prepared for them.

[00:05:50] The social networking, which we know is super important for keeping our cognition intact. So that’s a couple of the benefits exercise programs that they can participate in and other brain stimulating activities that they can participate in that keeps their functional and cognitive health as well as possible.

[00:06:08] So there are some benefits to congregate living, but what we know about COVID is the challenges of congregate living, particularly long-term care is that. If there’s an outbreak homes go into shutdown and isolation is hard for any of us. I know all of us, even those of us who are cognitively perfect. I don’t know if that’s me, but I will say cognitively well, living in the community.

[00:06:34] Who understands the need for all of this, have a hard time with it. This has been incredibly difficult for people to be separated from their loved ones. So imagine now you’ve got a loved one in long-term care. You can’t go in and visit because regulations say we need to keep visitors out to protect our residents at the same time.

[00:06:52] Keeping our visitors out is having a detrimental impact on function and cognition, especially for people who already have cognitive impairments, not being able to see your family with no explanation as to why or an explanation that you don’t understand remaining isolated. When you don’t understand why you need to be isolated, why your family is not coming visiting, why you need to wear a mask.

[00:07:15] When you go out and common spaces, these are all really difficult things for some of our older adults. Especially again, those who aren’t as cognitively preserved as they used to be. But even those living in retirement or living in the community, I know a lot of them are struggling with not being able to do the things they used to do.

[00:07:34] So it’s had a really dramatic impact and we know that this virus has sort of preferentially targeted older adults.

Hanh Brown: [00:07:42] I agree. I’m getting chills as you were talking, you’re speaking to me. I’m the daughter with a mom there’s 10 of us. And she is in the later stage of dementia. We haven’t seen her. And all of us are at the moment where, when we can, we’re going to fly out there and see her.

[00:07:58] And we just don’t know regarding like the flight, the two week quarantine and so forth.

[00:08:04] when one is in the later stage of dementia, as you know, They go in and out, out more frequently, they don’t understand. Let alone trying to explain to them. COVID my worst fear right now is to get a call from the community that she needs to go into the hospital without one of us.

[00:08:21] But anyways, that’s kind of a separate fear of mine is very unfortunate. The older adult generation having to go through this isolation, loneliness and being targeted with COVID very deadly. And then on top of that family members, can’t be with them for this.We’re going on five plus months.Right now. It’s very detrimental.

Dr. Rhonda Collins: [00:08:44] Absolutely. And one of the challenges we face, I’m so sorry that you’re going through this and I hear your story from so many people at it’s heartbreaking to me, because one of the challenges we faced throughout all of this is that, of course, particularly in long-term care, we are bound by directors who.

[00:09:03] Tightly regulated sector and the regulations are pretty strict. And so when the ministry of long-term care says, we can’t have visitors, we need to follow that. And particularly when a public health unit comes in and says, you’re in outbreak, we just finally. Got this green light to go forward with allowing visitors back into long-term care.

[00:09:26] And now, because the restrictions around public health, if there is so much as one staff member who tests positive, the home goes into outbreak. So now we’re excited to say we can let visitors back in. We’re going to follow very specific directives from the ministry to ensure the safety of all our residents and staff and family members.

[00:09:47] And then a staff member tests positive as we continue to do surveillance that is going to continue to happen. And each time it happens, it puts homes back into outbreak. So then we have to pull back and say, no, you can’t come in. And I’ve actually said this to some of our policymakers. We can’t keep doing this to families.

[00:10:07] We finally opened up enough to allow them to come back in and then we keep having this pushback when there’s an outbreak and they will continually be outraged because staff members will continue to be positive if we continue to test them. So there has to be a better balance act for sure.

Hanh Brown: [00:10:25] Absolutely.

[00:10:26] So share with us the challenges with regard to your ability to buy let’s say PPE and test equipment. And move in within the last couple of months. And I’m assuming it’s very low to none due to social distancing. So just share with us your experience in your company.

Dr. Rhonda Collins: [00:10:46] We are large company, and so we definitely have access to a lot of distributors.

[00:10:53] We have an entire team dedicated to acquisitions and procurement of PPE. I will keep saying one of the biggest challenges. There were a number of challenges that came out of this. And so in the very beginning, there was a global shortage of PPE. And because the hospitals were expecting a surge and the government was expecting a surge on the hospitals, much like what happened with SARS?

[00:11:18] All resources were redirected to acute care. So even our regular distributor was not allowed to release PPE and less. We were in an outbreak. Well, unfortunately at the beginning there were things we didn’t know that we know now we didn’t know there was spread amongst healthcare workers who were asymptomatic.

[00:11:41] So that was the biggest thing doing screening at the door is wonderful. But if somebody doesn’t have symptoms and they’re carrying the virus, then they can pass it along. So universal masking needed to happen much sooner in our sector, but it wasn’t pushed through the ministry until I believe it was too late.

[00:11:58] And we’ve always had enough PPE, but we didn’t have enough to implement universal masking as a strategy in the beginning because it just wasn’t available through all of the companies. Everybody was experiencing the same thing, the screening tool that we used, we used based on the information from the best health authorities that was available.

[00:12:18] And that was looking for cough fever, shortness of breath. Well, what we learned as time progressed was that those aren’t the typical symptoms we’re seeing in our older adults, headache, sore throat, lack of appetite, loss of taste buds, right?

[00:12:34] Feeling fatigued, feeling fatigued is not an uncommon symptom for a lot of people.

[00:12:39] And so there would be no way for us to say, Oh, this must be COVID when that’s not what we had learned. And remember, we were learning very early on in the process where we didn’t have really good data from the other countries. So this has been a progressive learning experience. So we were very quick to implement visitor restriction and essential visitors.

[00:12:59] We were very quick to implement universal masking and restricting our workers to one site because we know that the predominant. Spread is through infected healthcare workers who are providing direct contact. So those are some of the challenges we faced in the very beginning. .

Hanh Brown: [00:13:16] So how are you doing with regard to partitioning your communities and allowing folks to continue to dine engage?

[00:13:25] Are all those activities on hold for now? Or are you continuing with that? And if so, how do you partition the folks that are positive?

Dr. Rhonda Collins: [00:13:34] So it definitely, if there’s positive resonance in the home is an outbreak. Public health makes the determination as to whether it’s the whole home or just a particular unit.

[00:13:44] And so we have to follow the recommendations of public health in any home. That’s an outbreak, essentially all communal dining is canceled and tray services offered in rooms, creates challenges as well, because one of the other things is staffing shortages. If staff are positive, Put off by public health.

[00:14:02] They’re told to stay off work originally for 14 days. Can you imagine how dramatically that impacts the workforce? We had a hundred recruiters doing nothing but recruiting staff for homes. We recruited over 2000, which was fantastic. But then you have new staff coming in who have to be onboarded who have to learn all the procedures.

[00:14:25] And when you’re an outbreak, your focus is on managing the outbreak, not training new staff. So it just turns into this really. A difficult to navigate circumstance. And thankfully we have really great teams from operations and clinical that can help with this. So the programs having community sort of the regular recreation programs means a lot more one-to-one, but one-to-one is definitely more time consuming.

[00:14:49] And you can’t do as many programs when you’re doing one-to-one as you can with a larger group. So again, we follow the recommendations as far as when we can start having people physically distanced. In a communal space where we can have those group activities, because I think those group activities are incredibly important again, for that social component.

[00:15:08] We are social creatures.

Hanh Brown: [00:15:09] Yeah, no, absolutely. You know, I was just thinking, like you said, we’re human beings and we need that one-on-one interaction touching, physically communicating and technology has been a great alternative. And to me, that’s what it is. It’s an alternative, but ultimately we need to have face-to-face again, that physical next to a person where you hug and touch and that’s what we need.

[00:15:33] And I also see, not only the older adults are getting hit, obviously the most, but I see that in kids. Children, they’re active children in staying at home. Being safe is all good, but I think it’s affecting their mental health. I speak to that because I have children myself. It’s tough across the board for everybody.

[00:15:54] Oh, for sure. It is affecting so many people in so many ways. And yeah, I think there always needs to be a balance and we have to find the right balance between protection from disease versus protection, from the impact of loneliness and isolation. It’s so important to you’re. Absolutely right. Everybody has gone to zoom meetings.

[00:16:17] Everybody’s gone to these type of platform for communication. It is not the same at all. It just isn’t being with other people is so important for our mental and emotional wellbeing. Yeah.

[00:16:30] So now we talk about loneliness and I see in senior living some of the value proposition that we offer are all the, let’s say the wellness, the engagement, the activities, and dining.

[00:16:43] Those amenities are limited right now because of COVID and I have to come up with all their means to sell folks on the concept. Are you finding it to be the same? Because all the amenities that we offer to the older adults.

Dr. Rhonda Collins: [00:17:01] We’re limited at this point.And yeah, that’s a challenge. And there’s been a lot of back and forth discussion about this, whether or not right now, senior living as the place to be because of the risk of spread.

[00:17:12] I think one of the things to differentiate when I talked about the differentiation between long-term care and retirement, one of the differences between long-term care and retirement is that retirement hasn’t been hit nearly as hard as long-term care. And that’s because the design is quite different.

[00:17:29] Most retirement residences look more like apartments, so much easier for people to isolate themselves, to remain within their apartments and reduce the spread. Whereas in long-term care, you can’t close people in the rooms with the doors closed. That’s not an acceptable thing to do. If I’m able to close my own door in my own apartment, on my own suite, as we call them in retirement, then that’s one thing.

[00:17:56] But in long-term care, we can’t close people’s doors to isolate them. And so that’s one of the ways that I think spread has been contained in retirement so much better than it has in long-term care. Some retirement homes have care units. And so then there’s a greater risk of spread because it’s much more communal than the actual retirement residence.

[00:18:17] Of apartments is the other thing is in long-term care. A lot of the buildings are older. Those buildings that are up for redesign. So there may be shared space three to four bedrooms in a ward or shared bathrooms that makes spread really difficult to contain. And so that’s why we’ve seen larger spread.

[00:18:36] One of the reasons we’ve been doing a lot of analysis in our company has been doing a lot of analysis into the data we have trying to figure out why some homes. Didn’t get hit 80% over 80% of long-term care homes in Ontario did not have an outbreak. I mean that’s important, but the ones that did, some of them had one or two people get sick and that was all or one or two people test positive, I think is a better way to say it.

[00:19:01] And some had very significant outbreaks. What was difficult to contain the spread. So our organization, as well, as many others are looking at, what is the reason behind that and using all the data that we’ve gathered to try and analyze and make some recommendations for moving forward so that we don’t end up in the same position should have second way of it.

[00:19:20] But you’re absolutely right. The question becomes, do I want my mom or dad in a communal living space from a safety perspective, particularly if activities are not available. And that’s a great question. I think, as we are now coming out of the pandemic and things are moving into a safer environment and activities are beginning to open up.

[00:19:41] There’ll be a much greater level of comfort being in that type of environment.

Hanh Brown: [00:19:46] Yeah, no, I agree. And I’m thinking about the study that your organization is doing. I admire that. I opt to think about all the components that’s involved. There’s so many moving parts. Plus, not all those moving parts are tangible.

[00:20:01] For instance, you could have two communities in the same region. One could be doing exceptionally well and have all the equipment and the test results and all the containment and so forth. And then the other one could have a lot less. But there is no direct correlation that one who has the most following compliant with the CDC and then the other one, not, and that therefore one is going to have less deaths and the other, it’s not a linear correlation.

Dr. Rhonda Collins: [00:20:28] Absolutely. And we found that there are studies from the U S that show us that this virus does not discriminate. In the U S the centers for Medicaid and Medicare rate homes on a scale of their ability and their, their compliance and their care provisions, the quality of care. And there are five star homes in the U S who had got hit just as hard as one-star homes.

[00:20:52] So you like to look at everything we can and say, if there’s something correctable, then we want to do that. And certainly the four bed wards is something that we need the government to say, we can’t have this anymore. And in the long-term care sector, we’ve been asking for this for a long time. And I don’t think our voice has been heard very loudly.

[00:21:12] I think now it’s unfortunate that it took a be of this magnitude for everybody to look and say, Hey, this sector has been. Practically ignored for a really long time. It’s about time we pay attention.

Hanh Brown: [00:21:25] Amen. Yeah. Okay. So I want to know your take on aging aging process in societies. Take on this aging for the older adults.

[00:21:36] I know that’s separate from the medical side of this, but I think it’s important because society’s outlook influenced the individual’s outlook, which then affects their whole aging process. What do you think.

Dr. Rhonda Collins: [00:21:51] Completely. And there are studies to demonstrate that as well. So your outlook, your attitude definitely plays a large role into how well you age and I can share with you those documents, those studies, if you’re interested, but we know that there are certain things that we can do to promote a healthier lifestyle and then promote a robust aging process where we feel good about where we are in our life.

[00:22:19] Unfortunately age-ism is still the most tolerated form of discrimination. There is. I hear it often and I try and shut it down whenever I hear it. But I look at those people who have gone before the generation before us and think. How much we have to learn from them and how much we should respect what they have been through.

[00:22:41] And I just read this absolutely fascinating editorial about the complaints of today having to wear a mask for instance. And that was sort of the, the emphasis for what young people don’t understand. And it was talking about if you had been born in the 18 hundreds, you would have lifted through world war one and world war II and the great SLU.

[00:23:04] And the Vietnam war and the Korean war and all, and it went through the process of what somebody would have experienced it each age in their life having approached each of these major things that happened. And so we think that our generation and the younger generations have it kind of easy compared to what are the previous generation experience.

[00:23:26] And so I think that. One of the things I’ve always promoted within our homes and should be promoted universally, is that intergenerational communication? I think we hear older adults saying, you know, while the kids of today, they don’t have the gumption and we hear the millennials saying, well, I don’t want to be older.

[00:23:46] What does he know? He’s old. We hear all of these stereotypical comments. And one of the things that Revera does, which is absolutely phenomenal is something called ages more. And we partner with them. Company who makes films, who make short films. So what they do is they take high school students and they put them into long-term care home or retirement residents, usually it’s retirement.

[00:24:08] And they have them make a video, a short video about that person. So they’re partnered with an older person who lives in a retirement residence, and they’re asked to make a short film. And then we have this huge red carpet event where all of the filmmakers and all of the subjects. Walk, the red carpet and sit in the row is just like, it was an Emmy awards and those videos are shown and the community is invited and politicians are invited and it’s broadcast live via Facebook.

[00:24:39] And it’s so fantastic to see the, one of the questions I always ask is the filmmakers. What did you learn or what did you think you would know that you didn’t know? And almost universally from both sides? There is, I have so much to learn from the other person and that makes me happy because that’s exactly what I think it should be.

[00:25:01] We should be. Utilizing opportunities to help one another navigate younger people to what they need to know, and for the older people to share their wisdom and their experience. So I think on intergenerational, I love it so important.

Hanh Brown: [00:25:17] I love it because it removes a barrier, their stereotype and the disrespect, and at the end, You have the respect build and that relationship cultivated where there’s exchange of ideas and wisdom.

[00:25:31] Right? I think the older adults can share their experience with the younger, and of course a younger can give some great insight on many things that the older could experience as well. So that’s what I hope for is when I’m in my eighties or so I want to be around people in their fifties and thirties and in their teens.

[00:25:51] Because I have wisdom to share to those folks. And I’m sure by that time, there’s a lot that I don’t know from the folks that are in their twenties and forties. So I think it’s very important and we should do our very best to remove those stereotype and strive between the generations, because anything that we don’t remove, they become part of that generation.

[00:26:12] And it becomes a vicious cycle.

Dr. Rhonda Collins: [00:26:13] Yes, completely. Yeah.

Hanh Brown: [00:26:16] So let me ask you this. Have you thought about your senior living options and what is your take on that?

Dr. Rhonda Collins: [00:26:21] As far as me personally, going into senior living, just your take on.

Hanh Brown: [00:26:25] Senior living now and senior living, let’s say 10 or 20 years later. Is that something that you would consider?

[00:26:32] What would you hope for that to be.

Dr. Rhonda Collins: [00:26:34] what I would hope for it to be? So again, I, I’m a huge fan of living independently for as long as possible, provided that all of my social needs can be met, but if I were moving into a retirement residence, I would want to be certain that it was a. Very home-like environment where I was respected for my individual choices, where my needs could be met inside and outside.

[00:27:02] So being able to participate in regular physical activity inside the residence, but also to be able to come and go as often as needed to be able to take advantage of being outside, because that’s so incredibly important as well. Food I’m a foodie. So I need some really good cooking. I need somebody that’s going to prepare meals that are going to be right.

[00:27:23] All, I have a lot of choice in what I choose to eat and where I choose to eat. I don’t want to be told I have to sit down at five o’clock in the afternoon to eat a meal, because I may want to have a continental dining opportunity at eight o’clock at night. And I want to be able to enjoy a glass of wine with my meal.

[00:27:39] So I want to make sure that. All of my physical and mental and social and psychological needs are matched.

Hanh Brown: [00:27:50] well, I’m so thankful that we had this time to connect and for you to share your story, your expertise, and how you serve and do older adults. I admire that.

Dr. Rhonda Collins: [00:27:59] I love it. Thank you so much.

Hanh Brown: [00:28:03] Thank you so much for joining us this week.

You can reach Dr. Rhonda Collins M.D. via LinkedIn at https://www.linkedin.com/in/rhonda-collins-96ba4067/