When the first confirmed cases of COVID-19 started appearing at The Cardinal Retirement Residence employees stopped coming to work, leaving behind dozens of residents and just a handful of desperate staff members to care for them.

The sudden shortage of personnel at the central Hamilton home forced health officials to call in ambulances to ferry about a dozen of its most fragile patients, who were just out of hospital, to other facilities and prompted a scramble to find other workers to take their place.

Miranda Ferrier, president of the Ontario Personal Support Workers Association (OPSWA), said she received a "cry for help" about the home two weeks ago.

"They did not have any staff," she said. "I believe at that point they were down to three staff in the home, and that's including the managers."

Cardinal has 76 suites and a capacity of 86 residents, according to its profile on the Retirement Homes Regulatory Authority website.

"It's insane," Ferrier said of the staffing situation after the walkout.

The details Ferrier provided offer a glimpse into the dramatic situation that unfolded behind Cardinal's closed doors when it was struck by COVID-19 and reveal the depth of fear some workers had about the virus. They also provide a window into what was happening while public health officials spoke generically about "staffing issues" at the home.

Cardinal owner Roger Channa told CBC News that the home has enough workers "at the moment" to care for its residents.

In an interview this week about what happened at the home, Dr. Elizabeth Richardson, Hamilton's medical officer of health, said staffing had already been an issue at the Herkimer Street home, and continues to be, but fear about COVID-19 made the problem worse.

"With the onset of an outbreak it did lead to some more challenges," she explained. "We're seeing this across many other places other than just the Cardinal in terms of people being fearful about working in outbreak situations."

A city press release dated April 4 didn't provide many specifics about what was going on at Cardinal, saying only that seven residents were being transferred to hospitals.

"The facility is struggling with related staffing issues and PPE supply and has now reached a point where steps need to be taken to transition some residents who are ill out of the home," it read.

Some residents were moved out on April 4 and the others who were moved left on April 7.

'What we have is enough staff at the moment'

St. Joseph's Home Care accepted an additional group people who had been staying in the Cardinal's transitional bed program on April 7, said president Carolyn Gosse.

She would not say specifically how many patients were moved to the retirement home in First Place, citing patient privacy, but described the number as "fewer than five."

"We were aware there were perhaps some challenges around staffing and it was felt to be more appropriate to transition those patients out of the transitional bed program at the time," she added.

Transitional bed care is a short-term program for people who are ready to be discharged from hospital, but still require support they won't be able to get at home. Patients typically end up back in the community or in a long-term care home depending on their condition.

A notice on the door of The Cardinal warns all non-essential visits have been suspended during the COVID-19 pandemic. (Dan Taekema/CBC)

While there were some concerns about moving patients from a facility in outbreak to a 460-unit seniors' apartment building packed with people susceptible to COVID-19, Gosse said none of the new additions had symptoms of the virus.

Staff with St. Joe's Home Care also "took every precaution" and have isolated the new additions in a cluster of apartments to reduce the chances of possible exposure.

Channa said he couldn't provide a count of how many of his residents had been transferred out of the home, as some were taken to hospital.

He maintained only transitional bed residents were moved and said no "regular residents" had been transported to other retirement homes.

When asked about staff abandoning their posts he refused to comment.

"I cannot say anything," said Channa. "What we have is enough staff at the moment to look after the residents."

In a statement sent by email Thursday he added the "safety and protection" of seniors and staff at the home are its "top priority."

4 COVID-19 deaths at Cardinal

The Cardinal is one of six homes in Hamilton where a COVID-19 outbreak has been declared and "one where we remain concerned on a regular basis to make sure they're doing all they possibly can," said Richardson.

Four residents have died of the virus, while 45 others have tested positive for COVID-19, along with 17 staff members, public health officials said Thursday evening.

Three residents at the Cardinal have died so of COVID-19 so far, according to Hamilton public health. Twenty-six residents have tested positive for the virus, along with 16 staff members. (Dan Taekema/CBC)

The COVID-19 pandemic and the fear it's created have also made it difficult to find staffing replacements, said Richardson, who added she recognizes employers are asking people to risk their own health to care for others.

"These are some of the people we rely on to do some really difficult work and working with people who need supports … and they're not well-paid."

Job postings on Cardinal's website reveal the home is trying to hire personal support workers and cooks, as well as attract volunteers.

"Continuing to have staff in this location has been a challenge because of all those issues," said Richardson. "They're trying hard to get there and support people but it is an ongoing issue."

'Intense fear, anger, guilt'

Ferrier said her organization sent Cardinal a list of personal support workers (PSWs) who were willing to keep reporting for duty during the pandemic.

While the OPSWA president asks PSWs to stay on the job, she personally doesn't blame those who walk out.

In the past they weren't considered essential workers, and there was a severe shortage of staff at many homes even before COVID-19.

"Now what we're seeing is what happens when you don't pay attention to the very front line of Ontario healthcare," she said.

"Nurses are very important, doctors are very important … but the personal support worker is the one that performs the most intimate care for society's most vulnerable."

Among the issues PSWs face are a lack of financial support and professional recognition as well as limited access to PPE. The role also isn't regulated, something Ferrier has been pushing the government to change for more than a decade.

"When you don't have regulation or even the promise of self-regulation at the end of this tunnel and you're being expected to be that hero on the front line and dive into it headfirst, it can be daunting."

PSWs tend to be people who want to make a difference and care for others, she added. But right now COVID-19 has them scared.

"They go through varying degrees of emotion, intense fear, anger, guilt, these poor people ... especially the ones that walk off the job."