Some of Ontario's long-term care homes are now asking families to make a heart-wrenching decision about whether or not to send elderly relatives who contract COVID-19 to hospital.

It may seem like a no-brainer when a loved one is sick — but a letter CBC News obtained that was sent to families by Dr. Carson Kwok, medical director at Streamway Villa Long-Term Care Home in Cobourg, Ont., shows the decision isn't that simple.

"Very sadly, difficult decisions are going to need to be made soon," he writes.

Under normal circumstances, severely ill residents at Streamway would be sent to Northumberland Hills Hospital (NHH) for treatment — but that is going to "become very difficult with the severity of the pandemic," said Kwok, who is also an emergency doctor at the hospital.

The hospital has limited resources to treat a surge of patients, he said, and officials are concerned incoming patients could bring the virus in with them.

"It's possible that you may face the decision to send your loved one to NHH, especially if they develop pneumonia and have trouble breathing. That would raise the question of going on a ventilator," Kwok said. "A frail, elderly patient who is put on a ventilator is quite likely to suffer a great deal and may not survive."

Doctors have previously told CBC News that patients who are critically ill with COVID-19 need specialized ventilator care, but long stretches on the machine can damage a patient's lungs. That's why, they say, younger patients without underlying health conditions have a better chance of surviving.

"I am asking all of you to think hard about what would be in the best interest of your loved ones. By transferring to NHH, you are potentially exposing them to the virus, as well, their return to the home could expose everyone at Streamway Villa," Kwok said.

According to a "testing guidance update" from the province issued Wednesday, any patients being transferred from a hospital to a long term care home should be tested before their transfer.

"A negative result does not rule out the potential for incubating illness and all patients should remain under a 14-day self-isolation period following transfer," the guidelines state.

Seniors have access to same level of care, province says

Health Minister Christine Elliott has been clear that seniors will have access to the same level of treatment as everyone else during the pandemic.

Ontario's Ministry of Long-Term Care confirmed in an email to CBC Toronto that seniors living in care homes can be admitted to the hospital, but that decision is left to doctors in the emergency room triage.

However, the ministry could not provide figures about how many long-term care residents had been hospitalized in recent weeks.

Ontario Health Minister Christine Elliott answers questions at Queen's Park in Toronto. (Frank Gunn/The Canadian Press)

Ontario has confirmed outbreaks in more than 50 long-term care facilities across the province, although it can be hard to determine the severity of each one, as an outbreak is declared for a single confirmed case of COVID-19.

In some homes, like the Pinecrest Nursing Home in Bobcaygeon, Ont., an outbreak means 28 deaths. There have also been 16 deaths at Seven Oaks in Scarborough, and seven deaths at Hillsdale Terraces in Oshawa.

Sharleen Stewart, president of the SEIU Healthcare union, which represents workers in long term care homes, told CBC News that the situation is getting "out of control.

"The government has got to get a handle on this," Stewart said, also referencing Premier Doug Ford's plea to Ontarians to put an "iron ring" around these facilities.

"It's more like a plastic mesh that's around these facilities. It's full of holes. It's full of leaks."