As Premier Doug Ford calls in the army to help a handful of nursing homes devastated by COVID-19, Helen Lee has one question for him.

“How many deaths does it take to get on the list of the top five?”

Lee is talking about the five unnamed long-term care homes that Ford said would get extra staff from the Canadian military.

On Thursday, no one in the Ontario government would say exactly how those homes would be chosen from the others also suffering from outbreaks.

As COVID-19 spreads throughout nursing and retirement homes, death counts rise while the number of staff willing or able to work dwindles.

Lee’s 111-year-old grandmother, Foon Hay Lum, lives in Mon Sheong Home for the Aged on D’Arcy St., in downtown Toronto. The supercentenarian was one of the lobbyists who pushed Prime Minister Stephen Harper to apologize in 2006 for Canada’s head tax on Chinese-Canadian immigrants more than 100 years earlier.

Lum is one of 50 residents, nearly half of the home’s residents, who have tested positive for COVID-19. As of Thursday, 23 have died. Since the first cases were confirmed on April 4, Mon Sheong has lost 80 per cent of its staff. It now has 20 front-line workers putting in overtime each day to cover the morning, afternoon and overnight shifts for the remaining residents.

“It is horrible,” said Lee, chair of the Mon Sheong’s family council.

“I cannot believe how many nursing homes are crumbling. People are dying alone, and families are just torn and helpless.”

One evening, two weeks ago, there were just two workers to care for the entire home.

No one knows if residents are properly fed, toileted or if they are becoming dehydrated, Lee said.

“I think the premier is trying and pushing, but he is not delivering. He is failing the seniors. There is no help at Mon Sheong.”

In a letter sent to families Wednesday, Stephanie Wong, the CEO of the Mon Sheong Foundation, said “While we are waiting for help from the government, staffing has remained a critical pressure on our home.”

Wong’s letter also pointed to Mon Sheong’s supplies of personal protection equipment, called PPE in healthcare circles, saying, “We are in dire need of N95 masks, protective gowns and shoe covers.”

Last week, after Ford announced his plans for hospital “SWAT teams” to help struggling homes, Mon Sheong was partnered with Mount Sinai Hospital.

Wong’s letter said, “we are anxiously waiting for (the) help that they may offer.”

Mount Sinai spokesperson Barbara McCully said hospital staff “immediately” contacted the home to conduct an assessment.

The hospital looked at Mon Sheong’s needs from the perspective of infection control and prevention, locating PPE, expediting COVID-19 testing for staff and arranging access to specialists in palliative care, geriatrics or the identification of those needing acute care in hospital.

McCully said Mount Sinai is surveying its staff looking for volunteers to help in the home.

“Assisting Mon Sheong is a priority focus of the leadership team, and we will continue this partnership as long as necessary,” she said, in an email.

The hospital’s efforts are helping, but minimal staffing leaves residents and workers in a constant state of crisis, said Yi-Wen Hsu, a Toronto tax lawyer, whose 80-year-old mother lives in Mon Sheong.

Hsu’s mother, Chen Hwei Hsu, has tested negative for COVID-19.

Hsu said her siblings, including sister in Peterborough who is a physician, are considering removing their mother from the home, as the deaths continue to climb.

It’s a challenge to figure out where she is better off, but the family is working through checklists to make the right decision, she said.

While she’s relieved her mother does not currently have COVID, Hsu wonders how long she can avoid infection. She said she has heard that on some evenings, staffing numbers are so low that a worker who should be confined to a COVID-free area has had to rush to help in an area with infections, potentially spreading the virus upon return.

“After the outbreak was announced, a lot of staff did not come back in, and those that did come back in, and worked their butts off, they got sick. And there are still staff in there working who are exhausted, working 12-hour shifts each time, “ Hsu said.

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Stephanie Wong, the CEO of the Mon Sheong Foundation, which has two additional homes in the Toronto region, said all the residents of the downtown Toronto home were tested on Easter weekend by staff from Women’s College Hospital. The home has four floors and was built in 1975, but does not have the typical four-person ward rooms of that era. Most rooms have two beds, she said.

“We have residents who were confirmed positive, but they did not have symptoms,” she said. As well, 16 out of 80 full- and part-time staff have tested positive.

“If they tested positive, of course, they have to be isolated,” Wong said. “We are checking in with them to see how they are doing, because, of course, we want them to come back to work.”

Every day is different, she said. On Thursday, there were about 20 workers for the 24-hour period. It is busier during the day and evening shifts.

“Right now, it is so skeletal that it is hard to say how many (staff) are on each floor, because they will have to help out where needed,” she said. The home tries to separate workers who attend to people infected by COVID and those who are not, she said.

Mon Sheong has a three-week supply of PPE, she said, but needs more “of everything.” Wong said her staff are given N95 masks to wear throughout their shift, instead of the surgical masks the Ontario government said are safe to wear except during certain procedures, such as suctioning the airways of a person with COVID-19.

“This home is in an outbreak. Hopefully, the N95 will give more protection,” said Wong, who added that all homes are trying to order PPE from the same suppliers. “Every LTC (long-term care) operator is facing the same challenge, especially those with an outbreak.”

Helen Lee said the premier’s announcement last week of the hospital SWAT teams made her believe extra staffing was just hours away.

“He said it like they’d be roaring into the homes in 24 to 48 hours,” she said.

“I kept thinking maybe they’re coming on Friday, then maybe Monday, maybe Tuesday. And now I’m thinking, ‘oh my goodness, it’s been a week. I think I’ll go stand outside the home in the morning to see if anyone is coming in.’ ”

If her grandmother survives, Lee said she will turn 112 in July. Her birth records were destroyed in China years ago, Lee said, so her grandmother does not have the documentation required for the Guinness Book of World Records, but is considered one of the oldest living people in Canada.

She lived independently until selling her Toronto home at the age of 107. Until Mon Sheong was locked down, she still walked and went to the washroom on her own, Lee said. Last year, she fell five times and now needs help walking.

Lee said she does not know what condition her grandmother will be in when the outbreak ends.

“I am really scared that people might not just die of COVID-related symptoms, but they might actually die before, because they gave up, from dehydration, starvation or just the loss of will.

“It is heartbreaking. The home is decimated. Overburdened,” she said.

“The government keeps saying they are planning ahead. If this is the kind of planning you do, then, oh my!”