As the clock ticked closer to the 3 p.m. shift change, the Rekai Centres’ chief executive officer was still working the phones, trying to find enough staff for residents in the Wellesley Central Place long-term care home.

At the same time, Sue Graham-Nutter was taking calls from families considering removing their loved ones from Rekai Centres’ two downtown Toronto homes as the number of residents with COVID-19 rise and the number of workers declines.

Sherbourne Place now has 10 residents who have tested positive for COVID-19, including a 66-year-old man who died more than a week ago. As of Sunday, Toronto Public Health reported five residents had tested positive at Wellesley Central Place. Both homes are awaiting further test results, with 11 pending for residents at Sherbourne Place.

“I know a number of families are wrestling with the difficult decision of whether to discharge their loved one...” Graham-Nutter said, in a letter emailed on Monday. “There are numerous factors for each family to consider.”

The Ministry of Long-Term Care recently amended regulations to “expedite” the return of residents who leave for an extended period during the pandemic, a change pushed by seniors’ advocates like Dr. Samir Sinha, director of geriatrics at Sinai Health and the University Health Network.

“It’s enabling choice,” Sinha said. “These are difficult times, and families have a lot of anxiety. Why deny families the ability to withdraw their loved one if they feel it is a safer choice?”

Lisa Levin, CEO of Advantage Ontario, said the change is helpful but cautioned that residents who are out of the home more than 21 days won’t be able to immediately return if the beds have been taken by a new resident. Instead, their names will go to the top of the long-term care wait list.

“You might have to wait,” Levin said. “There could be a lot of other people at the top of that list.”

In her email, Graham-Nutter said residents can leave for up to 21 days if they continue to pay for their bed but asked families to consider whether they can “realistically meet the needs of your loved one at home.

“Having your loved one at home means providing 24-7 care, toileting, transferring, providing the medications, etc. This is a very difficult decision to make, we know that,” she wrote.

Colan Inglis said his 94-year-old mother, Helen, has lived in Wellesley Central Place for five years. Inglis said he cannot care for her at home because she has dementia and needs two workers to transfer her from bed to wheelchair.

“I would hesitate to bring her up here,” the retired refrigeration mechanic said of his home in Collingwood. “I always thought we would make the best of it where she is.”

His mom had a privately paid personal support worker to help with meals and other needs, but after the recent COVID-19 test results came back, Inglis said the PSW refused to return. Now he worries about his mom’s care.

On Sunday, Graham-Nutter sent a letter to families detailing the latest COVID-19 test results at Wellesley Central Place and the infection control procedures in the home. Staff working among residents with COVID-19 are wearing full personal protection equipment, she said.

She described the struggle of staffing during a pandemic.

“We had hoped to offer tray service (in bedrooms) but, to be honest, we reached out to our staff and the agencies with whom we work, but no one will pick up the shifts.” Instead, the home will continue to keep residents at a safe distance from each other during meals in the dining room, her letter said.

“All homes who experience COVID-19 suffer from a staff shortage. We are working to manage this as best as we can.”

Levin, of Advantage Ontario, said long-term care homes are struggling to find staff willing to work during COVID-19 outbreaks. In an industry that has long dealt with staffing shortages, even fewer workers are available now.

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Some workers, Levin said, have been sent home to spend 14 days in isolation after exposure to the coronavirus, while others are struggling with child care or had been working in multiple homes and had to choose just one location to avoid spreading the virus.

“On top of that, when there is an outbreak some staff don’t show up for work,” she said.

Doris Grinspun, president and CEO of the Registered Nurses’ Association of Ontario, said she is hearing stories from nurses and personal support workers across the province who are afraid to work because of a shortage of personal protection equipment (PPE). In addition to gloves and other PPE, all workers should be given two surgical masks a day, Grinspun said.

“I would be afraid too,” she said. “Most of these workers have a family, or a husband with cancer or a mother who needs their help.”