Heatwaves Spark Cooling Pressures: Ontario

COBBLED COOLING

New LTC Mandate Stops Short of Central Air Conditioning

BY BARBARA CARSS

Heatwave conditions and rudimentary cooling fallbacks posed challenges this summer in some Ontario longterm care (LTC) homes that do not have central air conditioning. As reported to the REMI Network, staff in at least one such facility dumped the collected condensate from portable air conditioners down sinks or toilets in residents’ rooms — a practice deemed to present a low risk for the spread of Legionella bacteria, but, nevertheless, far from the preferred maintenance standard.

“A best practice would be properly draining that water somewhere, but that might not be considered practical if this is just an interim measure before a central air conditioning system is installed,” observes Brennan Ficko, a project manager and environmental and risk management professional with Pinchin Ltd., a consulting fi rm specializing in environmental services.

REGULATORY REQUIREMENTS

The regulation, which came into force in the spring of 2020, stipulates that longterm care homes must provide access to cooling from May 15 to September 15, and on any other day when Environment Canada forecasts the outdoor temperature will reach at least 26 degrees Celsius or when interior temperatures climb to that level. However, there is still no requirement for air conditioning in all residents’ rooms.

As mandated in the regulation, long-term care home license holders must prepare a written prevention and management plan for heat-related illnesses, which is to be evaluated annually and revised as necessary. Plans must identify and outline protocols for responding to heat-related risks, including staff responsibilities, monitoring and cooling equipment/ systems and communication strategies.

The new regulation continues to exempt operators from installing central air conditioning if they provide one dedicated area per every 40 residents where temperatures are kept at “a comfortable level for residents”. However, unlike the previous circa-2010 rules, it stipulates that these areas must be maintained with a mechanical air cooling system.

Operators are now additionally required to take temperature readings in various areas three times daily, including: at least two resident bedrooms in different areas of the building; a common area on every fl oor of the building; and every dedicated cooling area, where they exist. Temperatures are to be recorded every morning, afternoon and evening, and retained in a log for at least one year.

“The ministry requires homes without air conditioning in all resident rooms to submit their temperature log daily for any resident room that does not have air conditioning,” says Donette Stoll, a spokesperson with Ontario’s Ministry of Long-term Care. “To ensure all homes are following this regulation, the ministry has a robust temperature monitoring reporting process. Should residents and visitors to homes have concerns, including if the temperature at the home is uncomfortable, they can make complaints to the ministry for an inspection. The ministry follows up with homes regarding hot weather related complaints.”

PROBLEMATIC LOGISTICS

Commenting on a REMI Network news item from May 2021, which outlined details of the new regulation, one LTC employee chronicled the problematic logistics in her workplace.

“They have installed portable air conditioners at the end of each hall that we, the staff, empty three times per shift for each air conditioner unit,” she reported. “That means lugging at least 10 to 15 litres of water to the closest resident room and dumping this container of water into the toilet or sink, while spilling water on the fl oor, as it is very awkward to manage.”

Air quality specialists advise there is little risk of airborne infections spreading this way. Legionella bacteria, which causes a pneumonia-like illness considered most threatening to people with chronic health conditions and compromised immunity, typically fl ourishes in warm stagnant water, but infi ltrates the respiratory systems when it is inhaled from mist or vapour.

“When it comes to Legionella, the risk comes from aerosolization of the bacteria and breathing it into your lungs,” Ficko affi rms.

“There is little to no risk from Legionella associated with condensate water from a regularly emptied condensate drain pan of a properly maintained portable air conditioner,” Stoll concurs.

Nevertheless, health care and seniors’ advocates point to the current development of national long-term care standards as an important step to support rigorous monitoring and enforcement of mandated operational requirements. Dr. Samir Sinha, Director of Geriatrics for the Mount Sinai and University Health Network hospitals and Director of Health Policy Research with the National Institute on Ageing, chairs the Health Standards Organization (HSO) committee leading the work. "The COVID-19 pandemic has brought decades-old health, safety and accountability issues in Canada's longterm care system to public attention. Systemic reform is imperative in order to improve health outcomes and the quality of life for long-term care residents and their families, and the working conditions for LTC staff,” he asserts. “Standards can become the new basis of care and work standards, regulation and enforcement mechanisms, and even legislation.” ■