MONTREAL — Long-term care homes were almost totally forgotten in Quebec's early COVID-19 planning, the province's ombudswoman said Tuesday in a report that called for widespread changes to "humanize" the senior care model in the province.
Marie Rinfret's report tabled Tuesday said government officials took a "hospital-centric" approach to preparing for the pandemic based on images of overwhelmed hospitals in Italy and elsewhere in Europe. The strategy neglected the danger posed to the vulnerable residents of long-term care homes, known in Quebec as CHSLDs, the report concluded.
"While Quebec’s eyes were turned toward Italy, no risk analysis tailored to Quebec’s residential-resource model and its specific features was carried out in crafting the strategy in response to the pandemic," she wrote. "This is how CHSLDs slipped through the cracks of any scenario."
This failure to prepare had devastating consequences on the care homes' ability to handle the first wave, the report found. In order to free up beds, patients were transferred from hospitals to care homes that had neither the staff, equipment nor the infection-control expertise to manage the health crisis that would engulf them.
Rinfret's report contradicts testimony given by former health minister Danielle McCann, who told a coroner's inquest last week that the heads of the regional health authorities had been told in January to update their contingency plans for long-term care homes.
In a news conference Tuesday afternoon, Rinfret said that while officials had expressed concern about the impact of COVID-19 on care homes, no "concrete and specific" action was taken before mid-March.
"So yes, there was a worry, but this worry didn't translate in reality into knowing what was the situation in the CHSLDs, what was the risk associated with transferring people from alternative levels of care in hospitals to these living environments," she said. The transfers created overcapacity in residences that were already short-staffed, she said, adding that officials also failed to account for the staff absences the virus would cause.
Rinfret told reporters she did not believe the problem stemmed from negligence, but rather from a fundamental misperception of long-term care homes as mere living environments, rather than places that need to provide complex care approaching that of hospitals.
Almost 4,000 people died in the homes between February and June 2020, accounting for nearly 70 per cent of the deaths reported in Quebec during the first wave.
An interim report published in December 2020 found the government failed in its duty to ensure the safety and dignity of residents, some of whom died alone and without palliative care.
The report published Tuesday called for a vast review of the way long-term care is delivered in the province in order to "humanize" conditions for residents and staff alike.
"For the women and men who attend to elderly people’s health and well-being to be better recognized and valued, CHSLD working environments must be held in greater esteem," the report read. "Caregivers were heroes at the height of an unprecedented crisis. For them, and for the residents and their families, the status quo is unthinkable."
The report paints a picture of a health system that was thrown into chaos, resulting in improvised decisions, confusion around staffing and a failure to properly apply directives.
The government's information systems were outdated, which made it hard to organize staff and transmit information in real time, it found. Understaffed homes struggled to separate infected and non-infected residents, and many workers were not properly trained in infection control and use of personal protective equipment.
And, unlike British Columbia, the Quebec government was unable to stop the movement of workers between facilities, despite this being acknowledged early as a risk factor for COVID-19 spread. Instead, Quebec focused on the risk posed by visits from caregivers, who were banned from the facilities to the detriment of residents' quality of life.
Quebec Premier François Legault said Tuesday that the government was lacking information in the pandemic's early days. "It's tough to make decisions when you don’t have all the information, and the information I had at the time was that we would have problems in our ERs, in our hospitals, not in our long-term care facilities,” he told reporters in Quebec City. “At the beginning, we didn’t know that we would (be missing) 10,000 employees in our long-term care facilities.”
Rinfret's 27 recommendations touch on strengthening nearly every aspect of the long-term care system. They include adopting a risk assessment and management policy in long-term care homes and creating a detailed plan for infection prevention and control. Other recommendations include a strategy to improve communication between departments, a plan to deploy emergency workers when needed, and a strategy to combat labour shortages.
Finally, Rinfret recommended the government organize annual acts of commemoration, which will serve as a reminder of the losses sustained and "highlight the generous contribution of those who struggled to keep care and services afloat during this period of turmoil."
This report by The Canadian Press was first published Nov. 23, 2021.
Morgan Lowrie, The Canadian Press