What happened at Markhaven ‘was going on in many, many places,’ expert says

Isolated in her room at the Markhaven Home for Seniors, Loulou Travlos stopped eating or drinking.

She was tested for COVID-19 and on April 4, the results came back positive.

Her daughter worried this could be the end, and when the nursing home phoned back a few days later, she knew what was coming.

“The nurse was crying and she said to me, ‘I’m sorry she has gone,’” Chloe Efthyvoulos said.

“That broke my heart because I always knew I would be with my mother at the end. I mean, that’s what we do,” she said. “Mom saw her brothers, her sisters and her mother go. She was there at the end for all of them. And I couldn’t be there for my mother.”

“You have no idea the guilt that I have for that.”

But that is one of the cruelest things about COVID-19, it keeps people apart.

Read Part 1 of this series. Read Part 2 of this series.

Efthyvoulos watched as her mother was taken out of Markhaven. She said the staff did their best, and the Ontario government just didn’t see it coming until it was too late.

Only three people were allowed to attend the church service, so Efthyvoulos went with her daughters. The rules were looser at the cemetery, so the grandchildren were allowed to be there.

“And that was it.”

Too many part-time staff, family says

Markhaven’s struggles with PPE got a boost on April 1 when a delivery of 10,000 masks, 10,000 gloves and 5,000 gowns arrived, courtesy of the province and region.

But the death announcements kept coming in grim succession.

On Twitter, Markham Mayor Frank Scarpetti reported Markhaven’s mounting toll. He did not provide names, but the obituaries did.

There was Helen Mary Doidge Hall, a teacher born in 1917 in Harwich County, Ont., who had married a soldier stationed in Europe with whom she had corresponded with during the Second World War.

Franco Pacitto had Parkinson’s disease and had spent just over two years at Markhaven when the outbreak hit. His family believes he got the virus from his Personal Support Worker, who also tested positive.

On April 4, Ken Hurst and Pat Cake lost their mother, but not to COVID-19. The 94-year-old had tested negative.

They said the home needed more full-time staff, as opposed to part-timers who came and went, and therefore did not have the same understanding of the needs of each resident.

“There were too many people in for two days, in for one day,” said Cake. The home “didn’t seem to have the same full-time staff that would really get to know people.”

When they got the call saying their mother wasn’t doing well, Cake was in quarantine, having just arrived home from Florida. Ken was allowed to see his mother through a window.

“It’s been hard for me to think about it,” she said. “Because I was in quarantine or isolation, I couldn’t go. So I just had to deal with it.”

They hope the province learns from the mistakes of the first-wave of COVID-19 and provides the funding necessary to hire more full-time support workers.

“The future needs to be more full-time, or all full-time, so that the caregivers get to know the residents better.”

Source of outbreak never determined

As the residents fell to COVID-19, their photos were displayed in the lobby at Markhaven, and later in the chapel, around a framed embroidery of the last supper.

Officially 17 died of COVID-19. Public health records list 26 deaths at the facility during the outbreak. Twenty of those residents had tested positive for the virus, but were not COVID-positive when they passed away.

Six more deliveries of gowns arrived at Markhaven in April and May, according to the Ministry of Long-Term Care.

And then the home turned a corner. Two weeks passed without any new cases, and on May 16 the outbreak was declared over.

York Public health investigated how COVID-19 entered the home.

Their records show that a private staffing agency hired by the home “is blaming themselves for bringing COVID-19 to the facility,” but said the outbreak was already underway when the agency was brought in.

A staff member had travelled to Florida, the records indicate. The union representing Markhaven workers said it understood the outbreak could be traced to a worker who had been out of the country.

Markhaven referred questions about the origin of the outbreak to York Health, but said it had not been informed of any findings.

“To the best of my knowledge, none of their leads resulted in a firm conclusion as to how the virus was introduced into the home,” said executive director Mike Bakewell.

York Health said the source of the outbreak was never determined.

“Our investigation suggests that COVID-19 was imported into this facility but like most outbreaks, the actual source of infection is very difficult to establish,” said Scott Cholewa, an Infectious Diseases manager.

‘Somebody needs to be going in and doing a forensic analysis’

One woman said that when she was looking for a care home for her mother in Markham, she visited Woodhaven, Union Villa and Markhaven.

She chose Markhaven.

When COVID-19 hit, all three homes had outbreaks, but neither Woodhaven nor Union Villa lost a single resident to the virus, while at Markhaven one out of every six residents died, including the woman’s mother.

“That, to me, says it all,” she said.

“So you’ve got double the residents, double staff and virtually no cases,” she said. “Why were they seemingly okay during this crisis?”

She believes the provincial government should be investigating why outbreaks in such close proximity had tragically different outcomes.

“They have to look at this,” said the woman who, like several others who spoke to Global News about their experiences at Markhaven, asked not to be identified, in her case because she works in health care.

“Somebody needs to be going in and doing a forensic analysis.”

Why COVID-19 ravaged some care homes and not others will likely be the subject of study for years to come. While Ontario long-term care homes had an infection rate of 7.6 per cent, in B.C. it was only 1.7 per cent, according to a recent study from the Canadian Medical Association Journal.

The study, released in September, said B.C. was better prepared and faster to respond.

Going into the pandemic, B.C. had: better coordination between long-term care homes, public health and hospitals and overall better funding. The study also found more hours of care per resident in B.C. homes, fewer shared rooms, more non-profit facilities; and more comprehensive inspections.

The Ontario commission looking at COVID-19 and long-term care said the hardest-hit homes had “insufficient leadership capacity,” staffing shortages and weak infection prevention and control.

Although the Long-Term Care COVID-19 Commission is not due to table its report until 2021, it released a list of interim recommendations, including more full-time positions at care homes.

It also recommended better collaboration between the most vulnerable care homes, public health units and local hospitals, and urged the province to “formalize these relationships proactively.”

Each care home should also have a dedicated infection protection and control leader “who can monitor, evaluate and ensure compliance with proper protocols; support and provide basic training for all staff, and access the local infection protection and control centre of expertise,” it said.

Residents who test positive for COVID-19, especially in older homes, should have the option to transfer to “alternate settings” to avoid further transmission of the virus and to help them recover, the commission said.

The Ontario government has announced the daily care provided by nurses and PSWs would increase to four hours per resident by 2024-2025, a change that advocates and unions have long called for.

Ontario Long-Term Care Minister Merrilee Fullerton declined to be interviewed for this story, as did York Region Public Health and the Markhaven Home for Seniors.

The ministry said the province gave Markhaven $415,000 for “prevention and containment efforts,” and it received another $74,000 in October “to support physical infrastructure upgrades that will improve infection prevention and control protocols and practices,” the ministry said.

A provincial inspection of the home resulted in a compliance order that was issued Oct. 20, but “no findings of non-compliance at the Markhaven home were identified related to outbreak management,” the ministry said in a statement.

The union representing Markhaven staff said it was dismayed by what it saw in the public health documents obtained by Global News, saying the home was too slow to respond.

“My experience with Markhaven is nothing was done correctly,” said Sharleen Stewart, the president of SEIU Healthcare.

A lawyer who specializes in long-term care said what happened at Markhaven was typical of the breakdown of the long-term care system.

Neither the home nor health officials were ready and it showed, Jane Meadus said. “It just seemed that nobody knew what they were really doing.”

Supplies of PPE should have been available, and homes should have known how to use them properly. Care homes should have known how to isolate residents to prevent the virus from spreading.

Staff should not have been working shifts at multiple care homes, and as they started to get sick and not show up for work, homes struggling with staffing shortages should have received the help they needed, she said.

“So they really had a lot of pressure on them, and public health kept wanting to have meetings that were taking very long periods of time, they were being very bureaucratic about everything,” she said.

When Markhaven’s management spoke to health officials about possibly shutting down and moving the residents out, Meadus said it was simply being responsible.

“If a home says, ‘I don’t have staff, I’m struggling. We have people who are here who are sick and we really need help,’ they shouldn’t have to wait for orders and things like that. We should be listening to them and getting the right help in. Because, again, as we saw in this case, delays can kill,” she said.

For all it went through, Markhaven was really no different from any other home, she said, calling it “just a very typical kind of case.”

“I think this was so indicative of exactly what was going on in many, many places.”

‘We were not prepared for something like this’

Markhaven’s management declined an interview but sent a statement to Global News.

“Although our Covid-19 outbreak was fraught with tragedy, we would have been proud to share details of the heroic efforts of our dedicated staff as we strictly followed the guidelines mandated by health authorities,” Bakewell said.

“Unfortunately, Markhaven is one of approximately 100 organizations named in a class-action lawsuit pertaining to the sector’s response to the first wave of Covid-19 outbreaks.”

“Although we are exceedingly confident Markhaven’s evidence-based response will hold up to scrutiny, we have been advised not to discuss the details of our outbreak publicly to respect the integrity of the legal process, and out of respect for our residents and their families.”

On Oct. 26, Bakewell and Markhaven’s director of care, Kevin McKay, spoke to residents’ families on a 2-1/2-hour Zoom call that dealt partly with their pandemic improvement plan.

They said a new floor cleaning machine had been purchased, and the home was trying out four South Korean-made air purifiers. The home had hired 17 staff and added a screener to the front desk, they said.

“We are adequately staffed for the circumstances we are in now. In March, we weren’t,” one of the managers told families, according to a recording of the event obtained by Global News.

“There was a scramble. I think there was a scramble with all long-term care homes, because we were not prepared for something like this.”

Read the entire series. Contact Stewart Bell and Andrew Russell.