Long-term care homes in Quebec were the “blind spot” in preparation for the novel coronavirus pandemic and management of the first wave put pressure on ill-equipped CHSLDs to provide the same level of care as hospitals, the province’s ombudsman has found.
Marie Rinfret issued a progress report Thursday into the handling of the first wave of the health crisis in the province’s CHSLDs, which largely bore the brunt of COVID-19 in the spring.
She is calling for several changes in those facilities, including fixing staff shortages and changing how they are managed, in order to provide better care and services to residents and their families.
In a statement, the ombudsman’s office points out that several witnesses to the pandemic “described a disorganized, exhausted system despite the immense dedication of healthcare workers” in long-term care homes.
The testimonies and complaints have helped the office find several lessons that can be learned from the management of the first wave, according to Rinfret.
The report is based on the testimonies of more than 1,350 people including residents, family members and staff in the long-term care homes. A majority of the deaths in the province during the first wave were among CHSLD residents, 3,890 in all.
“We can immediately pin down priorities for action in order to ensure that the care and services that CHSLD residents receive is a worthy response to their needs,” she said in a statement.
The progress report found that authorities in Quebec, who were facing an unknown virus, “sharply underestimated COVID-19’s virulence, its ability to spread and cause death, its impact on elderly people and staff, and the challenges of testing.”
The findings also show that the movement of staff contributed to the spread of the virus in long-term care homes and personal protective equipment was “insufficient and unequally distributed.”
Those facilities were also expected to provide the same level of care to residents as hospitals during the crisis, according to Rinfret, but they were not equipped to meet those expectations.
The report also outlines shortcomings in how the pandemic was handled from a managerial perspective. Rinfret says decisional power over long-term care homes “was far from the outbreaks” and relief teams’ arrival in hard-hit CHSLDs to provide much-needed assistance were late.
During the first wave of the pandemic, residents’ mental and physical well-being faced a “heavy toll” when informal caregivers were prohibited from visiting long-term care homes.
Rinfret also found that basic care and services — such as assistance with eating and mobility, hydration and hygiene — were also cancelled or postponed.
As a result, the ombudsman’s office has issued several recommendations to ensure long-term care homes “measure up to their mission to provide continuous care that respects the rights and dignity of the residents.”
This includes focusing efforts on providing care based on residents’ needs and acknowledging the role of informal caregivers.
Rinfret also calls for nursing and orderly staffing in CHSLDs to be bolstered to provide a stable work environment and for the government to continue its new practice of ensuring there is a local manager assigned to each facility “who can exercise strong local leadership.”
“A lesson from the first wave is that the understaffing in CHSLDs is a prime factor in the failings observed in the care and service offering to residents,” the report states.
The Quebec government must also create and implement a “rigorous culture of infection prevention and control” within long-term care homes. Rinfret stresses the protocol must be “known by all.”
She also called for better communication at the local, regional and provincewide levels in the management of CHSLDs “in order to convey clear information and directives and facilitate sharing of best practices.”
In a statement, Health Minister Christian Dubé and Marguerite Blais, the minister responsible for seniors, said the problems raised in the ombudsman report are already being addressed.
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“In light of the conclusions offered by this progress report, I conclude that we’re already on the right path, having already implemented all the proposed actions in our plan to tackle the second wave,” Dubé said.
The government’s plan for the second wave included naming a manager for each establishment, ensuring staff is trained in infection control and hiring 10,000 patient attendants at a higher salary than had previously been offered.
The omdbudsman’s report rang true for those who witnessed the impact of the beginning of the pandemic’s effects in long-term care homes.
Annette Demeny, whose friend was diagnosed with COVID-19 at Vigi Mont-Royal during the first wave, said though she beat the virus — the experience has forever changed her.
“I think she was deprived of basic care and I think that she was very traumatized,” Demeny said. “And the fact that family and friends couldn’t go in to check on them for safety reasons — I mean, I don’t think they were safe.”
Rinfret’s investigation was announced at the end of May, and covers the period from March until the first wave ended in June. A final report is expected to be released in the fall of 2021.
— With files from Global News’ Felicia Parrillo and The Canadian Press