Quebec's long-term care homes are about to be put to another test, and the cracks are already showing
Evidence is beginning to mount that CHSLDs and seniors' residences could see a repeat of the spring
Four days ago the CHSLD in Maria, on the Gaspé peninsula, declared a COVID-19 outbreak. On Thursday, regional health authorities issued a cry for help, imploring locals to apply for work cleaning, cooking and caring for patients at the centre.
The appeal, designed to ease the pressure on exhausted staff, came the same day the provincial ombudsman issued a report excoriating the Quebec government for ignoring repeated warnings about the fraying elder care system.
And it landed only hours after the release of a pair of investigations into mass infections at two other CHSLDs that found alarming administrative and other shortcomings.
The Herron and Sainte-Dorothée outbreaks in March and April, which claimed more than a hundred lives, heralded a cascading and devastating series of events in the CHSLD system.
Public health officials are quick to point out the ways in which the incipient second COVID wave is different from last spring's, but there is mounting evidence across the province that what took place earlier this year in extended care and seniors' residences is starting to happen again.
Seniors' facilities in Thetford Mines, Quebec City, Lambton and Saint-Georges-de-Beauce have all reported significant flare-ups in the past 10 days.
Four private seniors' residences — two in Quebec City and two in neighbouring Chaudière-Appalaches — are considered by the province to be at the 'critical' stage, meaning more than 25 per cent of their residents have COVID-19. Another 35 are 'under surveillance' because they have reported multiple active cases.
A total of 20 CHSLDs are also being closely monitored; the largest outbreaks are in Lambton, northeast of Sherbrooke, and, it seems, in Maria, where 15 new cases popped up in the space of a week.
'It is time for action. Now.'
In her annual report, Quebec Ombudsman Marie Rinfret said the failings of the province's network of long-term care homes should have been corrected long ago.
The document covered the period ending March 2020, just as the virus began to make its way into CHSLDs and other seniors' residences, but she included a special note on the crisis.
She pointed out that Quebec's ombudsman has, for decades, called out "the indignities suffered by residents with reduced autonomy."
The pandemic, she said, laid bare longstanding problems of "understaffing, employee burnout, lack of qualified workers and dilapidated premises."
"Unfortunately, solutions that would have provided the elderly with a safe, compassionate and responsive living environment were postponed," Rinfret said. "To sum up, after we have all done our homework, at a certain point we have to admit that there is nothing more to say, that no more information is needed, and that it is time for action. Now."
Health Minister Christian Dubé said he wanted to analyze the Rinfret report in greater depth before offering a detailed reaction, but admitted in a Quebec City news conference "she is right on many fronts."
He added that some of the holes identified in the report have already been plugged, including more robust reporting mechanisms. He now speaks to the CEOs of CHSLDs every week.
"Our aim is for what the ombudsman highlighted not to happen (again)," the minister said.
The government has also recruited nearly 10,000 new patient attendants, about 7,000 of whom are already working in the system. The rest are still in training courses.
But there are still gaps — potentially big ones.
One of the problems this past spring involved workers moving from so-called 'hot' zones to 'cold' zones, and medical personnel moving from one assignment to another within an institution, or, in some cases, at multiple locations.
"As a government, we must live with the current shortage of workers," Dubé said. "I would love for it to disappear all of a sudden. We succeeded in doing so with patient attendants, but we are a long way from that with nurses and nurses aides."
The fact is, there simply aren't enough nurses to go around. It's not realistic to expect someone working on a COVID ward in a given facility to work in only one place.
Dubé had a message for CHSLDs planning on moving personnel around to make up for staff shortages.
"The day you authorize personnel movement … the director-general will have to approve it personally and in writing," Dubé said. And if a CHSLD moves someone from a hot zone to another area, "the CEO of the centre will have to authorize it."
Dubé said the lack of qualified nursing staff explains why he's been so insistent on the public buying into distancing and isolation measures.
In fact, the government strategy essentially depends on it.
As Dr. Horacio Arruda, Quebec's public health director, put it: "If community spread isn't controlled, particularly cases involving young people ... elderly people will go out into the community and become infected. And then you have the elements of a problem."
Dubé was frank about what lies ahead.
"There will be outbreaks. We cannot prevent 100 per cent of them," the health minister said. "But I want to reassure (the population) that we want to be aware of that, and if they hear something that we didn't hear, I want the people to call us, because I want to make sure that we will do that job."
Québec Solidaire: nationalize private CHSLDs
On Wednesday, the results of investigations into two of the province's hardest-hit homes, CHSLD Herron and CHSLD Sainte-Dorothée, were made public.
At Herron, at least 38 residents died and at Sainte-Dorothée, 100.
The reports highlighted problems seen across the network, including a lack of protective equipment, staffing shortages, the movement of staff and a lack of managerial oversight made worse by the reforms of the previous Liberal government.
The report into CHSLD Herron highlighted, in particular, the lack of oversight over privately run CHSLDs. At Herron, the local regional authority did not take over operations until April 7, despite a multitude of warning signs.
By then, the virus had spread through the home and the few staff still working at the residence were unable to provide proper care.
The opposition Québec Solidaire said the findings were further evidence that the entire network of CHSLDs should be made public.
The province counts some 400 CHSLDs and another 2,000 privately-owned seniors' residences.
"The bureaucratic maze linked to the private status of CHSLD Herron caused delays in the government's intervention," Gabriel Nadeau-Dubois, the party's co-spokesperson. "While the government was wondering how to intervene in the private sector, people died. The state can no longer abdicate its responsibilities to seniors in Quebec."