Higgs government approved drastic cuts at special care homes that continued during pandemic
Former special care home employees say crisis at Manoir de la Vallée started long before COVID-19 outbreak
Malnourished, dehydrated residents in need of bathing, living in filthy conditions.
That is what volunteer health-care workers found when the first COVID-19 outbreak in New Brunswick happened at a special care home in Atholville in June.
CBC News has learned the crisis at Manoir de la Vallée started more than a year earlier, when the Blaine Higgs government approved a pilot project at the special care home.
Former employees say that five special care homes owned by the Lokia Group, including Manoir de la Vallée, quietly struck a deal that exempted them from following the staff ratios set out in provincial regulations.
"We were told by the owners and high-up management that this program is basically a program to be more efficient for the company," said one of the former workers.
The other special care homes that were part of the pilot were Manoir Brise de l'Oasis and Manoir Oasis de la Baie in Bathurst, Manoir Sugarloaf in Campbellton and Manoir Sunrise in Dalhousie. The homes range in size from 30 to 63 beds.
CBC has agreed not to name the two former workers who spoke out about the pilot program because they fear repercussions. They will be known here as Matthew and Susan.
When this program hit, it was like throwing the staff in the middle of a forest fire with a bucket of water. It's just impossible to do the amount of work that needs to be done in a 24-hour period with the amount of staff that was there.- Former Lokia employee
The longtime employees explained that the special care homes in northern New Brunswick were given free rein to cut staff on the condition that management could demonstrate that adequate care was being provided and the facilities were maintained.
They say as soon as the pilot program was introduced in the spring of 2019, many cleaners and caregivers were let go or had their hours cut dramatically.
Susan said at the home where she worked, there had been two 12-hour shifts dedicated to cleaning, but both were cut back to eight hours, and caregivers like her were expected to pick up the slack.
"When this program hit, it was like throwing the staff in the middle of a forest fire with a bucket of water," Matthew said. "It's just impossible to do the amount of work that needs to be done in a 24-hour period with the amount of staff that was there."
Ratio slashed to 1 caregiver to 18 residents
To prove to government officials that residents were still being well cared for under the pilot program, digital work plans were introduced that tracked everything from dressing residents, to wiping down tables after meals, to mopping rooms.
Staff were given tablets at the beginning of each shift with all of their tasks for the day, and how much time they had to complete each.
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For instance, Matthew said, workers were allocated 15 minutes to bathe a resident, and five minutes to clean a room.
"If I have to give a bath to somebody … from the room, to the bathtub, get them in the bath, wash them, get them dried, get them dressed, bring them back to the room — you would have a 15-minute window," he said.
When caregivers explained to management that it wasn't possible to complete a bath in 15 minutes, they were ignored, Matthew said.
"They would take all these numbers in a 24-hour period, and they would tally them up and they would say, 'OK, we tallied it up. There's 24 hours worth of work that is given out to care for the residents, so if you're doing a 12-hour [shift], that's two staff."
On paper, the digital reports showed that there were enough staff to provide the required minutes of care, but the workers say the timelines were impossible to meet, so they had to cut corners.
The Department of Social Development sets out strict staff ratios for adult residential facilities. In a special care home with residents who require level 1 and 2 care, that ratio is three staff for every 18 residents during the day.
Susan said that under the pilot program, she would often care for 18 residents on her own.
"It's hard to do alone," she said.
"You have to do all the laundry, you have to pass all the snacks, you have to pass their meals and you have to pass the pills and you have to bathe them … if more than one person wanted something at the same time you're like, 'Well, I can't divide myself in three.'"
In memory care units, which are dedicated to residents with Alzheimer's and dementia, the ratio is six caregivers for an 18-bed unit, but workers told CBC the staff requirement was cut to three during the pilot project.
Susan eventually left her Lokia job because of "the lack of hours" given to care. By the end of her time there, residents were only being bathed once per week, she said.
'I gave more attention … to my dog'
Matthew and Susan said the worst part of the pilot program was not having time to spend with the residents, many of whom were lonely.
"They need someone to listen to them … just go, sit down, have a little talk. That will make their day and just to give them a hug," said Susan.
Matthew watched staff "burn out" as the number of caregivers and cleaners declined. He said those who stayed often ended their shifts in tears because they were unable to provide good care to the lonely, vulnerable residents they had formed a bond with.
"Sometimes when they would try to talk to us, we would have to cut them off and say, 'I'm sorry, I don't have time, I have to go to the next person," he said.
"I gave more attention and more time to my dog when I got home than I could to the residents because of the timeline that we were squeezed into."
Cleaners cut, homes 'filthy'
Matthew and Susan watched the cleanliness of the homes where they worked deteriorate during the pilot program.
Matthew remembers filling in on housekeeping, looking down at the digital care plan and realizing he had the impossible job of dusting, mopping and scrubbing each room in five minutes.
"It broke our heart but to be able to do it and keep our jobs … and not get repercussions for the day, a lot of the jobs were not done well," he said.
"You would do it to say you did it, but you would do it in a way that it's plausible to do in five minutes. So the quality of work went down dramatically, drastically, once the program came into play."
He explained that cleaners only had enough time to do one section of the home each shift, and by the time they returned to the first section, a few days later, it was filthy.
Susan said there were many complaints, with some family members coming in on weekends to clean the rooms.
"They would come in and clean their mother's or father's room. They would wash the floors, they would wash the toilet, and that I find was not right. The residents pay enough to have that service. It shouldn't be a family member that does that."
The descriptions from health-care workers who responded during the COVID-19 outbreak at Manoir de la Vallée in June are very similar to what Matthew and Susan told CBC.
In a report obtained by CBC News, one worker said, "Sinks and toilets were dirty. One room had dried sputum and secretions on the wall." That worker went on to describe trying to give a resident a drink from their water bottle and discovering the top was mildewed.
"Medications were found under the beds along with old food and thick layers of dust and dirt," the report said.
Jan Seely, president of the New Brunswick Special Care Home Association, said it is common for homes to request what are known as "variances" from the Department of Social Development.
Province called for ideas
She said they are usually temporary exemptions that allow special care homes to have one fewer staff member in the overnight hours, but Seely was not aware of the far-reaching pilot program at Lokia's five special care homes.
"A couple of years ago, Social Development put out a call for homes to provide proposals with suggestions of how they would change their hours of care for their staff-to-resident ratio," she said.
Seely understood that the idea was to provide more flexibility to homes that might want to have more staff in the mornings or evenings, not to reduce care across the board.
CBC News asked Lokia president and CEO Guy Tremblay about the pilot program, and why it was necessary, but in an email the company spokesperson said, "We have received your inquiry but will not make any comment."
Social Development Minister Bruce Fitch confirmed the pilot program was granted to the five Lokia homes, but said it has been cancelled "due to various reasons," including COVID.
Fitch couldn't say when it was cancelled, but it appears it was still in place when the COVID-19 outbreak happened at Manoir de la Vallée in late May and June.
Health care workers who volunteered to help at that time told CBC News managers informed them that a pilot project was underway at the home and they were trying to get by with fewer staff.
Fitch said the idea behind the pilot was to see if there is a better way to deliver care to residents in special care homes.
"The point of it … was to see that if there's a greater demand for staff at a certain point in time in the day," Fitch explained.
"The idea was to look at that, to say, 'Well, if we need to have more concentration of employees or care at one particular time of the day and maybe less when everyone's asleep or in the afternoon when there's entertainment going on or something,'"
Fitch said the pandemic made it difficult to analyze whether the pilot program was working, and whether the needs of residents were being met.
He said outside annual inspections, there are spot inspections by officials with the Department of Social Development to ensure the homes are safe and any type of variance can be cancelled at any time.
"If the department doesn't think the compliance is there, then they can review that and pull back on it."
Improved inspections needed
Matthew believes Lokia should have realized the staffing levels under the pilot program were inadequate for the care the residents needed, but he reserves his most severe criticism for government.
"I blame the government most because without their licences, these places don't exist. They don't run."
He said government officials never visited the homes where he worked, and asked to see the care plans or determine whether the plans were "doable."
"Because if they would have did that, anybody with half of a brain would have been able to see that, no it's not possible. You cannot wash somebody in 15 minutes, you cannot clean a room in five minutes."
'You feel like you're abandoning them'
Both Matthew and Susan eventually left their jobs with Lokia.
Susan continues to work in the field and said there are many special care homes in the province that treat their residents and their staff well.
If we don't speak up for them, no one is going to speak up for them. That's somebody's mother, father, brother or sister.- Former Lokia employee
In some ways, she said, it was difficult to move on to another job and say good-bye to the residents she came to know so well.
"You feel like you're abandoning them," she said. "It's hard to leave them especially when you know it's not going to get better. You kind of feel like you're giving up on them."
As for the government officials who approved the pilot project that allowed the special care homes to cut staff, Susan has a simple message.
"I would tell them to come and try to work a day on the floor … and see what it is that we are really doing — that it's not easy work. It is hard, it is demanding, but it is rewarding."
Matthew hopes people will contact their MLAs and remind them that it's important for elderly and vulnerable people to be cared for "the way that you would want to be taken care of."
"If we don't speak up for them, no one is going to speak up for them," he said. "That's somebody's mother, father, brother or sister."