Of the 5,634 Covid deaths reported up to June 30 last year, 69 per cent were in CHSLDs
In a special report tabled last week in the National Assembly on how the COVID-19 crisis was managed in CHSLDs during the first wave of the pandemic, Quebec Ombudswoman Marie Rinfret makes 27 recommendations, while allowing the facts to suggest negligence on the part of the CAQ government.
They ‘were the blind spot’
As they braced for COVID-19, Rinfret’s report states, government authorities were quick to make hospitals the focal point. Then, in order to free up hospital beds, many patients were transferred to CHSLDs. Of the 5,634 COVID-19 deaths reported up to June 30 last year, 3,894 (69 per cent) were in CHSLDs.
“CHSLDs were the blind spot in bracing for COVID-19,” said Rinfret. “The truth is that, above and beyond the CHSLDs, it was the residents who were cast aside when the attack against the virus was being mounted.”
CHSLDs ‘were doubly hit’
A progress report released by Rinfret’s office in December 2020 highlighted firsthand witness statements. The new report includes an analysis of accounts by experts and government authorities in key areas, including health institution management, geriatrics, crisis management, epidemiology, and infection control and prevention.
“Our investigation made it possible to dig deep and understand why CHSLDs were doubly hit – under siege during the pandemic, and unable to deal with the outbreaks and deaths,” Rinfret said in a statement. “Our report brings into sharp relief the frailty of services, structures and communication channels.”
Were already short-staffed
The Ombudswoman’s office said the CHSLDs “already short-staffed, did not have the resources needed to accommodate the sudden influx of people who were already fragile. As a result, decisions were made by authorities who did not have the wherewithal to adequately gauge the ability of CHSLDs to fulfil this unusual mission.”
According to Rinfret, other factors contributed to a decline in service and disorganization, including the authorities’ underestimating CHSLD residents’ vulnerability to the virus. The effects of staff absenteeism due to COVID-19 hadn’t been foreseen either. She said the complex nature of the jobs of the healthcare teams should have quickly sounded the alarm about why things went as they did and required an urgent solution.
Knowledge was lacking
Rinfret said that when planning for the pandemic, the Quebec Ministry of Health and Social Services hadn’t considered how serious it was that CHSLD staff knew very little about best practices in infection prevention and control during major outbreaks.
Given the circumstances, she added, the virus spread widely, exacerbated by a lack of personal protective equipment, as well as outdated facilities. Moreover, Rinfret continued, lack of managers in each CHSLD often slowed the response to a succession of ever-changing instructions from health authorities.
The recommendations
Given the extent of the crisis during the first wave and the dramatic repercussions on the province, the Ombudswoman’s office recommended that the Ministry of Health and Social Services put in place various mechanisms. Here are the principal ones:
- A risk assessment and management policy concerning CHSLDs;
- A detailed plan for strengthening the CHSLDs’ ability to apply infection prevention and control measures;
- A personal protective equipment supply strategy;
- A provincial plan for deploying emergency personnel within the health and social services network to make the most of back-up resources;
- Protocols with professional orders, federations and associations, unions, and educational institutions for deploying extra staff in exceptional circumstances;
- A Quebec strategy to combat staff shortages and to promote health and social services trades and professions;
- An action plan to recognize the complexity of care and service provision in CHSLDs.
Memorials should be held
Rinfret said all the reforms should include the introduction of reliable and efficient information systems. The Ombudswoman’s office also recommended that the ministry organize annual services of commemoration for the COVID-19 victims in CHSLDs and for the people who worked with them directly or indirectly.
‘CHSLDs were the blind spot in bracing for COVID-19,’ said Rinfret
“It is important to remember what these people went through so that their experiences are the catalyst for sustainable action and change,” said the ombudswoman’s office. Rinfet also asked the minister to provide a progress report about the implementation of the recommendations by March 1 next year and that a follow-up schedule be agreed upon.
Premier Legault’s reaction
In Quebec City, Premier François Legault reacted to Rinfret’s 66-page report, saying it was relatively easy for an onlooker to second-guess the situation, but that the provincial government did its best to manage given the extreme circumstances.
“With the information I had, I did the best I was able to do at the time,” he told journalists last week. “It’s tough to take decisions when you don’t have all the information.
“And the information we had was that we would have problems in our hospital ERs and not in our long-term care facilities. So, it’s easy Monday morning to say you should have done things differently. But I think with the information we had we did the best we were able to do.”
‘No real action taken’
Despite the government’s claim it warned CHSLDs to prepare for the pandemic as early as January 2020, the report states that no real action was taken until April, when devastating Covid outbreaks in Montreal and at Laval’s CHSLD Sainte-Dorothée led to hundreds of Covid deaths.
Rinfret’s report described a disconnect between Quebec’s Ministry of Health and Social Services and the regional health authorities overseeing the CHSLDs. Staff absenteeism worsened the problems.
The report states that between March 1 and June 14 last year, 13,581 health-care workers contracted COVID-19, representing 25 per cent of all reported cases in the first wave. While eleven health-care workers died, many others were left psychologically and emotionally scarred by the death and suffering they witnessed first-hand.
