Full reports available in French at: https://www.msss.gouv.qc.ca/ministere/salle-de-presse/
“Were our elders forgotten? Did the authorities [in 2015, when the government reformed the healthcare system] lack foresight? We have to answer in the affirmative.” –Sylvain Gagnon, investigator
Other entries in this series have briefly mentioned that the COVID-19 pandemic has exposed longstanding problems in the long-term care system, both in Ontario and across Canada. These problems have drawn public attention due to the alarming number of COVID-19 deaths in long-term care homes, which account for a large majority of all COVID-19 deaths in Canada. Even the federal government has promised action, with commitments in the recent Speech from the Throne to introduce federal standards for long-term care, and Criminal Code amendments to address neglect of residents’ needs.
While the broad problems in the system are often easy to recognize, with understaffing and insufficient equipment being common themes, specifics are not always as easy to come by. Provincial investigations have, however, promised to shed light on what exactly has occurred so far, and to inform the governments on how to address the problems. In Ontario, the government has announced an independent commission to study the pandemic’s impacts in long-term care. In Quebec, the government commissioned investigations on the situations at individual homes, and has recently made some investigations reports public.
As reported by The Canadian Press, the investigation of Residence Herron in Dorval uncovered “organizational negligence,” with previous inspection reports often ignored. The home was chronically understaffed, and turnover was high. As the home continued to operate with very little protective equipment after its first identified case, staff began to stay home out of fear, which caused the residents’ needs to be further neglected. The investigator did not identify and ill intent in the home’s managers, but found that “they did not have full control over their facility and they lacked understanding of what was required to respond to residents’ needs”.
The investigator noted that, at one point, only three staff were available at Residence Herron to care for 133 residents, many of whose basic needs were clearly not met. The Montreal Gazette has reported that the investigator primarily blamed the home’s private owners for the situation, and that it appears likely that “the Montreal police are investigating allegations of criminal negligence causing death”. Reporting by The Canadian Press in April indicated that staff were pressured to continue working, even after they displayed COVID-19 symptoms. However, the investigator also raised questions about the actions of regional health authorities.
The investigation of the Ste-Dorothée home in Laval identified similar problems, as well as a worsening of the home’s understaffing due to staff needing to self-isolate, and asymptomatic staff spreading COVID-19 throughout the facility. Staff from an employment agency also refused to work at the home while it was a “hot zone”.
The Canadian Press noted that “[m]anagers at [St-Dorothée] criticized health authorities for not setting foot on the site, leading them to feel abandoned”. The Montreal Gazette noted that employees criticized the local health bureaucracy for being “too large, too distant from the reality on the ground where quick decisions were necessary,” and that the investigator found that the government had neglected long-term care homes while preparing hospitals for the pandemic.
The government of Quebec has announced reforms to address the problems raised in the reports. These reforms include, among others:
- A requirement that a manager be appointed at every home;
- Measures to ensure that more staff are available in the system;
- Increased training in infection prevention and control;
- Measures to more effectively disseminate ministerial directives;
- Improved technology for monitoring symptoms; and
- Legislation “to strengthen the system for examining complaints from the health and social services network, in particular for users who receive services from private institutions”.
A pattern in the investigation reports is that people in positions in authority knew already that many of the problems existed, and ignored the findings of previous investigations. This is consistent with recent findings by the Quebec Ombudsperson, who found that problems in the system have repeatedly been reported and not fixed. Blame for this situation appears to lie with both public officials and private long-term care home owners, and it is clear that both will to reform their practices before the problems can be addressed.
The stakes are high for long-term care residents, and there are many ways in which their needs can be left unmet. For example, adequate staffing is essential to their care, and inadequate staffing is clearly unacceptable, but it is also unacceptable that infected staff be made to work with vulnerable residents. In Ontario, Quebec, and elsewhere, large-scale reforms will be needed if the problems are to finally be resolved.