Why officials took over this Calgary seniors home with a COVID-19 outbreak (and 4 others with the same owner)

It's the note anyone with a relative in a seniors' facility dreads: "We wish to advise you that two residents of Millrise Care Centre have tested positive for COVID-19." 

Both of Michael Sondermann's parents live at Millrise, in Calgary's south end, which on Monday became one of only two seniors care facilities in the province to be taken over by Alberta health authorities for failing to provide the basic standards of care amid the coronavirus pandemic.

It's actually the fifth time that provincial health services have seized a seniors care home owned by the same parent company — Retirement Concepts, which was controversially bought by a Chinese company a few years ago and operates homes in B.C., Alberta and Quebec.

Sondermann says he had been wary about the home before the pandemic, but the details that have emerged since that outbreak notice have "distressed" him. 

It was mid-April. Sondermann's mother told him she hadn't been informed the outbreak was COVID or told that she needed to stay isolated in her room. 

He spoke with the manager for clarification, who he says informed him they "never considered" isolating the residents. The manager also said some residents were not told about the positive cases in an effort to avoid causing anxiety, Sondermann said. 

"This is all supposed to be planned. Surely they didn't just wake up to discover COVID there," Sondermann told CBC News.

His parents, both in their 90s, do not have the virus at this time and are in good health. 

What he heard prompted him to alert Alberta Health Services (AHS). 

It wasn't the only time in his parents' four-year residency there that Sondermann had concerns about how the home operated. He says he had noticed staff working unusually long hours, high employee turnover, poor food, insufficient communication from the management and at least one improper fire drill. 

As of Tuesday, four Millrise residents have died from COVID-19. Twenty others have tested positive, as have 13 staff.

An outbreak was declared by AHS on April 14; families were made aware in a company statement on April 16. The first death was revealed on April 28.

Experts say there were clues before the pandemic escalated that Millrise couldn't stay afloat without help if it were hit with an outbreak — and that Retirement Concepts' track record shows the need to overhaul the seniors care industry across the country.

"I think Alberta Health Services will have to have a real good look as to what we do going forward when it comes to ownership models of our seniors' facilities," said Sandra Azocar, executive director at Friends of Medicare. 

Staffing levels, quality of care issues and failed health inspections have all been recurring issues for Retirement Concepts.

AHS steps in

The week the outbreak there was confirmed, AHS sent a manager to oversee the response. Later, 20 AHS staff members were loaned to the facility. 

Chief Medical Officer of Health Dr. Deena Hinshaw said the health authority encountered "patient care issues" and "challenges" getting the home to follow outbreak guidelines.

Hinshaw warned if Millrise didn't increase the level of care, AHS would escalate its actions — and it did. AHS formally took over the home on Monday, retaining AgeCare Health Services to manage the facility. 

"The only conclusion that I can draw from it is that Millrise itself was unprepared for what happened and that they weren't able to manage on a day-to-day basis on their own. And that's really disturbing," Sondermann said.

Millrise has been inspected at least once annually, in keeping with Alberta's care home regulations. More than half of the inspections in the past three years found the facility in violation. 

Seniors are one of the most at-risk groups to die of COVID-19. Of Alberta's 106 deaths, 92 of them were people over the age of 70. There are 622 cases of the virus in continuing care homes.

The company provided a statement to CBC News but did not respond to multiple requests for answers to specific questions about operations in the facility. Representatives also declined to be interviewed.

After "a few very tough days" because of symptomatic staff, Millrise said it was working to get back to a higher level of staffing. 

"A return to a full complement of staff means we are able to accommodate an increased level of care, enhanced cleaning and sanitizing, more time to undertake important initiatives like bathing and showers, and ensuring we are in a better position to communicate with families of COVID-positive residents on a daily basis," said Belinda Ditangan, who works with the company that runs Retirement Concepts.

She acknowledged the "concern and anxiety" residents and families are experiencing at this time. The facility had also previously apologized on Facebook for a "lack of communication" with families. 

Track record of troubles in B.C.

This isn't the first time Retirement Concepts has faced outside action from a provincial health authority. In fact, Millrise is its fifth home to be seized by health services. Four of the company's facilities in British Columbia have been taken over in the past six months for failing to meet basic standards of care — a very rare move in the province. 

B.C. medical officers had attempted to have the company comply with corrections without success. 

"We have a serious process of when it's required to take a seniors home under administration. The law has been in place since 1990. It's only been used seven times in its whole history. And we've used it four times in six months — all of them facilities owned by Retirement Concepts," B.C. Health Minister Adrian Dix told CBC Radio in February.

It's only been used seven times in its whole history. And we've used it four times in six months — all of them facilities owned by Retirement Concepts.- Adrian Dix, B.C. health minister

Retirement Concepts used to be domestically owned. In 2017, the federal government ignored pushback and approved its sale to an insurance company, Anbang, based in Beijing. The founder of that enterprise was sentenced to 18 years in prison for fraud the following year. China took state custody of the company for two years, releasing it this February.

B.C. has had a difficult time getting accountability from the foreign organization. The province says it hasn't been in contact with Alberta about its concerns with Retirement Concepts.

That company operates 17 facilities in B.C., two in Alberta — Monterey Seniors Village and Millrise — and one in Quebec. 

Lawsuit gearing up

A class-action lawsuit is gearing up for residents and families against Retirement Concepts. The lawsuit is based in B.C. but has a national purview. 

"This is a chain of for-profit care homes that has failed to maintain minimum standards or any acceptable standard of care at virtually every level, across the board," said Patrick Dudding, co-counsel for this lawsuit at Acheson Sweeney Foley Sahota. 

Dudding and his colleague Rajinder Sahota say they have identified high turnover, difficulties hiring staff and low wages as systematic problems with this company. At least 50 complainants have joined the lawsuit, which is set to be certified in the summer.

"It comes as no surprise to hear that this is an issue that's affected Alberta as well. We've seen no evidence that there's any aspect to this organization that escapes the effects of these issues," Dudding said.

One of the B.C. government's biggest concerns with the facilities was staffing, something that has been identified by AHS as an issue at Millrise. 

Sondermann noted that as well. 

"We had been around long enough to notice that a massive number of staff had turned over," he said. 

In Alberta, assisted living and long-term care homes are a mix of public and private ownership.

A 2014 report by Alberta's auditor general remarked that improvements in that industry have concentrated on process and administration, and less on enhancing care. At the time, more than a third of long term care beds in the province were run for profit.

Another study from the Parkland Institute, a public policy research institute at the University of Alberta, concluded that for-profit senior care in Alberta was notably inferior to public care.

The province's long-term care accommodation standards were last updated in 2010.

In neighbouring B.C., a review stated that for-profit homes were more likely to have high turnover, less staff and fewer hours spent caring for residents. 

"I think this pandemic has served as a harrowing reminder of the failure of our seniors care system that we have in this province and across the country," Azocar said. 

'What a waste' if nothing learned, family member says

She added Millrise should serve as a wake-up call. 

The lawyers agreed underlying issues can evolve into critical failing points when you add extra stress, like a pandemic. 

"Then you don't have an industry that's able to absorb that situation and continue to provide a decent level of care," Sahota said.

"You have an industry that collapses because they weren't able to provide that minimal level of care to begin with." 

Both sets of experts say it's important people report any problems observed in these homes to AHS and the provincial government. 

Azocar adds there needs to be a reckoning after the pandemic. She says a regulated staff-to-patient ratio and more unannounced inspections would be good starting points — along with the government bringing repeat violators under public ownership.

"That's the conversation that Albertans will have to have with this government."

Sondermann doesn't know what his parents will do after the pandemic subsides. In their 90s, the stress of moving could be dangerous to their health, but he says something has to shift. 

"If this pandemic doesn't result in some learning and some desire to change the system, what a waste."