Quebec allowing up to 4 residents per room in long-term care, despite ongoing pandemic

Despite the ongoing COVID-19 pandemic, long-term care homes in Quebec are once again allowed to place three or four residents in a single room, Radio-Canada has learned.

The new directive was sent to the establishments at the end of July.

The measure goes against a recommendation by Quebec coroner Géhane Kamel, who presented a damning report into long-term care deaths during the first wave of the pandemic.

The Quebec government said the move is exceptional and temporary, aiming to address a backlog as thousands wait to enter in the province's public long-term care homes, also known as CHSLDs.

According to the Health Ministry, about 4,300 people are currently waiting for a spot in a CHSLD. Many of them are currently housed in beds in Quebec hospitals.

Marjorie Larouche, a spokesperson for the ministry, said that putting that many residents in a single room is only allowed when they have "living conditions for residents that respect standards, and guidelines," such as having a washroom.

She also said the "highest standards in terms of infection prevention and control" have to be in place.

Medical experts disappointed, stunned

Dr. Sophie Zhang, who co-chairs a community of practice for physicians in CHSLDs, said she's concerned by the government's decision.

"The scientific literature is quite clear, that the number of beds and the number of users per room is associated with an increase in COVID infections," she said. 

She said the government had all but eliminated rooms with more than two residents with a directive back in 2017, before the pandemic. Since then, Zhang said "no one" in the long-term care field — be it doctors, infectious control specialists, or managers — wanted the practice to return.

"Several patients in the same room creates complications in terms of providing care," she said, also noting the lack of privacy for the residents.

Paul Brunet, head of the Quebec Council for the Protection of Patients, said he was stunned to learn the news, especially since the province is anticipating another wave of COVID-19 in the fall.

"We may look good by reducing the number of people waiting on stretchers in hospitals, but we will increase the risk of infection — and not just COVID," he said.

Brunet lamented that the government hadn't learned its lessons from the pandemic.

"It's sad, but it's also worrying," he said. "One of the causes [of all the long-term care deaths] was the fact that a lot of people lived together, a lot of people walked around, the staff infected the residents."

Dr. Zhang said she acknowledges the lack of space in CHSLDs, but said the government needs to be planning ahead on the issue.

"We should have short, medium and long-term plans to solve this problem … that does not put the health and well-being of CHSLD residents at risk," she said.

Single-occupancy rooms

In coroner Géhane Kamel's scathing report, she recommended the government push to offer single-occupancy long-term care rooms in the future.

Single rooms are a core principle of the government's plans for future long-term care homes, first unveiled in 2019. A total of 46 of the new facilities are planned, with 43 under construction.

Marguerite Blais, Quebec's minister responsible for seniors, said that 2,600 spaces in those facilities will open up this fall, out of a total of 3,480.

In the meantime, the Health Ministry said it does not have an end date for the directive authorizing up to four residents per room.

"The measure is in effect until further notice," a spokesperson confirmed.

Over 16,000 people in Quebec have died due to complications related to COVID-19 since the pandemic began.