How Quebec's nursing homes became ground zero for COVID-19

There was never any doubt seniors are especially vulnerable to COVID-19, and how that has played out so far within Quebec's elder-care infrastructure has been particularly troubling.

People over 70, and those with pre-existing health issues, are more likely to die from the novel coronavirus.

Elderly care homes across Canada have seen outbreaks.

But, experts say, the scale at which COVID-19 has spread through Quebec's long-term care homes — which house elderly people in need of assistance, as well as people with disabilities — could have been avoided, and point to problems that predate the crisis.   

"A lot of these things definitely could have been prevented," said Daphne Nahmiash, a retired gerontology professor at Université Laval.

Across the province, hundreds of patients at CHSLDs, as the homes are called, have tested positive. Cases that originated in the homes, which are primarily government-run, now account for about half of the total deaths in Quebec.

In the past week, the province has scrambled to address the shortfalls of the system, brought to light by nurses and doctors on the front lines who have been overwhelmed by the outbreak.

They complained of a lack of staff, inadequate personal protective equipment and delays in testing workers and residents.

The top priority, Legault says

As the acting president of Handicap-Vie-Dignité, an organization advocating for improved conditions in long-term care homes, Nahmiash has been calling for years for more resources and improved staff.

In a February 2020 report, her organization singled out one issue in particular: the practice of staff working at multiple residences, increasing the risk of spreading infection.

That practice allowed the virus to keep spreading even after families were barred from visiting CHSLDs on March 14, said Nahmiash.

This week, Premier François Legault's government put an end to it.

The province has put more money, staff and protective equipment in the homes.

It also says it plans to test both staff and residents across the province's 440 CHSLDs. In all, the long-term care homes house roughly 40,000 people.

As the extent of the problem in the homes has become clear, Legault has stressed in his daily briefings that protecting the province's seniors is the top priority.

"They built Quebec," he said Thursday. "We live in a fairer, richer, more beautiful society thanks to them and we have a duty to protect them."

A history of problems

But long-term care homes in Quebec have been riddled with problems for years.

A scathing 2018 report from Marie Rinfret, the province's ombudsman, said the services provided to seniors and people living with disabilities in long-term care homes were "deficient" and "flawed."

"At many institutions, staff can barely keep up," she said at the time. "The upshot is that services such as baths and dental care are put off. Needless to say, this causes significant harm to people who are highly vulnerable."

Legault's Coalition Avenir Québec took power on a promise to improve those homes, with money earmarked to address the long waiting lists and hire more staff.

They also promised, in the long run, to create smaller and "more humane" homes for seniors dubbed "Maisons des aînés."

Now, they are charged with trying to control an outbreak.

Paul Brunet, executive director of the Quebec Council for the Protection of Patients, is skeptical the resources are in place to prevent further spread.

"If there was a problem before, you understand that we're not going to get better during the crisis," said Brunet.

Last fall, the council got the green light from Quebec's Superior Court to pursue a class action lawsuit against the province and regional health authorities over poor living conditions at the homes.

Now, he said, "we're stuck with the problem that I think we could have helped diminish a lot."

Lessons learned

One of the hardest hit centres is in Laval, at the CHSLD de Sainte-Dorothée, where more than 100 residents and 50 staff have tested positive.

Nurses at the home complained they didn't have enough protective equipment, or support staff.

"I think there are some places where we were really ready, and right from the get go, and unfortunately there were some places where we weren't ready," said Jeff Begley, president of the federation of health and social services at the CSN union, which represents nurses at the home.

Begley said the province was faced with an enormous challenge in trying to prepare the whole health and social services network to be ready for a virus.

Quebec made efforts in February to clear beds in hospitals in anticipation of the spread of COVID-19. But CHSLDs weren't seen, originally, as a top priority, he said.

Begley said the decision five years ago to organize the system of long-term care under regional health authorities, rather than individual boards with more direct oversight, didn't help matters.

"Obviously, the emergency departments got a lot of attention, and as we go down the scale and, unfortunately, long-term care centres, among other things, don't get as much attention as they did in the past," he said.

With Canada's epidemic far from over, he stressed it's worth exploring how things can be improved.

"If COVID comes back, if there's a second wave or if there's any other kind of pandemic, the next time there has to be some better preparations. And it isn't a question of bad faith. I think we just didn't see everything coming and we weren't as prepared as we should have been."