CHSLDs were a 'blind spot' in government's pandemic planning, Quebec ombudsman says

Quebec's ombudsman Marie Rinfret has conducted an investigation into what went wrong in the province's CHSLDs this past spring, and has identified major problems in the government's pandemic planning.

The interim report, based on interviews and 1,355 witness statements from CHSLD residents and their family members, CHSLD employees, health authority managers and caregivers, concludes the provincially run long-term care facilities were a "blind spot" for the government.

The document describes widespread institutional failures, including shorthanded, inadequately trained and under-equipped staff, residents being deprived of care and dying alone, and a planning process that simply didn't account for the on-the-ground reality in CHSLDs, many of which were stretched to the limit even before the pandemic began.

Among the findings:

• The province focused heavily on preparing hospitals for the coronavirus pandemic and didn't do enough to prepare CHSLDs, which "pressed into service to quickly and massively take in hospitalized people."
• The facilities were asked to become de facto hospitals "in a matter of days" without the appropriate resources.
• There were bed shortages, staff shortages and patients were moved in without being tested or isolated.
• Health officials underestimated the virulence and contagiousness of the virus and "there was a lack of an infection prevention and control culture in CHSLDs."
• There was an acute shortage of personal protective equipment. In the news conference, Rinfret said "CHSLDs} were the poor cousins" of the health system, which counters assertions at the time that Quebec had provided ample equipment.
• Staff mobility between institutions worsened the crisis and caused the virus to spread.
• Relief teams arrived too late to help.
• The "decisional chain" was weakened because those with the power to implement measures were "far from where the action really occurred."

None of the shortcomings are news to people like Peter Wheeland, who lost his 85-year-old father in a Lasalle CHSLD in April and witnessed the chaos first-hand.

Wheeland said reading Rinfret's 20-page document prompted tears and dredged up uncomfortable memories, like an orderly's account (published last spring) of events at the home where his father died.

"This préposée was describing how people had been locked in their rooms, kept in their rooms for weeks on end with no contact with their family, were crying, begging her to let them die," Wheeland said. "And I just imagined my father, being in that situation. And it crushed me."

Laurie Gordon, whose mother died at the Vigi Mont-Royal CHSLD, said the hardest part was not being allowed to visit because of safety measures.

"I think one of the most haunting things I have is like, the very last visit I had with my mom – I'm happy it was a beautiful time, we had espresso ... but it really haunts me to think it was the last time I'd see her," she said.

In Rinfret's view, one of the main issues this past spring was decision-makers' "ignorance about the state of CHSLDs and the work they do."

"[The government] simply didn't see the magnitude of the vulnerability of people who live in CHSLDs," Rinfret told a virtual news conference. 

Asked whether they should have been more aware, she replied "certainly."

Rinfret also said the early decision to prevent family members and care-givers from entering CHSLDs had "a massive impact" that in some cases "was irreversible, unfortunately."

During the first COVID-19 wave, CHSLD residents accounted for six in 10 deaths. In all, 3,890 people died in the provincially-funded homes between March 1 and June 30. That number now stands at 4,588 according to the Institut national de santé publique.

Rinfret noted that in some cases staff were forced to decide between dying patients when it came time to administering "comfort care." In others, CHSLD workers were inadequately trained in palliative measures, so they didn't provide any. Some residents were found dead in their rooms, alone.

"I don't consider that these people died in dignity," said Rinfret.

Premier François Legault said he's willing to shoulder his share of blame, but pointed out successive governments have neglected CHSLDs. And he lauded the steps his government has taken since the spring, telling a news conference "that's why the number of deaths has been reduced by 90 per cent this fall."

Health Minister Christian Dubé said "it should not happen ever again" and apologized.

"Saying we're worry, it's one thing. But acting as we do now for all those people that are still in CHSLD and in RPA, we're doing our best. And I think that our action that we have taken since then have proven that we do a lot better this time in a second wave that is much longer, that is more in the community," he said.

Beyond chronicling slipshod organization and operational failures, the interim report also proposes a number of recommendations:

• Make "people-centered care" the focus and allow caregivers and family members to play a larger role.
• Ensure a stable and sufficient workforce.
• "Develop a culture of prevention and infection control, right now," Rinfret said.
• Continue appointing local managers and give them power to make decisions.
• Establish clearer channels for communication.

Rinfret acknowledged the government has acted on many of those priorities since the spring, notably in terms of increasing staffing ranks to the tune of 10,000 new patient attendants and orderlies.

The issue, she said, is ensuring they stay in the field, and that budgets are "recurring and permanent."

While the government has appointed managers in several institutions, Rinfret said "there are still establishments where no senior manager has been named.

In the next phase of a comprehensive investigation into the CHSLD crisis, the ombudsman's office will focus on the Health Ministry and the provincial public health apparatus.

A final report is due in September of 2021.