N.B. failed to ensure nursing homes were prepared for a pandemic, audit finds

The New Brunswick government did not make sure nursing homes were prepared for a pandemic, and their staff shortages and other problems played a critical role in the impact of COVID-19, Auditor General Paul Martin says in an audit released Thursday.

Ninety nursing-home residents and one staff member died because of the pandemic, as of March 31, 2022.

The Department of Social Development did not have an up-to-date pandemic plan before COVID-19 or provide financial resources to nursing homes to support the development of pandemic plans, Martin told the legislature's standing committee on public accounts.

Departmental standards for infection prevention and control were also "below best practice," according to Martin.

Infection Prevention and Control Canada recommends a minimum of one full-time infection prevention and control professional for every 150 to 200 beds, depending on the severity of illness. The department hired two infection prevention and control specialists to guide nursing homes on minimizing the spread of COVID-19.

"According to the department, the specialists made efforts to work with each home in outbreak, but with the number of nursing homes experiencing outbreaks they were unable to visit every home in person," the report says.

"Departmental staff informed us the risk of contamination was high in nursing homes due to a lack of conformity with [infection prevention control] measures and poor PPE [personal protective equipment] competency among nursing home staff," such as some COVID units not utilizing PPE, not changing PPE between units, and improper donning and doffing procedures.

The department continued annual inspections of nursing homes during the pandemic and several areas of non-compliance were noted, "however, enforcement options were limited as the department lacked enforcement mechanisms."

As it stands, the department can either modify a nursing home's licence, revoke it, or place a home into trusteeship. The department has been "hesitant" about the first two because of the hardship they could cause for residents, according to the report.

As a result, "modified licences have been the primary enforcement mechanism and it has not proven to be an effective one."

Areas of non-compliance increased during the pandemic, said Martin. For example, 20 nursing homes reported staffing levels as "strained or critical," and 73 per cent of the homes did not meet nursing home design standards.

"Departmental staff informed us they believe a contributing factor to COVID-19 outbreaks was that older home layouts were not adequate to deal with airborne and communicable disease," the report says.

There is no formalized plan to bring nursing homes up to the design standards or convert double occupancy rooms into single rooms, as this would "have a significant financial impact [and] cause patient backlog in hospitals."

"Nursing home risks remain unaddressed," Martin concluded.

Staffing remains biggest challenge, says union

Sharon Teare, president of the New Brunswick Council of Nursing Home Unions, said she's not surprised by the auditor general's criticisms.

The biggest issue was, and remains, staffing, she said.

"I think any of the improvement we've seen is, you know, the utilization of staffing agencies, which is a real Band-Aid fix to the situation.

"Folks aren't staying. I know in our sector that we need continuity of care as well as the consistency."

Teare is hopeful lessons will be learned. She contends that's owed to the seniors and the workers who take care of them.

Martin made a total of eight recommendations, including that the department work with nursing homes to address key inspection non-compliance areas, particularly staffing levels, and that timely access to infection prevention and control specialists be ensured.

Green Party Leader David Coon told reporters he thinks the government should use its budget surplus, now estimated at nearly $200 million, to improve the the salaries and working conditions of nursing home and special care home employees, and to upgrade homes to modern standards to "ensure the infrastructure itself is more effective at resisting the transmission of viruses."

Scope of report criticized

Coon said he's "quite upset" the auditor general looked at only roughly half the long-term care sector in his report. He questioned why Martin didn't also review the pandemic response at special care homes, which have about 6,000 residents, compared to about 5,000 in nursing homes.

He noted the first COVID outbreak at a long-term care home was at Manoir de la Vallée, a special care home in Atholville. The Manoir was also the site of the province's first COVID death — Daniel Ouellette, 84, and the first place where someone couldn't be with their loved one who was dying because of COVID restrictions.

Martin "really missed the opportunity to produce a report that in the end needs to be of a quality and of a comprehensiveness to enable us to ensure that we're better prepared for a variant that might come along that's COVID, that's going to be particularly problematic, or a new novel virus," Coon told reporters.

"And that's what concerns me because in the end this is all about being better prepared for what what we may face in the future, and this report doesn't do that for me."

Martin said his decision was based on available resources and on turning around a timely report.

Coon, who was a member of the COVID cabinet committee and took an oath of confidentiality, suggested the report would have looked "much different" if Martin had interviewed a number of key people, both inside and outside of government.

Tory MLA Dorothy Shephard, who served as social development minister as well as the minister of health during periods of the pandemic, said she was "really quite shocked" Martin didn't speak to elected officials — "or at least to those that I know."

Martin declined to say whom he interviewed, calling it confidential. But he said he had strong public engagement.

He will table another volume of his performance audit in December.