The Québec Ombudsman filed its final report on what went wrong in the province’s long-term care homes during the first wave of the pandemic, claiming that residents were “put aside” and begging the government to right its wrongs by immediately making the recommended changes.
Marie Rinfret says she is asking Quebec Health Minister Christian Dubé to provide her with ongoing updates on progress, starting this spring, until the 27 recommendations in her report are implemented. artwork. masterpieces.
Rinfret’s investigation is separate from the Quebec coroner’s inquest into the number of pandemic-related deaths in nursing homes and the impact of the pandemic on the sector as a whole – although the two share the aim to find out what went wrong and identify needs to change.
Although they expressed concern about seniors in long-term care in January 2020 before the first wave of the COVID-19 pandemic in Quebec, health officials took no action to protect them until. ‘nowadays. ‘in mid-March, Rinfret noted.
The mediator presented his findings at a press conference on Tuesday afternoon. She noted that on the eve of Quebec’s declaration of emergency on March 13, it had given a “very general” guide to health councils on measures in the event of a pandemic.
She compared it to the advice given to long-term care providers in British Columbia, which was much clearer and more robust.
The first epidemics in long-term care homes in Quebec appeared around March 23, but it was not until mid-April that the government recognized the extent of the crisis and sent reinforcements.
“The strategy was based on freeing up space in hospitals. They really believed in good faith that this was where the crisis would occur, ”said Rinfret.
But in doing so, officials failed to assess the risks and potential impacts of transferring resources to hospitals.
For example, in mid-March 2020, hospitalized seniors were transferred to long-term care homes without being tested for COVID-19 and regardless of whether they would push facilities beyond. beyond their capabilities.
Majority of 1st wave deaths in long-term care
Rinfret released an interim report last fall in which she identified major issues in government pandemic planning, noting that the province’s long-term care facilities – commonly referred to by their French abbreviation CHSLD – were a ” blind spot “.
Most of the 3,890 deaths in Quebec in the first wave were to residents of CHSLDs, while staff watched helplessly, fled the overwhelming conditions or themselves had the virus.
In his final report released Tuesday afternoon, Rinfret concluded that long-term care workers “have been hit hard by government inaction.”
These workers accounted for 25% of COVID-19 cases at the time and 11 died.
Officials knew how under-resourced long-term care homes were before the pandemic, Rinfret said, but failed to act in the first wave. She also pointed out that homes should provide similar services to hospitals, despite the lack of expertise and staff to do so.
At the same time, hospital resources have been strengthened. The document details how Quebec officials were distracted by the disaster in European hospitals, especially in Italy, and believed those in the province would also be besieged by the virus.
Staff and personal protective equipment moved to hospitals, but the kind of patient flare they expected never happened. At the same time, hundreds of older people were dying in long-term care facilities.
Quebec Premier François Legault admitted his government was too focused on preparing hospitals in response to the report.
“We were very focused on hospitals and not enough on CHSLDs, that’s definitely a lesson,” said Legault, adding that Quebec was not the only one to neglect long-term care, affirming that others provinces and countries have been surprised by similar crises.
The seriousness of the situation has gone under the radar
Authorities largely underestimated what would happen if the virus entered institutions, where Quebec’s most vulnerable live, Rinfret said.
A lack of “real-time data on the health system as a whole” has meant that the gravity of the situation has gone unnoticed.
“While the eyes of Quebec were turned towards Italy, no risk analysis adapted to the residential-resource model of Quebec and its specificities was carried out”, writes Rinfret. “This is how the CHSLDs slipped through the cracks of any scenario.
The report also paints a picture of the results of this lack of foresight.
It describes how personal protective equipment was not distributed adequately, how staff moving from facility to facility contributed to the rapid spread of the virus, and how basic hygiene care, diet and hydration were postponed or canceled.
“The exclusion of informal caregivers has had serious consequences for the mental and physical health of residents,” said a summary of the report.
The document builds on the interim report, which also described widespread institutional failures.
It enumerated an understaffed, insufficiently trained and under-equipped staff, residents deprived of care and dying alone, and a planning process that simply did not take into account the reality on the ground of the CHSLDs, which were being pushed to their limits. . extreme even before the start of the pandemic.
The final report is based on interviews and 1,355 testimonials from CHSLD residents and members of their families, CHSLD employees, managers of health authorities and family caregivers. Rinfret wrote that his investigation did not seek to blame, but to help avert such a disaster in the future.
Among the recommendations, Rinfret calls on the government to create:
- A long-term care risk assessment and management policy.
- A detailed plan to strengthen the capacity of residences to apply infection prevention and control measures.
- A strategy for sourcing personal protective equipment.
- A deployment plan for emergency personnel within the health network.
- Protocols with professional orders, federations and associations, unions and educational institutions for the deployment of additional staff in exceptional circumstances.
- A national strategy to fight against staff shortages and promote trades and professions in health and social services.
- An action plan to recognize the complexity of providing care and services in long-term care homes.
Dubé, Quebec’s health minister, said he had so far only read the report quickly, but about half of Rinfret’s recommendations have already been implemented.
One thing he said the ministry is working on is to increase the frequency of inspections of long-term care homes, to ensure that infection prevention and control measures continue to be in place and that homes are adequately staffed.