Senior care homes, COVID-19: death and working conditions

Quebec has been the hardest hit province both in terms of total COVID-19 cases and its problems in longterm care homes. The factors leading to the long term care home resident crisis were laregly predictable. 

It is interesting that Quebec has three times as many private long term care residents (18.4% ) as the Canadian average of 6.1%. The Maison Herron private long-term care facility in Dorval, whose owners are under criminal investigation over the death of 31 residents, had a bitter strike by workers for higher pay last year. In CBC National interview, the family of one of the deceased seniors said the failure to increase the home's low pay left many health care attendants in the home feeling little sense of loyalty to the employer, thereby contributing to their willingness to stop working as the risks to their own health grew. 

It should have been clear long before COVID-19 that the issues in the province’s long-term care homes would leave them poorly equipped to handle a pandemic.

“We already knew there was a lack of personnel, the salary wasn’t attractive, a heavy workload, a lack of manpower,” Philippe Voyer, a professor and researcher whose specialities including nursing and aging, said.

Louis Demers, who studies the health-care system and seniors residences at Quebec’s Ecole nationale d’administration publique, said he believes collective living arrangements for seniors were a governmental “blind spot” when it came to preparation, even though he believes officials reacted well overall. ...

Demers says it’s impossible to make blanket judgments about the long-term care system, since problems crop up on a case-by-case basis.

He says there are times when management may be fingered, such as the high-profile case of a private residence in Dorval, Que., where health authorities found residents lacking food and basic personal care, and eventually called police after learning that 31 people had died within weeks.

However, he noted there have also been major outbreaks at well-regarded public institutions, such as the Montreal Geriatric Institute.

While both Voyer and Demers are reluctant to assign blame, they say there are certainly lessons that need to be learned, especially given an aging population that is likely to need increasing levels of care.

Quebec Premier Francois Legault has promised to address worker shortages in care homes, through both temporary pay hikes and long-term recruitment, which both experts say is essential.

Voyer says badly configured residences, with long corridors and residents sharing rooms, have a harder time isolating sick residents from uninfected ones, compared to residences with house-style layouts, where residents live in smaller wings.

And both he and Demers say there’s an urgent need for more investment in home care, which can help avoid institutional settings altogether.

Statistics show that private seniors residences are a popular option for Quebecers when compared with the rest of Canada.

Some 18.4 per cent of Quebecers occupied such spaces in 2019, compared with just 6.1 per cent on average in other Canadian provinces, according to the Canadian Mortgage and Housing Corporation. It says the discrepancy is explained by a much larger pool of residence spaces in Quebec and the lowest average rents for such spaces in the country.

https://nationalpost.com/pmn/news-pmn/canada-news-pmn/many-factors-behin...

On CBC's the National, Quebec Minister of Health Danielle McCann admits that the provinces long term care homes had a large shortage of workers before COVID-19, saying that "we need thousands and thousands of people, not just a few hundred." indicating that then long-term care problem was severe well before this crisis. For a former Parti Quebecois independentiste Minister and now CAQ Premier, who is extremely jealous of provincial jurisdictions, to ask Trudeau for  help from the Canadian military shows how dire the situation is. 

Legault says long-term care homes are facing a shortfall of about 2,000 staff, but that 2,000 medical specialists have offered to step in since his appeal to them Wednesday.

He's also asked the federal government to send trained military personnel to help but says it is still unclear how many people are available. The premier estimated there may be between 60 and 100 qualified people who may be sent as reinforcements.

https://www.cbc.ca/news/canada/montreal/covid-19-quebec-april-17-1.5535556

Quebec also seems willing to call in the extremely well paid specialists, who although highly trained often have skills to match this situation, even though there are "retired nurses are waiting to be called that are more suited to the work than specialsts", according to the CBC National News. Roberto Bomba from the Quebec Nurses Union said, in referring to the specialists, "They better have a knowledge base and run around and care for the residents. But under no circumstances are they to put in requests for nurses. Our nurses are doing the work. They don't have time to babysit specialists." These quotes can be seen at this url (https://www.cbc.ca/player/play/1725790275768)

I would also say that the extremely poorly paid residential care attendants don't have time to babysit specialists also. It's another example of elites preferring to use other elites even when they are not the best choice. 

The same sad trail of death's in senior's care homes in Ontario, Quebec and BC, brought on by  minimal staffing, little or no Personal Protective Equipement (PPE), poor wages and benefits that often force workers to be employed in more than one place and thereby assisting in the spread of disease, and little to no government checkup of homes, has also occurred in Alberta.

 The real scandal is that “Everyone knew this could happen,” said Doris Grinspun, president and CEO of the Registered Nurses’ Association of Ontario.  “It’s like somebody sat in a room and said, ‘This is a population we can live without.’ ”

In the Calgary nursing home, Nina Vaughan watches her father survive. ...

Lorne Vaughan has COVID-19. He lives in McKenzie Towne, where 21 fellow residents, including his sister-in-law, Doreen Gauvreau, have died of COVID-related conditions. Another 60 people, the same number that jam inside a TTC bus during rush hour, have tested positive for the virus.

Given the number of deaths at Toronto’s Eatonville Care Centre, reporting 27 as of Tuesday, Bobcaygeon’s Pinecrest with 29, or the 31 at Quebec’s Résidence Herron, odds are that a lot more will die in Vaughan’s home, too. ...

Across Canada, seniors homes have become the epicentres for the COVID-19 pandemic. People who were teachers, soldiers, plumbers, professors are dying en masse. Many are fragile, living in a long-term-care or retirement home system that runs on low-paid, part-time staff who are forced to work in multiple homes to make a full-time salary. That is how a virus can spread.

“Everyone knew this could happen,” said Doris Grinspun, president and CEO of the Registered Nurses’ Association of Ontario. “It’s like somebody sat in a room and said, ‘This is a population we can live without.’” ...

York University professor Pat Armstrong wants long-term care to move from provincial control to the Canada Health Act, the federal legislation for public health care. With national care priorities defined in legislation, Armstrong said federal money for nursing homes could require proof of improvement in a system that has long been underfunded and staffed by part-time workers.

“I think (governments) have got to realize that long-term care needs to be an integral part of the health-care system,” said Armstrong, known for her research into long-term care.

“They need to be doing the same thing (in nursing homes) as they are doing in hospitals. That means we need a new piece of national legislation, a national long-term-care act,” Armstrong said.

In Canada, each province has had a unique response to desperate families and staff.

Late last week, British Columbia moved to limit the spread of infections by mandating that staff who hold multiple part-time jobs work in only one location. The province provided funding to augment lost wages.

Notley, the Alberta NDP leader, asked the government April 2 to implement similar one-site rules. Last week, Alberta confirmed the employment change, saying it is “considering financial supports” for affected workers. Until Ontario announced its one-site rule Tuesday, the province had offered little more than a recommendation that employees work at one location. Some homes, struggling for staff, were still accepting workers juggling multiple jobs.

With the push for one location resolved in some provinces, advocates are still pressing for better reporting of COVID-related deaths. Right now, it’s hit-and-miss.

Quality data is key to prevention, said Dr. Samir Sinha, director of geriatrics for Sinai Health System in Toronto. His staff have been trying to cobble together details of outbreaks and deaths in Ontario’s 630 long-term-care and 775 retirement homes.

“It’s important so we can have an accurate picture on how the situation is unfolding,” Sinha said. “If we don’t understand these things or have the level of knowledge we need, we are likely to repeat mistakes.

https://www.toronto.com/news-story/9952198--everyone-knew-this-could-hap...

In Ontario, while Ford has looked shaken at his TV presentations because of the impact of COVID-19, especially with regard to the large number of deaths at seniors care homes, his government is a major part of the problem.

This scandal also includes former Premier Mike Harris who privatized a large part of Ontario's care home system and now is the chair of the private sector's Chartwell Retirement Residences.

The private sector care homes are also major contributors to the Progressive Conservatives. 

It took the pandemic to break an already compromised system. In Canada, almost half of the approximately 1,000 deaths from the virus as of April 14 occurred in long-term care homes. In Ontario, where I live, as of April there were 14 COVID-19 infections in 114 of 626 facilities.

At a news conference, Ontario Premier Doug Ford looked shaken. He said, among other things, that he would make it illegal for individuals to work in more than one care home simultaneously, a situation which potentially allows the virus to either enter or leave the premises with those workers.

But Ford has been a big part of the problem. Having people work in multiple locations has become commonplace primarily because the corporations that own for-profit long-term care homes hire workers part-time so that they can pay them poorly and avoid providing benefits. Until now, the Ford government has turned a blind eye to this. As well, the previous Liberal government was set to raise the minimum wage in Ontario, a move that would have helped many long-term care workers. Yet one of Ford's first acts when elected in 2018 was to cancel that planned increase.

Ford has much to answer for. The CBC reported on April 14 that in 2019 only nine of the province's 626 homes received a comprehensive resident quality inspection, or RQI. The CBC reviewed reports from the last five years for all homes in the province. They found that most received RQIs in 2015, 2016 and 2017, but that number dropped to just over half in 2018 and to only nine in 2019. To be blunt, that means that under Kathleen Wynne's government there were a good number of comprehensive inspections, but Ford cancelled almost all of them. ...

Mike Harris, who was Ontario's premier from 1995-2002, responded to growing waiting lists in 1998 by announcing that more than $1 billion would be spent to create 20,000 new spaces. When the contracts were awarded for construction of beds, 68 per cent of them were handed to the private sector. Three giant companies, Extendicare, Leisureworld and Central Park Lodges, received 40 per cent of the contracted spaces. The public was to pay for building facilities to be owned and operated by corporations to enrich their shareholders.

Provincial election finance records showed that between 1995 and 1999 for-profit long-term care companies donated almost $340,000 to the Ontario Conservative party. That did not include thousands of dollars donated to the provincial leadership campaigns of Ernie Eves, Tony Clement and Jim Flaherty.

One of the biggest players in the private sector long-term care field is Chartwell Retirement Residences. Mike Harris now sits comfortably as the chair of Chartwell's board of directors and according to Unifor, another union in the sector, Harris pulls down $237,000 a year for this part-time job. Meanwhile, Unifor, says the company pays only the minimum wage to many of its front-line employees.

The 2006 NUPGE report says that the long-term care model promoted by Harris drains the profits from care into the pockets of owners and shareholders. The public sector model provides better care and keeps people safer than a for-profit system governed by the same market forces that motivate software developers, cable companies and fast food chains. Yet, Harris and some other premiers consistently pushed privatization. But the exploitative practices in the privatized for-profit sector have also had a negative and cascading effect upon the quality of care for clients, not to mention the wages and working conditions of care providers.

https://rabble.ca/blogs/bloggers/pulpit-and-politics/2020/04/covid-19-ex...

Nova Scotia's long term care homes also are facing catastrophic COVID-19 situations. 

As of Tuesday, 10 licensed and unlicensed long-term care and seniors’ facilities in the province had confirmed cases of COVID-19, involving 148 residents and 65 staff members.

Most of the cases are at Northwood, which was reporting 112 cases among residents and 40 cases among staff members, on Tuesday.

https://atlantic.ctvnews.ca/nova-scotia-reports-2-more-deaths-at-northwo...

The situation in Ontario and Quebec is now so desperate that both the Ford and Legault government have asked the federal government to send Canadian Forces soldiers to fight the desperate situation in their long-term care homes, with Legault asking for 1,000 military in addition to the 125 he already has. 

The Canadian Forces are preparing to deploy medical personnel to Ontario, where COVID-19 has ripped through the province’s long-term care system like “raging wildfire,” leaving staff overworked and desperate as they try to curb a mounting death toll.

During a Wednesday press conference, Premier Doug Ford announced Ontario is formally requesting assistance from the federal government, including Canadian Forces personnel and Public Health Agency of Canada resources. Initially, those personnel will be directed to deploy to five “priority homes,” Ford said. Personnel will provide staffing relief and other support for the day-to-day operations of the homes. ...

“We’re in the thick of a raging battle against COVID-19 in our long-term care homes. And when you’re in a fight like this, you leave nothing on the table,” said Ford.

Planning staff at national defence headquarters in Ottawa had been given an earlier heads-up that Ontario was expected to request assistance similar to that provided to Quebec. The Canadian Forces has already sent about 125 military health-care personnel and support staff to Quebec after the federal government received a request last week for assistance from that provincial government. ...

Quebec Premier Francois Legault also announced Wednesday that he was asking for another 1,000 military personnel to be sent to long-term care facilities in the province.

Ford said that the requested assistance from Canadian Forces personnel and the Public Health Agency of Canada is just one small part of Ontario’s efforts to deal with COVID-19.

“Their support will provide staffing relief so staff can focus on the care of the residents,” he said of the request to send the military personnel to long-term care facilities. “They will assist with operations, co-ordination or medical care, logistics and general assistance to support the day-to-day operations.”

The military teams sent to Quebec long-term care facilities were comprised of nurses, medical technicians and support personnel. Similar teams would be brought together for Ontario’s request.

Volunteer emergency nurses and cleaning staff, infection control specialists and staff from provincial hospitals are also being used to support the more than 100 long-term care homes in Ontario, Ford added. “Every set of boots on the ground will make a difference in this fight,” he said. ...

Military sources say they expect most of the personnel to go to long-term care facilities in the Toronto area. ...

Ford, when asked why he didn’t call on the military earlier for aid, said the situation has been changing every day. “As we see an influx we’ll take all the resources possible,” he explained. “There will be enough people to take care of the five homes.”

The situation with COVID-19 in the long-term care facilities is like a “raging wildfire,” Ford said. Staff in those facilities have been working long hours. “They need a rest and they need support,” he added.

Legault said Wednesday that Quebec’s new request for 1,000 military personnel is centred on staff that can be used in non-medical tasks in the province’s long-term care homes. ...

The Canadian Forces has yet to officially receive that request but military sources say Quebec’s appeal for such a large number of personnel came as a surprise.

The Canadian military has limited numbers of trained medical staff. There are around 2,600 regular force medical professionals, said Department of National Defence spokesman Dan LeBouthillier. That figure includes approximately 460 doctors and nurses.

However, those 2,600 individuals have a primary job of taking care of the 68,000 regular force personnel as well as reservists on operations or full-time service. The number also includes positions such as medical lab technicians, medical technicians, pharmacists, dentists and dental hygienists.

https://ottawacitizen.com/news/national/defence-watch/canadian-military-...

The bankruptcy of Premier Legault's proposal to seek to overcome Covid-19 by fostering the development of herd immunity illustrates how ethically bankrupt this regime is. This is a province with the highest Covid death toll in the country, the greatest number of infections, as well as the greatest number and percentage of deaths in senior care homes, but he still proposes to begin openning up the Quebec economy under these circumstances, putting everyone, but especially seniors and those with underlying health conditions, such as diabetes at risk.  

Premier Francois Legault pushed the concept of "herd immunity" on Thursday as he prepared to lay the groundwork next week for a plan to gradually restart the economy and get children back to schools.

The approach would involve exposing a large proportion of Quebecers to the novel coronavirus in a measured, gradual way, to help them develop a natural immunity.

The idea of reopening schools has garnered an unfavourable response among some parents, teachers and unions, who worry about kids returning to class just weeks after physical distancing and stay-at-home measures were enacted to slow the spread of COVID-19.

But Legault argued Thursday that less than 10 per cent of the province is currently naturally immune to COVID-19 — perhaps a bit more in hard-hit Montreal — and that number won't change unless the province starts resuming certain activities.

"The idea is to go very gradually so that people who are less at risk can develop antibodies to be able to become immune," Legault said. 

Quebec reported an 109 additional COVID-19 linked deaths Thursday, bringing the provincewide death toll to 1,243. The province also confirmed 873 new cases, bringing the overall tally to 21,838.

Legault stressed that the situation in long-term care homes — which accounted for 93 of the additional deaths Thursday — is much different than the rest of the province, which has had more stable figures. ...

Health experts have questioned the strategy, saying there are larger ethical questions that need to be considered.

Alison Thompson, a professor at University of Toronto’s faculty of pharmacy, said letting children be exposed in schools to COVID-19 is a far cry from a mandatory vaccination program. "It’s not just a matter of building immunity — they have to get sick first," she said in a recent interview, calling the proposal a "sickness strategy."

Legault has revealed little about the province's plan, but said parents won't be obliged to send their kids to school. ...

Quebec's association of pediatricians came out in favour of the plan in a two-page letter published Thursday, noting that one thing scientists agree upon is that COVID-19 isn't dangerous for most kids, who are confined largely to protect their grandparents. ...

Quebec reports 9,500 health care workers are missing — 4,000 are recovering or infected with novel coronavirus while 5,500 simply haven't returned to the job.

"We need you," Legault said, reassuring them they would have the protective equipment they need. "The network cannot function with 9,500 people absent." 

The federal government announced 1,000 Canadian Forces members would help shore up staffing at long-term care homes.

A patients' rights group has filed a human rights complaint on behalf of long-term care residents in Quebec.

The Quebec Council for the Protection of Patients' complaint describes alleged discrimination and exploitation of those who live or have lived in long-term care or seniors homes since the beginning of the COVID-19 crisis and seeks financial compensation from the Quebec tribunal.

The province's seniors homes have been the epicentre of the fight against the novel coronavirus, accounting for nearly 80 per cent of deaths — something the council argues the province should have known given what had happened elsewhere.

https://www.toronto.com/news-story/9960228-legault-pushes-herd-immunity-...

Dr. Amit Arya,  a palliative care specialist who works in nursing homes, discusses the systemic problems faced by these homes below. 

None of us can imagine a beloved parent or grandparent in one of the nursing homes we are reading about without an involuntary shudder. Human beings dehydrated, starving, and left sitting in their own feces and urine in one Quebec institution. Military personnel deployed to homes desperate for staff. More than 1,000 people dead in long-term care homes across the country, and many more cowering in fear, sealed off from their loved ones as COVID-19 stalks the hallways of the nursing homes they live in.

Some of this is particular to this pandemic. No one could have been completely prepared for it.

However, COVID-19 has also ripped the bandage off an open wound, revealing what was previously there. It has exposed the inadequacy of the existing system.

Most nursing home residents have advanced incurable conditions — often dementia, but also heart, lung or kidney disease. People like me who work in nursing homes already know that care is driven by efficiency, rather than giving seniors with declining function the life they deserve. COVID-19 is showing us all why many of us would not choose these places for ourselves.

So what can we do? ...

The crowded conditions in which we warehouse our frail elderly aren't just an issue of personal privacy, they contribute to the spread of disease. Even in normal times, seasonal flu can be a killer in these homes. And with COVID-19, everyone is now discovering what those of us working in the system always knew: many nursing homes simply do not have the space to isolate patients in order to keep people safe during an outbreak. We need to create the space to provide the privacy seniors want for their dignity and autonomy – space which also serves to combat the spread of viral illness. ...

What about staff? These are the people our elderly are so dependent upon. They dress many of the residents and brush their teeth. They take them to the bathroom, clean them afterwards, and give them baths. To stop the spread of COVID-19, some provinces are now saying support workers may work in only one home, rather than different institutions from day to day or week to week. This will reduce the spread of the virus, but it will also build better relationships between workers and their patients.

Obviously, also mandating that nursing homes provide workers with proper protective gear as well as sick leave is as important to the patients as it is to the staff.

However, support workers need to be paid a decent wage, and receive full-time work and benefits. Earlier this year the Ontario government capped the wages of personal support workers at many nursing homes, for example, but the truth is that few of these workers make much more than minimum wage.

And we need more of them — not just to protect against illness, but also to relieve the regimentation of daily routine for the residents. ...

Few people realize how thinly nurses are stretched in these homes. There is usually only one nurse for about 30 often very ill residents in the daytime, one for about 60 at night. Usually there is no doctor on-site — residents typically see a doctor once every week or two. There aren't enough doctors and nurses to look after the routine needs of these patients, including palliative care in many cases, much less address the COVID-19 crisis. ...

The truth is that there would be fewer residents in these institutions if families had more help at home. Increased funding is needed for geriatric and palliative home care, to support not just the patient but also their family.

COVID-19 has made everyone think about what it means to be isolated and alone. For people in nursing homes, loneliness may be the most powerful condition of their everyday lives. When the pandemic is over, each one of us – whether we have a loved one in one of these homes or not – needs to consider whether there is something we can do to improve the living conditions and relieve the monotony and loneliness of our sickest seniors.

Many of our parents and grandparents will live their last months and years in these places. Many of us will end our days there, too. ...

Now and after the pandemic, let's make sure that nursing homes are not a feared destination in which to live or die.

https://www.cbc.ca/news/opinion/opinion-nursing-homes-conditions-1.5541155

The numbers for deaths in long term care homes just keep getting worse.

Canada is closing in on 50,000 known cases, of which more than 2,700 have been fatal. Deaths in senior and long-term care facilities make up 79 per cent of COVID-19 fatalities, according to government data — particularly in Quebec, Ontario and Nova Scotia.

https://nationalpost.com/news/canada/covid-19-trudeau-says-in-many-parts...

The flood of lawsuits in Canada over failing to deal adequately with the Covid-19 crisis has already started, with many of them invovling long-term care homes. 

Nursing homes, insurance companies, airlines among the targets of legal action already underway

Legal experts say to expect a slew of lawsuits to be filed in the coming months.

"Will there be a big bubble? Yes, absolutely,"  said Erik Knutsen, a Queen's University law professor and co-author of Canadian Tort Law and The Civil Litigation Process. "Is that a bad thing? No, because that's how we sort these things out. That's the mechanism. Do I expect there will be a large explosion of COVID-19 related litigation? 100 per cent." ...

According to research conducted by the law firm DLA Piper, there were just under 700 COVID-19 related individual legal actions and 176 ‎class actions filed in the U.S. as of April 28. 

In Canada, a total of 17 COVID-19-related class actions were filed across Canada with many more under investigation as of the same date. There have also ‎been a number of high profile, non-class action claims commenced, the law firm said. ...

Because Canadian class action plaintiff lawyers closely monitor U.S. court filings, the law firm said it anticipates a "host of 'copycat' class proceedings in Canada."

In the U.S.:

• Nursing homes, where the virus has been most deadly, are expected to be hit by an onslaught of litigation.
• Companies including Amazon and Costco are facing lawsuits, accused of price gouging.
• Insurance companies are being taken to court for denying claims.
• Airlines are being sued for not refunding tickets.
• Cruise lines are being sued for negligence in their response to the COVID-19 outbreak.
• Schools are facing lawsuits from students who are demanding partial refunds on tuition and campus fees, arguing they're not getting the calibre of education they were promised.

Experts say Canada may follow a similar path and in a few cases already has.

For instance, a $50-million class action lawsuit has been launched against Revera Retirement Living on behalf of the families of COVID-19 victims at the company's long-term care facilities in Ontario. ...

If it's a case of negligence, like those pertaining to nursing homes or cruise lines, the defence will likely be that none of it was foreseeable, that they couldn't predict or prevent all infections and that they complied with government regulations, Kalajdzic said. ...

But even though places like nursing homes may have met the minimum standards set out by the government, that doesn't mean they met the negligence standard, Knutsen said. Even if a statute of standards has been passed by the government, those standards may not meet the reasonableness test, he said.

"You may have to do more. The catch is it has to be obvious to a layperson, not a lawyer, a non-expert, that the standard itself was deficient." ...

However, in the U.S., at least, there's already a lot of pressure on governments to pass statutes that immunize various companies against liability, Kalajdzic said.

Nursing homes are pushing back against potential lawsuits with a lobbying effort to get states to grant them emergency protection from claims of inadequate care.

"There may be a solid case in law, but if the government passes a statute that provides statutory protection against liability, then there's very little litigants can do," Kalajdzic said.

And there's precedent, she said. In the wake of 9/11, Congress passed a statute that immunized airlines from any civil liability.

https://www.cbc.ca/news/coronavirus-lawsuits-insurance-nursing-homes-1.5...

During Sunday's CBC The National, the broadcast showed the wretched living and working conditions found at many long term cares starting at 28:25 on the url below. It shows long term care worker staffing be changed from 4 residents to worker to 10 residents to worker in private homes, with workers begging inspectors to increase the staffing so that patient needs can be met and inspectors in Ontario saying there is nothing they can do as there are no regulations requiring this. 

https://www.youtube.com/watch?v=Cb5C25jjoOk