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As the numbers are updated with frightening regularity, it’s becoming clearer that Canada’s long-term care facilities will be on the front lines in the battle against COVID-19 until we develop and distribute a vaccine.

Even as jurisdictions slowly lift restrictions in a bid to open up their pandemic-battered economies, moms, dads, aunts, uncles, sisters and brothers in nursing homes will remain cloistered, hostages to this deadly foe.

What remains unclear is whether there will be a meaningful discussion about ways to improve the level of care delivered at homes that for years have been hampered by staff shortages, inadequate funding and a lack of attention from policy-makers and politicians.

Public records tell a large part of the story that should have been evident and concerning.

In 2005, an inspection at a Calgary facility cited comments from the spouse of a resident who said “…the care staff are so very busy that I know that if it wasn’t for my being here every day, my husband would not still be walking, and he would be much thinner. The staff just do not have time to spend with him. I help out with other residents as well. Something should be done about increasing the staffing.”

Then, on January 8, 2020, 15 years later in another part of the country, this excerpt from an Ontario nursing home inspection report:

“During the interview with the acting (director of care), they indicated there were a number of vacancies for (personal support workers) that had not been filled…The acting (director of care) also indicated they also used a number of agencies… to replace the PSW shortages…The acting DOC confirmed awareness of several dates when the home was working short staffed of (personal support workers) and resulted in bathing not being provided as a result.”

In the lead-up to my previous investigations into long-term care when I was at the CBC, I read countless reports that recount similar problems.

None of this comes as a surprise to Lindsay Couture, who, after three years as a personal support worker at an Ontario nursing home, burned out from working too many double-shifts.

It's unclear whether there will be a meaningful discussion about ways to improve the level of care delivered at nursing homes as COVID-19 continues its deadly path.

“None of (the residents) were cared for the way they deserved to be cared for,” she said in an interview with National Observer.

“You had so many residents and so few personal support workers.”

Couture made sure to emphasize that safety always came first. But sticking to that priority list came at a cost.

“To be honest, the people who are the most sick and confused got forgotten because they weren’t the ones who were able to voice their concerns. It breaks your heart.”

Couture says more staff would help, evidenced by Quebec and Ontario calling in the military for reinforcements in the most acutely affected long-term care homes.

To be sure, many personal support workers are being hailed as heroes for their continued dedication, even as they recently mourned the passing of one of their own, Christine Bacalocos Mandegarian, the personal support worker who died from COVID-19 on April 15.

“She loved to cook, garden, travel, play with her grand-doggies, and live life,” read part of the tribute to Christine Bacalocos Mandegarian on the GoFundMe page set up to raise money for supplies such as masks, gloves and gowns for the home where she worked. “She always had a smile that radiated the whole room. We truly miss her, and the world will never be the same without her.”

Governments under fire for their neglect

During his April 15 daily briefing, Ontario Premier Doug Ford called the situation a “wake-up” call. Minister of Long-Term Care Merrilee Fullerton, a medical doctor, said they would “spare no expense.”

On the same day, Nova Scotia Premier Stephen McNeil vowed to “look at new protocols” after the crisis is over, acknowledging the dangers of putting too many residents in one room.

On April 16, Prime Minister Justin Trudeau said we need to do “better,” signalling that the federal government would help to subsidize temporary wage increases for nursing-home staff.

On April 17, Quebec Premier François Legault vowed to shift into “problem-solving mode,” as he told reporters about the need to increase wages for personal support workers.

On April 25, Ontario announced a salary top-up.

While governments are receiving credit for their short-term response in the court of public opinion, legal battles loom.

‘Defendants breached their duties of care’

Last Friday, a proposed class-action lawsuit was filed against Responsive Group Inc., a company that owns several nursing homes in Ontario. Among other things, the suit alleges that the “defendants breached their duties of care… by failing to ensure adequate staffing within the Homes to care for elderly residents.”

None of the allegations have been proven in court, and Response Group Inc. must still file a statement of defence.

However, in a statement to National Observer, a company representative wrote that in the meantime, “We continue to work closely with government(s), public health units and our other health-care partners to accelerate testing, initiate outbreak protocols, and comply with directives.”

Even though it is not named in the lawsuit, critics have blasted governments such as Ontario for dropping the ball well before the pandemic struck.

Though it neglected to comment on a matter before the courts, as governments usually do, the Ontario Ministry of Long-Term Care said that it is giving long-term care homes the tools they need to fight back.

“We have taken significant actions that include our aggressive COVID-19 Action Plan for Protecting Long-Term Care Homes, four emergency orders, two packages of amended regulations, and $243 million in emergency funding,” wrote spokesperson Macey Aramburo in a statement to National Observer.

“These measures ensure all long-term care homes have the flexibility and funds to rapidly hire and retain nurses, personal support workers, and other front-line staff they need, when they need them.”

As far as Ian Da Silva is concerned, the fact that personal support workers, who comprise the bulk of the staff at long-term care homes, are overworked, under-paid and under-valued has been known to successive provincial governments for many, many years.

As director of human resources for the Canadian Support Workers Association, he has seen the problems play out the same across the country.

In Ontario, occupying the same position with the Ontario Personal Support Workers Association, he has been demanding action.

A regulatory college for personal support workers, he argues, would address issues such as working conditions, qualifications and pay.

“We need to establish protection for this group of workers,” Da Silva said in an interview with National Observer.

“What we’re essentially asking (PSWs) for the last ten years is, ‘Please come to work for us. We’re not going to pay you a lot. We’re not going to treat you very well. You’re not going to have a lot of rights.’ And then that conversation ends. That’s what (employers) have been advertising.”

The pandemic’s legacy

Still, advocates such as Da Silva see an opportunity while governments are scrambling to keep residents in long-term care homes alive.

He’s encouraged when he hears Fullerton, Ontario’s minister of long-term care, who he says has been a strong ally, vow to “spare no expense.”

But the proof will be in the quality and depth of the political discussions that take place once the first wave — and perhaps a possible second wave — of the pandemic have passed, and scientists develop the hoped-for vaccine.

It will be interesting to see if the various lessons-learned exercises will take heed of the overwhelming evidence buried in all those public records: the inspection reports; auditors general reports; work-loss data due to illnesses and injuries; and Statistics Canada’s table that tracks deaths among the elderly in care facilities due to communicable diseases.

For Couture, the personal support worker, anecdotal evidence was enough to prompt her decision. She quit her job at the Ontario nursing home where she worked for three years, took a much-needed break, and then decided she still wanted to be a personal support worker after all, but under different conditions.

Now, she runs her own company that delivers services to seniors and other clients in their homes. And, as fate would have it, she’s also helping out in long-term care homes.

Her message to the lawmakers and bureaucrats who have promised to make changes?

“It should have never gotten to this point. We should not have been this low on personal protective equipment. We would never send a firefighter into a burning house with no oxygen mask or hose. We would never send a cop into a gun battle without a gun or a bullet-proof vest. So why are we sending health-care workers into their (workplaces) unprotected?”

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My Dad went into hospital Jan. 3. He's 84. He has dementia. He has never been away from his family his whole life. No one has been allowed to visit him for 8 weeks now. No, there is no window that we can go to see him through. I call him everyday at the same time that I used to go visit him everyday. He thinks we abandoned him. He is crying. I have never heard my Dad cry, until now. Then they transfered him to a different hospital, not as near to us. Still no window. Then they transfered him to a different floor in the hospital, & put him in isolation, because of the new rules & regulations. But, does that make sense? I think he fell throught the cracks. He will be in isolation (no TV, no newspaper, no Ipad, no wheelchair,etc ) for a few more days & then allowed out into general population in the Veterans Unit where he will be allowed to use his wheelchair to get around (he self-propels). But....Monday he will be transferred to a Seniors Home, still not the one that he was supposed to go to, near us....where they say he has to go into isolation for 2 weeks AGAIN ! Why?

A real horror sorry. We need to hear more of them......and articles such as this one need to 'woman up' and name the privatization, corporate government partnerships that have put the almighty dollar ahead of good patient worker ratios, good pay for caregivers, and state of the art emergency plans aimed at keeping our seniors and their caregivers safe.

During the April 30, 2020 Government of Quebec Covid-19 press conference, it was announced that 4,400 Covid-19 infected cases were identified in 140 of Quebec’s 2,600 long-term healthcare facilities (CHSLD/public and RPA/private long-term residences for the elderly). This is a ticking time bomb, given 80% of deaths in the province involve people in these residences.

In the 24-hour period, May 29th to 30th, 944 additional deaths were added to the totals.

Already, Quebec is number 9 in the top 10 most affected jurisdictions in North America, as measured in deaths/100,000 residents, specifically 20 deaths/100,000 residents. This is largely explained by the fact that the percentage of the population 70 and over is growing rapidly and the proportion of persons in this age group in CHSLDs is greater than that of other provinces, twice that of Ontario for the 75 to 84 age group. The percentage of those 85 and over in CHSLDs in 40%, higher than in other provinces. And life expectancy is higher in Quebec than other provinces.

In Montréal-Nord, a poor multicultural borough where a high proportion of the population are orderlies in the long-term homes, a severe outbreak made the headlines on April 30, 2020. As of May 1, 2020, massive testing has begun in the borough.

The original Covid-19 game plan of Premier Legault and CAQ entailed making 6000 beds available in hospitals ready to take on the crisis. The successive massive outbreaks of the disease in long term healthcare homes caught the CAQ government totally off guard.

The combination of underpaid personal workers and insufficient staff meant many orderlies moved from one long term care home to another, spreading the disease with them.

The icing on the cake came with Canada Emergency Response Benefit which offered more money to be unemployed for month than an orderly can earn in a month.

Suddenly, the focus turned away from hospitals to long term care healthcare homes. This included raising the pay of orderlies by $4/hour. But that wasn’t enough. The absence rate in these understaffed homes exploded.

The government subsequently set up an online registry for volunteers to offer assistance in the homes,

It also called upon doctor specialists to participate to provide their services to the CHSLDs.

One of the people who signed in via the voluntary registry was Dr. Joanne Liu who, up until recently, was the International President of Doctors Without Borders, a woman who had worked in Africa treating Ebola cases. Her application was rejected, and this was reported on Radio-Canada’s Le Téléjournal (French equivalent to the CBC National).

The next day, the rejection of Dr. Joanne Liu was raised at the daily Covid-19 press conference. The Minister of Heath, Danielle McCann, said the government would request the services of Dr. Liu.

Another volunteer is Bianief Tchiloemba, a fourth year McGill medical student, who had worked in Nepal. Volunteer at the Montreal CHSLD Grace-Dart, he described the conditions at the CHSLD as comparable to the third world. What he saw was completely disorganized chaos, insufficient staff with one nurse responsible for 30 patients, many patients who missed meals and didn’t have their soiled diapers changed and infected patients in the “cold” zones because of inadequate space in the “hot” zones.

Not enough people signed up to be volunteers, while the outbreaks in the CHSLDs got worse. That led to one call for military medical staff, followed by another request for military personal, without medical experience, for a total of 1000 to eventually be deployed at CHSLDs.

Now the Canadian Red Cross (CRC) has been called in to help. The CRC offers people with experience in epidemics in underdeveloped countries.

In the middle of this all, Premier Legault has wondered out loud if all private long-term healthcare homes should be nationalized. This would not address the long-term challenges, specifically the problem of 3000 additional spaces required/year.

Offering more healthcare services to own’s private home would be both cheaper and more attractive for the elderly needing regular medical assistance. Switzerland, Austria and the Netherlands offer models to emulate.

All of the above is in addition to the propagation of Covid-19 in four Montréal hospitals, Sacre-Coeur, Rosemount-Maisonneuve, Lakeshore and Douglas, the latter being a mental health institution.

In the hospitals, 68% of Covid-19 patients in intensive care are between 19 and 70 years old. With de-confinement this can quickly change.

Two deaths out of three in the province are in the Montreal metropolitan community which explains why the timelines for de-confinement are different for the Montreal area than for the rest of the province. Elementary schools will open outside the Montreal area on May 4th and in the Montreal metropolitan community on May 19th. All other educational institutions will remain closed until September. Shops with doors to the outside are scheduled to open May 4th outside the Montreal metropolitan area and May 11th in the Montreal zone. Manufacturers can re-open beginning May 4th with certain restrictions and if all goes well, can transition to full operation capacity on May 11th.

Throughout the Quebec Covid-19 saga, Dr. Horacio Arruda, National Director of Public Health (Quebec) who appears at every press conference, has become a Quebec-wide hero guiding the Covid-19 ship, resolving problems as soon as notified. This deserves an article in its own right. I don’t know what Quebec would do without him. There have been several francophone media reports about him.

Thanks for your detailed account of the situation in Quebec. I'm left a bit confused about your solution to this mess however.....wondering if the private for profit model successive Canadian governments have been talked into pursuing will be part of the post pandemic enquiry.

Because for darn sure, just begging for more government money to address a series of private schemes that obviously have left our seniors neglected, vulnerable, and in some ways, expendable victims......makes little sense.

For profit businesses exist to extract profit. If doing the job right, while still extracting profit, demands large new infusions of tax dollars, it makes more sense to me to bring our long term care homes back under public management....good jobs at one site for caregivers will mean more taxes for provincial and federal coffers...(workers generally don't invest in stock options, or ship their earnings abroad....they pay taxes )....and if our governments screw up and exploit workers and pensioners..........we can defeat them at the polls........and perhaps even take some of the 'rotten apples' to court.

Thinking private care was going to be cheaper....and more 'efficient'...seems to have been our mistake. Especially since 'efficient' now appears to mean 'cheap and penny pinching'.

This is a problem we should ALL be ashamed of, one that we have known about for decades. The elephant in the room is the switch to “for profit!”. We should NOT be making profits off of our old moms and dads health care, those places where our older, often very needy citizens go should be part of our health care system that we brag about so often. It starts with those that work in long term care facilities, what part of under paid, overworked and under valued don’t we as Canadians get. The people that care for our aged should be well compensated, not having to go to several places just to earn a living and should be respected. This is an easy fix, give that system more money, stiffer regulations and ban “for profit” corporations. One thing this crisis has taught us, there is money to be had if needed!! Start putting my tax dollars into our health care system instead of cleaning up oil wells and buying pipelines. I’m ashamed of how we treat our senior citizens. Cheerio from Salt Spring Island BC

Thanks for the work you do. I would appreciate an article from National Observer detailing what companies operate in Canada as long term care providers. I'd like to know their names, where their head offices are, who is on their boards, what their profits are, if they are publically traded entities of totally private organizations...............etc. etc.
What are the private public arrangements in various provinces? How much of my tax dollars have gone to enriching Private Care Corporations and treating vulnerable seniors as captive cash cows.

We should be enraged about the conditions in our senior homes. But we need more information as to who to hold accountable........or when this pandemic passes, so will our awarenesses..........and we'll go back to pretending we don't know.
Just as assault rifles have no place in just might be the case that privatized senior care centres are un-Canadian. National Observer could help more of us understand by 'following the money' behind this horror story.

Thanks again for what you do.

regulating standard of care--ie. how many patients per staff, and with what degree of training--imagine 5 not 30 people to care for--regulating infection control standards, regulating quality of food etc. and then INSPECTING every facility every few month randomly with stiff penalties for non compliance would clean up this mess. These are all within government power right now especially since we are under emergency orders ie martial law. It is always a choice.
Let there be for profit if you can do the gold standard of care and then add profit, fine but not profit at the expense of standards.
This situation is directly due to policy choices by governments over decades and the lie of for -profit as "better" is flaming up as "liier lier pant on fire" right now.