There was never any doubt seniors are especially vulnerable to COVID-19, and how that has played out so far within Quebec’s elder-care infrastructure has been particularly troubling.
People over 70, and those with pre-existing health issues, are more likely to die from the novel coronavirus.
Elderly care homes across Canada have seen outbreaks.
But, experts say, the scale at which COVID-19 has spread through Quebec’s long-term care homes — which house elderly people in need of assistance, as well as people with disabilities — could have been avoided, and point to problems that predate the crisis.
“A lot of these things definitely could have been prevented,” said Daphne Nahmiash, a retired gerontology professor at Université Laval.
Across the province, hundreds of patients at CHSLDs, as the homes are called, have tested positive. Cases that originated in the homes, which are primarily government-run, now account for about half of the total deaths in Quebec.
They complained of a lack of staff, inadequate personal protective equipment and delays in testing workers and residents.
The top priority, Legault says
As the acting president of Handicap-Vie-Dignité, an organization advocating for improved conditions in long-term care homes, Nahmiash has been calling for years for more resources and improved staff.
In a February 2020 report, her organization singled out one issue in particular: the practice of staff working at multiple residences, increasing the risk of spreading infection.
That practice allowed the virus to keep spreading even after families were barred from visiting CHSLDs on March 14, said Nahmiash.
This week, Premier François Legault’s government put an end to it.
The province has put more money, staff and protective equipment in the homes.
It also says it plans to test both staff and residents across the province’s 440 CHSLDs. In all, the long-term care homes house roughly 40,000 people.
Over the past week, as the extent of the problem in the homes has become clear, Legault has stressed in his daily briefings that protecting the province’s seniors is the top priority.
“They built Quebec,” he said Thursday. “We live in a fairer, richer, more beautiful society thanks to them and we have a duty to protect them.”
Legault said the bulk of the cases in CHSLDs are in six homes, and that measures are now in place at others to help prevent further outbreaks from happening.
One of the hardest hit centres is in Laval, at the CHSLD de Sainte-Dorothée, where more than 100 residents and 50 staff have tested positive.
“I think there are some places where we were really ready, and right from the get go, and unfortunately there were some places where we weren’t ready,” said Jeff Begley, president of the federation of health and social services at the CSN union, which represents nurses at the home.
A history of problems
CHSLDs have been an issue in Quebec for years.
A scathing 2018 report from Marie Rinfret, the province’s ombudsman, said the services provided to seniors and people living with disabilities in long-term care homes were “deficient” and “flawed.”
“At many institutions, staff can barely keep up,” she said at the time. “The upshot is that services such as baths and dental care are put off. Needless to say, this causes significant harm to people who are highly vulnerable.”
Legault’s Coalition Avenir Quebec took power on a promise to improve those homes, with money earmarked to address the long waiting lists and hire more staff.
They also promised, in the long run, to create smaller and “more humane” homes for seniors dubbed “Maisons des aînés.”
Now, they are charged with trying to control an outbreak.
Paul Brunet, executive director of the Quebec Council for the Protection of Patients, has been fighting for improved conditions for years.
Last fall, the council got the green light from Quebec’s Superior Court to pursue a class action lawsuit against the province and regional health authorities over poor living conditions at the homes.
“If there was a problem before, you understand that we’re not going to get better during the crisis,” said Brunet, who is concerned the virus will spread widely in far more than the six homes cited by Legault.
“We’re stuck with the problem that I think we could have helped diminish a lot.”
Begley said the province was faced with an enormous challenge in trying to prepare the whole health and social services network to be ready for a virus.
Quebec made efforts in February to clear beds in hospitals in anticipation of the spread of COVID-19.
Begley said it’s not surprising CHSLDs weren’t seen, originally, as a top priority.
He said the decision five years ago to organize the system of long-term care under regional health authorities, rather than individual boards with more direct oversight, didn’t help matters.
“If COVID comes back, if there’s a second wave or if there’s any other kind of pandemic, the next time there has to be some better preparations. And it isn’t a question of bad faith. I think we just didn’t see everything coming and we weren’t as prepared as we should have been.”