Spring testimonials from CHSLDS paint harrowing picture
CHSLD staff told ombudsperson they were ill prepared for surge of infections
Quebec's ombudsperson has presented a scathing condemnation of the province's failure to protect the vulnerable in longterm care homes during the first wave of COVID-19 infections.
Disorganization, staffing failures, a top-heavy bureaucracy and a lack of sufficient personal protective equipment provided ample tinder to spark a wildfire of human misery inside the province's longterm care homes, ombudsperson Marie Rinfret said.
Her 21-page progress report, presented on Thursday, provided a new look into the catastrophe that left more than 4,000 people dead in Quebec's CHSLDS, between late March and early June, according to health ministry statistics.
The report was intended as an alarm bell, to signal what went wrong and how the situation could be improved, even as Quebec continues to count on average more than 10 deaths in CHSLDS each day amid a second wave of infections.
“Considering what the pandemic has taught us, no delay in decision-making is now acceptable in allowing us to take action so that the rights and dignity of people living in CHSLDS can be respected,” Rinfret wrote.
Her progress report, which comes in advance of the full investigation due to be released in the fall of 2021, drew upon hundreds of interviews with CHSLD residents, caregivers, staff and managers.
Their testimonies, many of which appeared anonymously in the report, echo a sense of hopelessness felt by staff and the feeling they had been forgotten. At a time when Quebec society was placing rainbows in windows that said “it will all be fine,” inside many CHSLDS it was anything but.
“I experienced the horror of witnessing the deaths of so many residents I was attached to,” one worker said. “Some of the images will stay in my mind forever. My colleagues and I often cried together because it was too much for me. It's hard to see all these people die.”
Rinfret noted how the severity of the infections took the government by surprise and quickly overwhelmed the CHSLDS, which had been in poor condition before COVID-19 arrived and were suffering from significant staffing shortages.
“In addition to the lack of understanding (of the virus) from a scientific and clinical point of view, there was a lack of a culture of infection prevention and control in CHSLDS,” Rinfret's report reads. “Staff were not accustomed to being subject to strict standards in this regard and the training was minimal.”
Added one CHSLD worker: “In our planning, we never imagined the magnitude of what lay ahead. We didn't think 25 to 50 per cent of the clientele would be infected at the same time as half of the staff would be absent.”
The government's decision to protect hospitals from becoming overloaded aggravated the issues in the CHSLDS. Patients were even transferred out of hospitals to CHSLDS, resulting in overloaded residences that had no room to isolate patients who tested positive for COVID-19.
Rinfret said that decision, and others like it, happened because government officials were unaware of the degree to which the CHSLDS were vulnerable. She called the residences a “blind spot.”
To Anne Kettenbeil, the use of that term ignores how the government wilfully left the CHSLDS vulnerable. Kettenbeil lost her partner Solange Arsenault to COVID-19 in the spring and says she saw for herself how the residence where Arsenault lived, the Centre d'hébergement Alfred-desrochers, was unprepared for the pandemic.
“What happened in the CHSLDS was never a blind spot,” said Kettenbeil, who remains the president of the residents' committee at the Centre d'hébergement Alfred-desrochers.
“By March,” she said, “there was enough evidence of what was going on elsewhere, in Europe, with the number of deaths in the seniors' residences. The government of Quebec already had enough information to know that they needed to protect the CHSLDS. ... It is negligence, and because it's negligence there has to be a call for accountability.”
When questioned by reporters after the report's release, Rinfret tiptoed around the word “negligence.”
The virus was an unknown, she said, and government officials were often acting on incomplete information.
Overworked staff members unaware of its virulence carried it from room to room, in conditions where close contact is a necessity to feed and aid residents, or it spread through large communal rooms where residents lay close to each other breathing the same air.
Some workers might have carried it to multiple residences where they worked double shifts because, as union officials have noted, they were unable to support themselves with pay from only one residence. Rinfret warned that such practices should end. Premier François Legault has said he regrets not raising orderlies' salaries before the pandemic.
Legault posted his reaction to Rinfret's report on Facebook. “For several years now,” he wrote, “our CHSLDS have lacked funding and personnel. All successive governments are responsible for this, including mine. I take my share of the responsibility.”
Though he was not in his current post at the time — that job belonged to Danielle Mccann — Health Minister Christian Dubé tried to explain why the ombudsperson found that, in some CHSLDS during the first wave, personal protective equipment was scarce, even as the government was insisting there were no shortages.
“Was the equipment at the right place at the right time? This is what we need to clarify,” he said. “At the beginning, the equipment was in certain establishments, but was not at the perfect location at the right time.”
Dubé said all of the ombudsperson's recommendations in the report had been implemented and the CHSLDS are in much better shape now than they were in the spring.
Among those recommendations was a call to improve communication at CHSLDS, optimize infection control, reinforce ground-level leadership and humanize the care residents receive by valuing the position of their caregivers.
That humanization was lost, Rinfret wrote, due to the restriction of caregiver visits, leaving many patients to die alone, without their loved ones by their sides.
At some residences, like the CHSLD Ste-dorothée in Laval or the Résidence Herron CHSLD in Dorval, the most vulnerable Quebecers died by the dozens, sometimes in soiled diapers, without food or care for extended periods.
Rinfret saluted the staff who worked in the CHSLDS under incredibly difficult circumstances. “Many of them,” she wrote, “have been morally affected by the health crisis, by the suffering and death they had before their eyes for many weeks.”