Alberta’s auditor-general to review province’s COVID-19 response in continuing care facilities

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Alberta’s independent watchdog is reviewing the government’s management of the province’s continuing-care system during the coronavirus pandemic, investigating the circumstances under which COVID-19 flourished in facilities housing vulnerable citizens.

The auditor-general of Alberta is in the initial stages of the review and expects to release its report this year, according to spokeswoman Val Mellesmoen. The auditor-general’s office is still determining the scope of the audit, but it will focus more on processes and oversight than finances, she said.

The pandemic has devastated Canada’s continuing-care facilities, especially long-term care operations. Outbreaks have taken hold at 43 per cent of long-term care facilities across the country, according to Ryerson University’s National Institute on Ageing (NIA). In Alberta, outbreaks have rippled through 73 per cent of long-term care operations, making it the worst-performing province in Canada, according to NIA’s statistics. The vast majority of deaths related to COVID-19 in Canada stem from long-term care facilities and various investigations are under way across the country. In Quebec, for example, a coroner’s inquiry into that province’s nursing home disaster begins Feb. 8.

In Alberta, the auditor-general’s continuing care review consists of two parts: One will be a new performance audit, and the other will assess the status of three recommendations the auditor-general issued in 2014, Ms. Mellesmoen said.

“I can confirm we are doing some audit work related to continuing care facilities stemming from COVID-19,” she said in a statement.

Steve Buick, a spokesman for the Minister of Health, said department staff connect with the auditor-general regularly to support the review, adding that Alberta Health Services has made changes to address the auditor-general’s previous concerns over monitoring care and managing performance of continuing care facilities.

He also noted the government is conducing two of its own health care reviews related to the COVID-19 pandemic.

About 1,000 residents in Alberta’s long-term care facilities have died of COVID-19, according to NIA, and some family members are not waiting for official reports before pointing fingers. Brentwood Care Centre and its owner, Intercare Corporate Group Inc., are facing a class-action lawsuit alleging low staffing levels, poor training and weak protocols contributed to an outbreak that infected 87 residents and staff and killed 18. The allegations have not been tested in court.

British Columbia commissioned a review of its long-term care system this spring, but only released it last month after the province came under pressure. It found residents in private and non-profit homes did not receive the same level of protection as those in publicly owned facilities.

Alberta’s auditor-general has not yet determined whether the review will include private facilities. If they are included, investigators will examine Alberta’s oversight of those operations, rather than the organizations themselves. Auditor-General Doug Wylie in May said his office would review the government’s response to the pandemic, but provided few details. However, he noted the review may include outstanding recommendations, such as those around seniors care.

The earlier recommendations provide a glimpse of what the continuing care review will encompass. The auditor-general’s 2014 report recommended, for example, the need for Alberta Health Services to better monitor care of residents. It suggested AHS develop a system to verify that facilities provide residents with “adequate number and level of staff, every day of their operation,” and that the operations “deliver the right care every day by implementing individual resident care plans and meeting basic needs of residents.”

It also suggested AHS better monitor and manage performance of long-term care facilities, and that the Department of Health improve oversight at the provincial level, including improving public reporting “on what results the provincial long-term care system is expected to achieve and whether it is achieving them.”

Samir Sinha, director of health policy research and co-chair of the National Institute on Ageing, argues NIA’s data on long-term care facilities and COVID-19 demonstrates the need for Alberta’s investigation.

“We have to figure out how we allowed this story to unfold in Alberta,” he said. “Alberta is the outlier across Canada.”

NIA has logged COVID-19 outbreaks at 73 per cent of Alberta’s long-term care facilities, compared to 62 per cent of those in Ontario. In British Columbia, 39 per cent of long-term care facilities have been hit with outbreaks, according to NIA. Meanwhile, these facilities account for 64 per cent of all COVID-19-related deaths in Alberta, putting the province in the middle of the pack.

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