Six months after the pandemic first hit, Quebec Health Minister, Christian Dubé says his government has drawn lessons from the spring crisis in nursing homes that killed more than 2,000 elderly Quebeckers, but concedes that staffing problems remain.
The minister made his remarks Thursday as he urged Quebeckers to limit social interactions in coming weeks to keep the second wave of the pandemic under control. He said it would be better if people skipped Thanksgiving gatherings “to ensure we have a nice Christmas.”
Quebec authorities reported 582 new cases Thursday, the second time in a week that there has been a daily increase of more than 580 infections.
“We are going to hit a wall if we don’t change our behaviours,” said Horacio Arruda, Quebec’s Director of National Public Health.
Unlike the spring’s first wave, there are more infections among young people, but Dr. Arruda warned that the problem could still ripple into long-term care (LTC) homes, the main victims of the initial outbreaks.
What happened to LTCs is still fiercely debated. Provincial ombudswoman Marie Rinfret criticized the province for failing to heed repeated calls to strengthen its elder-care system in the years before the pandemic.
“We’ve blamed it on staff shortage, exhausted personnel, lack of qualified workers, aging buildings. These shortcomings struck harder than usual but they were there before, and they were often flagged in previous decades,” Ms. Rinfret said Thursday.
Quebec has now hired more orderlies, increased their salaries and banned them from working at different nursing homes at the same time, to prevent the disease from spreading.
However, Mr. Dubé conceded there is still a shortage of nurses and auxiliary nurses. Sometimes nursing staff will have to practise in several facilities to prevent a breach in medical care, he said. Such movements will have to be authorized by the CEOs of local health boards.
“I say this with a lot of realism everyday, we cannot change all of that within months,” the minister said. “ … We managed to do that with orderlies but we are far from achieving that with nurses."
Meanwhile, Marguerite Blais, the minister responsible for seniors, gave an interview with Radio-Canada where she replied to questions about the spring’s crisis by noting that decisions were made by Premier François Legault and Dr. Arruda, not her. “The Premier has the power. He’s the one who decides the strategy," she said.
The interview left opposition parties asking why Ms. Blais was still in cabinet. “Frankly I wonder what role the Minister for Seniors still has in this government,” Parti Québécois acting leader Pascal Bérubé said.
On Wednesday, the government released two reports on investigations into the spring COVID-19 outbreaks at the Herron and Sainte-Dorothée long-term care facilities.
Sainte-Dorothée, in Laval, north of Montreal, is a public home and was well run, its report said. Still, 100 of its residents died of COVID-19.
The report noted the government’s decision to off-load hospital patients to care homes to bolster its intensive-care capacity. “That strategy focused on hospitals to the detriment of LTC homes, limiting the latter’s margin of manoeuvre.”
And once the virus struck Sainte-Dorothée, the response was sluggish, the report said. Staff were not systematically tested right away so “asymptomatic employees became transmission vectors.”
There were five hierarchical tiers between the CEO of the local health authority and the frontline manager at Ste-Dorothée. As a result, the alarm wasn’t raised when COVID-19 began striking staff and residents in the days after March 18.
Unlike Ste-Dorothée, Herron is a private home, located in Montreal’s West Island. In the three years before the pandemic, it was the target of nine investigations from eight different bodies, including the ombudswoman, professional orders for nurses and for auxiliary nurses, the coroner’s office.
The investigations all found shortcomings. Herron was chronically understaffed and lacking medical supplies. “People in charge at the Herron LTC never managed to set up a stable, properly-trained work team," its report said.
After a first COVID-19 case on March 26, most of the Herron staff stayed away, in part because of confusing instructions to quarantine, the report said, noting that those who remained had no protective gear and few masks.
When the local health board stepped in on March 29, only three staffers were looking after 133 residents in squalid conditions – 38 residents eventually died.
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