Monday, June 15, 2020

Report on Quebec nursing homes confirms the need to rethink nursing homes

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

During the COVID-19 crisis, several nursing homes in Ontario and Quebec had uncontrolled outbreaks leading to the deaths of hundreds of residents with a large number of nursing home staff becoming sick. The outbreaks in these nursing homes was so critical that the Ontario and Quebec government's asked the federal government for assistance from Canada's military.

On May 27, I wrote about a Canadian military report stating that there were disturbing conditions in Ontario nursing homes. Military personnel who were caring for nursing home residents reported of systemic nursing home elder abuse. According to the CBC News Report by Nick Boisvert:

The list of allegations includes:
  • Repeated use of medical equipment between COVID-19 patients and others who had not tested positive, without it being disinfected. 
  • Improper use of personal protective equipment (PPE) by staff and doctors. 
  • Housing of COVID-19 patients with residents who had not tested positive. 
  • Staff reusing gloves or not washing hands between resident interactions. 
  • Staff being aggressive with residents during medical procedures. 
  • Residents calling for help with no response for up to two hours. 
  • The presence of insects, including cockroaches and ants.
The military report stated that one resident choked to death due to negligence of a staff member.

The Canadian military released a similar report concerning Quebec nursing homes. Compared to the Ontario report, it appears that the Quebec report may have been 'cleaned up' before being released.

It is estimated that 2700 Quebec nursing home residents died from COVID-19. According to Les Perreaux and Tu Thanh Ha, reporting for the Canadian Press:
Orderlies showed up late or disappeared during their shifts. Boxes of surgical masks and narcotics went missing. Long-time employees quarrelled with newcomers and repeatedly ignored safety instructions.
The 60-page report summarizes the observations of more than 1,000 military personnel deployed at 25 Quebec seniors’ homes.
While some homes were praised for having efficient management, the military detailed a litany of poor medical practices or management issues at other locations.
The CP article focused on several nursing homes that were featured in the military report:
At Montreal’s Grace Dart Extended Care Centre, where 61 patients have died, personal protective equipment (PPE) was an issue. “Prevention and control of the contamination didn’t follow the guidelines set by [the local health authority]. On our arrival, the use of PPE was a major problem,”
The military said Vigi Mont-Royal, where 70 residents died, had trouble controlling the distribution of PPE and medications. For example, a shipment of 20 boxes of surgical masks and one of narcotics disappeared.
“We noticed that [safety] guidelines were not followed by some civilian employees despite constant reminder by our military … each day we witnessed employees who didn’t follow the protocols set up by the facility.”
The response that we are hearing is that we need to improve nursing homes. I agree that existing nursing home care is often substandard, but the answer to the problem is to move to a system of home care.

The report of the Parliamentary Committee on Palliative and Compassionate Care that was published in November 2011 is a fundamental guide to moving healthcare systems forward.

In its recommendation XV on page 52, concerning Palliative and End-of-Life care the report states:
Home care is foundational to transforming Canada’s health care system. In reality it is a paradigm shift in our vision of health care. Allowing patients to stay at home has pronounced benefits for everyone involved, not least of which, the person being cared for in their own home and community. This is important as our nation seeks ways to improve the care of the elderly and vulnerable.
We need to learn from the community living movement. I recognize that the needs of people with disabilities can be very similar to the needs of the elderly.

We need a caring culture: a culture that does not institutionalize the elderly, infirm or people with disabilities, but rather offers compassionate community care.

Policies that promote home care and enable people to live independently need to be implemented. For people experiencing dementia or Alzheimer's, a community such as Hogeweyk, in the Netherlands provide an excellent example of how this is done.

Institutionalizing and warehousing people results in a culture of abandonment, abuse and often death.

Let's rethink the concept of nursing homes.


Unknown said...

The move to Home Care to resolve the issues in Long Term Care Homes is not sustainable. Someone obviously does not understand the issues involved. After 14 years in the administration of nursing care in the Long Term Care Sector, I can definitely state that Home Care is not the answer for the majority of residents currently in Long Term Care Homes.
The solution to the problem in Long Term Care is a combination of more bedside staff and more supervisors to ensure that the direct care givers are doing what they should do in the manner that they were taught to do it. Anything short of this will not resolve the issues.

Alex Schadenberg said...

Dear Unknown: I have a policy of not publishing comments who are unwilling to put their name on their comment. Nonetheless, nursing home care is unsustainable. To fix the problem, as you say, will require more bedside staff and more supervisors. Whereas more bedside staff will be a big help, more supervisors are expensive and don't provide care at the bed side.

Homecare isn't for everyone, but more homecare and the provision of more help for people caring for loved ones at home will lead to fewer institutional beds and more loving care.

Anonymous said...

Home care suffers from the same problem long term care facilities suffer from: there are just not enough people want to make a living changing adult diapers for minimum wage!

My father had home care for a year before he died. Only a few Personal Support Workers (PSWs) were skilled, gentle, and reliable. Most were mediocre. A shocking number were downright awful--unreliable, no-shows, or treated my father very roughly. My mother had to supervise VERY closely.

Note that most of the PSWs worked part time with a home care agency and part time with a long-term care facility. So, you are getting the same staff giving rough and irregular care under both at home and in institutions.

- Julie