Canada’s Hidden Shame: How COVID-19 Exposed Years of Systemic Neglect in Long-Term Care

long-term care

Long before COVID-19 began ravaging long-term care homes, the country’s most vulnerable seniors were suffering from years of systemic neglect. Photo: duncan1890/ iStock / Getty Images Plus

This story originally appeared in Zoomer’s July/August 2020 issue.

Long before COVID-19 began ravaging long-term care homes, the country’s most vulnerable seniors were suffering from years of systemic neglect.

Anita Coueffin-Cairns was watching the news when she learned about the COVID-19 outbreak at the long-term care home where her mother-in-law lived. Alarmed, she called the Lynn Valley Care Centre in North Vancouver to see how 80-year-old Sandra Cairns was doing.

The family was especially worried because Cairns had chronic obstructive pulmonary disease, which, along with her age, made her far more vulnerable to complications.

A day later, on March 8, an 83-year-old resident of the nursing home died. It was Canada’s first death attributed to the novel coronavirus, and the 204-bed facility, where the average age was about 87, was soon struggling as staff fell ill and didn’t come to work.

On March 16, five days after the World Health Organization declared a global pandemic, the family learned Cairns had tested positive for the virus that causes COVID-19. Getting information on her status was difficult, Coueffin-Cairns said. “My mother-in-law is dying of COVID, and I had to call 10 or 15 times to get an update.”

Cairns died March 19 with no family at her side because they were worried about taking the virus home to their children, including a daughter with a high-risk pregnancy. “Sandy died alone,” Coueffin-Cairns said. “That’s the part my husband has such trouble with. It really weighs on him. He talks about it every day.”

Grief turned to anger when the family saw reports that adequate infection-control measures weren’t taken to protect seniors homes, even though it was well known from COVID-19’s toll in China, Italy and the U.S. that older people were especially vulnerable.

Meanwhile, seniors homes in B.C. were still allowing visitors, and staff were not required to wear masks around all residents. An infected Lynn Valley employee spread COVID-19 to a second seniors home where they also worked.

Yet it took 13 days after the first Lynn Valley death for Vancouver’s health authority to tighten rules at seniors facilities by barring non-essential visitors and prohibiting personnel from working at more than one home.

By this point, eight of the home’s residents had died at a time when the province had recorded just one other death from COVID-19, and more than 50 residents and staff at the home were infected. Twelve more seniors died at Lynn Valley in the following weeks.

“They didn’t take it seriously enough,” Coueffin-Cairns said. “Definitely more could have been done. Had they done something when they first caught wind of it, we wouldn’t be in the state we’re in right now. I feel like these people didn’t have to die.”

 

Ill-Prepared for COVID-19

 

Similar horror stories are playing out across Canada as ill-prepared long-term care homes and other types of seniors residences emerge as hotbeds for COVID-19. A slow, weak and fragmented response by health authorities has exacerbated the impact, which means seniors homes — already plagued by dire staff shortages, lax oversight and inadequate funding — are ticking time bombs for coronavirus explosions.

As this story was being written in April, six weeks after the first Canadian COVID-19 death at the Lynn Valley home, many provinces and territories had yet to adopt rigorous protective measures recommended by advocates and leading geriatric medicine experts.

Dr. Samir Sinha, the director of geriatrics for seven Toronto hospitals, said they include more widespread COVID-19 testing in homes, staff wearing masks around all residents, curbing non-essential visits and barring employees from working at more than one home. In his role as co-chair of Ryerson University’s National Institute on Ageing and an adviser on seniors to federal and provincial authorities, he has been pleading for these four protective measures since late March.

“I feel there were lives lost along the way that didn’t need to be lost. The fact is we weren’t as prepared as we could have been,” Sinha said.

By April 20, only two provinces or territories, British Columbia and Ontario, had adopted all four measures, according to a Zoomer examination. And of those that were adopted, more than 60 per cent weren’t implemented until April. The door was closed after the horse had bolted.

The inaction is all the more galling because it follows years of systemic neglect and repeated investigations warning that seniors homes had grave safety problems. Instead of finding respite and comfort, residents were dying from preventable fires and, in Ontario, at the hands of a serial killer nurse. What’s more, the SARS epidemic had shown clearly that the homes, which house 400,000 Canadians, were highly vulnerable to a pandemic. Yet Canadian authorities, including those in the two provinces hardest hit by COVID-19, Ontario and Quebec, remained astonishingly blasé about the dangers to older people, even as coronavirus cases started to mount in China, and it became plain that COVID-19 would be a dagger pointed at the hearts of seniors.

Then, the coronavirus burst into the Life Care Center in Kirkland, Wash., in late February, quickly felling 43 seniors. By early May, the exploding number of deaths in seniors homes had become a source of international shame, with 3,282 residents losing their lives to the virus, or 82 per cent of Canada’s total of 3,983 COVID-19 fatalities, according to data from Sinha. He noted a May 3 study by the International Long-Term Care Policy Network showed Canada had the highest proportion of COVID-19 deaths in seniors homes out of 14 countries.

 

The Reckoning

 

When the dust finally settles, advocates say, Canada and other nations must face a reckoning over how their most vulnerable citizens were left as sitting ducks when the pandemic swept in.

Prime Minister Justin Trudeau decried the “terrible tragedies in long-term care facilities” at his daily briefing on April 23. “If you’re angry, frustrated, scared, you’re right to feel this way. We can do better. We need to do better because we are failing our parents or grandparents, our elders, the greatest generation who built this country…. In the weeks and months to come, we will all have to ask tough questions about how it came to this.”

But when Trudeau was asked about adding seniors homes to the Canada Health Act, which would require meeting national standards, he didn’t address the question directly.

“There will be a lot of conversations that Canadians are going to demand and that politicians will have about what is the best way to ensure that we are
properly protecting our elders,” he told reporters at the briefing.

In an interview with Zoomer, Minister of Seniors Deb Schulte acknowledged “there have been some massive failures” in COVID-19-stricken seniors homes. “There is an opportunity in all crises to look at what has happened,” she said. When asked if there should be an inquiry, she said it was too early in the pandemic because the country was still focused on saving lives.

As for money, she wouldn’t say whether the $40 billion in 2019-20 transfer payments to provinces and territories for health care would be increased, despite a July 2019 plea from premiers for the federal government “to return to a sustainable partnership” and increase funding by 5.2 per cent a year as “a starting point,” in part to meet the needs of Canada’s aging population.

Quebec Premier François Legault has been particularly vocal about the shortfall in health-care funding, saying the federal share has fallen to 23 per cent from 50 per cent since Medicare was introduced in 1966.

“If I have one request of Mr. Trudeau, it’s that he get back to 50 per cent,” Legault said in late April.

Almost half of Pinecrest Nursing Home’s 65 residents died of COVID-19. Photo: Fred Thornhill/CP images

 

During the 2015 election campaign, Trudeau promised to negotiate a new deal with provinces and territories that addressed long-term health-care funding. He denounced the Harper government’s decision to reduce annual increases in the Canada Health Transfer to three per cent from six at a time when the population was aging and “the number of Canadians in need of long-term care will only rise.” The Liberal government subsequently held the funding escalator to three per cent in individual deals struck with all provinces and territories.

But Schulte shifted the conversation on understaffing and lack of preparedness in seniors homes away from the federal government. “Long-term care regulation and administration is under the provinces and territories. The federal government has obviously stepped in to help,” she said, referring to soldiers deployed to Ontario and Quebec to help out in short-staffed homes and new infection-control guidelines from the Public Health Agency of Canada.

After the nightmare of Lynn Valley came the horror show in Bobcaygeon, Ont. The community’s 65-bed Pinecrest Nursing Home made international headlines after it lost nearly half of its residents to COVID-19 by early April. The aging, chronically understaffed facility, which houses up to four residents to a room and was long-slated to be modernized, didn’t isolate the infected from the healthy until 16 had died. In some cases, only a curtain separated residents.

In Quebec, the province with the highest number of COVID-19 deaths, the coroner’s office, police and health authorities are investigating the Résidence Herron long-term care home in Montreal after 33 residents died in just 17 days by April 12, at least five of them from COVID-19. Authorities found shocking scenes of neglect: dehydrated and undernourished residents, others with overflowing diapers, urine bags full to bursting and dried excrement on their skin, a lack of protective equipment and virtually no staff coming to work.

Northwood Manor
The workers union at Northwood Manor in Halifax have called for an inquiry into the facility’s COVID-19 deaths, which accounted for 85 per cent of all deaths from the virus in Nova Scotia at the time of writing. Photo: Andrew Vaughan/CP images

 

The private residence’s co-owner has denied Premier Legault’s claim of gross negligence and said the facility had pleaded in vain for government help after sick and fearful personnel didn’t come to work.

Health authorities quietly put the home under government management, but it was only after media reports surfaced about the living conditions that the province took stronger action, ordering inspections of all seniors homes, COVID-19 testing of all staff and residents and enhanced monitoring of five other problem homes.

One of Canada’s worst outbreaks happened at the Sainte-Dorothée long-term care home in the Montreal suburb of Laval, which was reporting 78 deaths from COVID-19 and 183 positive cases — 95 per cent of total residents — on April 27. The virus is thought to have entered the home via two infected workers, who were told to work despite having flu-like symptoms, the Quebec news site La Presse reported.

The employees asked to be excused from work and get tested for COVID-19, but they were reportedly refused because they “didn’t have all the symptoms,” a union official, Gilles Tremblay, told La Presse. They stayed on the job and had contact with dozens of patients. After they were finally tested the following week, the results came back positive for the coronavirus. A provincial workplace safety inspector, called to the home after employees complained about poor infection controls, confirmed in a report “workers who had symptoms compatible with COVID-19 continued to work.”

“On March 22, we had practically no cases,” Tremblay told the Quebec news outlet. “The next week, we had a lot of new cases on the floors where they worked. Then, it degenerated in the whole building.” If rules on sick workers had been followed, he said, “none of this would have happened, or at least it wouldn’t have been as bad.”

Remarkably, Quebec and Ontario exacerbated the problem when they uprooted hundreds of hospitalized seniors in an effort to free up beds in anticipation of a flood of COVID-19 cases that never materialized. Some of the seniors were moved to understaffed long-term care homes already reeling from absenteeism after workers called in sick because they had COVID-19 or were afraid of getting it.

Some of the homes were already experiencing coronavirus outbreaks, including the Sainte-Dorothée facility. The discharged patients may have spread the coronavirus in those homes, while others later tested positive for COVID-19 after their transfer. “We threw these seniors to the wolves,” one unnamed health official told La Presse.

Meanwhile, in Nova Scotia, the union representing health workers at Northwood Manor, the province’s largest long-term care home, is demanding an inquiry after 35 residents in the facility died from COVID-19 — at press time, 85 per cent of all deaths from the virus in Nova Scotia.

Federal, provincial and municipal governments took swift, decisive action in other ways after the World Health Organization declared COVID-19 a global pandemic. Within days, schools, parks and many non-essential businesses were shuttered. Canadians were urged to practise physical distancing and self-isolate for two weeks if they had been sick or recently travelled, with a quarantine enforced by stiff fines and even potential prison time if they did not comply.

In contrast, steps to protect seniors homes have come in dribs and drabs, with a patchwork of different rules in each province and territory. “More than 80 per cent of Canada’s deaths have occurred in seniors homes, where just one per cent of Canadians live,” Sinha said. “It really begs the question of how it got so bad.”

 

Guidelines Didn’t Go Far Enough

 

It wasn’t until April 8 — four weeks after COVID-19 was declared a pandemic — that the Public Health Agency of Canada finally issued voluntary national guidelines for seniors homes. No one is obliged to follow the rules, and these, too, fall short of Sinha’s recommendations. For example, they recommend testing only symptomatic staff and residents, even though some infected people never show symptoms, and it takes an average of five days — and sometimes as many as 14 — to appear in others. They also suggest banning staff from working at multiple homes “where possible.” The guidelines were actually weaker than the steps some provinces had already taken.

Health Canada refused an interview for this story. “There will not be any interviews on this,” spokeswoman Maryse Durette said in an email. “Long-term care facilities are governed by provinces and territories. Call them for their rules about mobility of workers as well as how they do testing.”

Sainte-Dorothée
A lawsuit has been filed against Sainte-Dorothée in Laval where 78 died. Photo: Ryan Remiorz/CP images

 

Sinha, who works for Mount Sinai and University Health Network hospitals in Toronto, said there is a “hodgepodge” of recommendations. “It’s deeply
fragmented. Every province and territory is doing things at their own pace. It’s a shame to see how
this is unfolding.”

Sinha is working around the clock these days, sometimes forgetting to eat as he cares for patients and advises the Ontario and federal governments on their COVID-19 response for seniors.

He believes more should have been done and sooner. While most provinces and territories eventually took basic steps such as barring non-essential visitors and checking residents’ temperatures, his other recommended measures were still not in place in much of the country by mid-April.

As of April 20, in five provinces, COVID-19 tests were done only when symptoms appeared in residents and staff, according to a Zoomer review of provincial and territorial websites. Only five provinces barred staff from working at multiple facilities. And in two provinces, masks were required only when staff was around residents with COVID-19 symptoms or who had tested positive. Meanwhile, seniors homes and unions across Canada have complained of a dire shortage of masks and other protective gear.

It took an average of 24 days for provinces to adopt protective measures for seniors homes after March 11, the day the World Health Organization declared a global pandemic. As a comparison, schools were closed after just six days on average. (The territories, where few COVID-19 cases have emerged, publish incomplete information on their practices.)

Even basic data is lacking. The federal government doesn’t regularly report detailed statistics on the number of COVID-19 cases in seniors homes. Each province reports different metrics, making it impossible to get a clear picture of the impact on Canada’s most affected and vulnerable population.

Quebec, for example, puts out a daily list of every seniors home with an outbreak but not the numbers of deaths. The province has about 400 public and private long-term care homes with 45,000 residents, along with 3,600 retirement homes and other types of seniors lodging such as assisted living, where 140,000 live.

Ontario, for its part, publishes data on the number of cases, deaths and outbreaks in the province’s 625 long-term care facilities where 114,000 people live and 750 retirement homes that house 60,000 residents, but the data has been criticized for being incomplete.

Sinha is working with colleagues at the National Institute on Ageing in Toronto to comb through media accounts and public health reports to compile numbers on outbreaks in all Canadian seniors homes. On April 29, Sinha’s list for Ontario had five more seniors homes with outbreaks than the province’s data, plus 1,546 more COVID-19 cases among seniors home residents and staff, and 287 more deaths. “You can’t fight a fire blindfolded,” he said. “More transparency will allow better efforts.” With data and better protections, “we may be able to stem a significant number of additional deaths.”

 

“Deplorable and Shameful”

 

The failings don’t come as a surprise to Daniel Pilote, 58, a quadriplegic with muscular dystrophy who needs a tracheostomy tube and ventilator to breathe at night.

Since the week of March 16, he has stayed in his 10- by 12-foot room in the Champagnat long-term care home in Saint-Jean-sur-Richelieu, 40 kilometres south of Montreal. “It’s better for me not to leave my room because it could be dangerous for me to have an infection.” He eats meals in his room and spends his time on a daily live forum he hosts on the Zoom video conference service about COVID-19, which lets him connect with other long-term care residents and talk about their concerns.

Pilote is the lead plaintiff in a $500 million class action lawsuit filed in 2018 against the province and regional health authorities over “deplorable and shameful” conditions, abuse and neglect in long-term care facilities. In September, a Quebec Superior Court judge authorized the lawsuit, which the plaintiffs’ lawyers estimate covers 37,000 residents in the province’s 300 public long-term care homes.

He said Quebec authorities once again are showing their neglect of seniors by moving too slowly to shield them from COVID-19. The province waited until the virus had spread to 813 private and public long-term homes and retirement facilities in early April before finally ordering COVID-19 tests for residents and staff and requiring employees to wear masks. “There has been terrible carnage,” Pilote said. “They haven’t taken the right precautions.”

The Quebec health and social services ministry said no one was available for an interview for this article. In an email, spokesman Robert Maranda said early COVID-19 testing focused on travellers with symptoms because seniors homes “weren’t considered hot spots,” adding that “priorities are evolving and will be reconsidered based on the epidemiological situation.” And the province had yet to adopt Sinha’s recommendation barring employees from working at multiple homes, a step B.C. took in mid-March. Maranda said this was to give facilities flexibility to assign staff to homes where they are most needed, although he acknowledged the practice could lead to “a certain risk of transmission.”

CARP, Canada’s largest advocacy organization for older Canadians and a not-for-profit affiliate of ZoomerMedia, has been calling on governments for years to address chronic understaffing in seniors homes.

“We needed to invest in personal support workers and care staff long ago,” said Marissa Lennox, chief advocacy officer of CARP. “We’ve known this for many years.”

Reacting to the mounting death toll and problems in seniors homes, Lennox recommended in early April that families consider taking relatives out of facilities they had concerns about, if they had the capacity to care for them at home.

“Some of the better-run homes coped well and managed to limit outbreaks. But the pandemic exposed those facilities that were simply incapable of delivering even the minimum standards of care for their most vulnerable residents,” Lennox said.

The pandemic shows Canada’s entire system of elder care is “totally inadequate.” A key pillar in CARP’s Fix Health Care Now campaign, launched in February, is to improve access to at-home services and ensure safe and accessible long-term care facilities.

“CARP will focus on pushing governments to take a hard look at the entire system of long-term care: the facilities, infection control, inspections, staffing and operations,” Lennox said. “We’re asking governments to take an entirely fresh approach to how they care for seniors because it’s only going to get worse if they don’t fix it now.”

The number of long-term care beds in Ontario has increased 0.8 per cent to 78,664 since 2001, while the number of Ontarians aged 75 and over has shot up 20 per cent to 1.1 million, according to a 2019 report from the province’s Financial Accountability Office. The waiting list for long-term care now has 35,000 names, and the aging population means 55,000 new beds are needed by 2034 to keep the wait list at the current level, the report said.

Jane Meadus, a lawyer at the Toronto-based Advocacy Centre for the Elderly, points to the 2018 Ontario inquiry into nurse Elizabeth Wettlaufer’s murder of eight seniors in her care by injecting them with lethal doses of insulin. The inquiry found that understaffing in seniors homes and lax government oversight helped Wettlaufer get away with her killing spree. The nurse had more than 50 complaints filed against her for abusing seniors and other work-related problems, for which she was mostly unpunished.

The Wettlaufer inquiry had 91 recommendations to make seniors homes safer. Many also apply to COVID-19, such as boosting staff numbers, improving inspections and better tracking of deaths. Only 18 have been enacted, according to the province’s long-term care ministry, and Ontario has yet to act on the understaffing issue, promising only to study it. In fact, under Doug Ford’s watch, the province has actually moved in the opposite direction when it comes to oversight, sharply reducing the number of comprehensive annual inspections from 500 to 625 a year between 2014 and 2017 to just nine in 2019, according to an April 15 CBC investigation.

Arpad Horvath Jr., whose 75-year-old father was killed by Wettlaufer in London, Ont., filed a 2017 civil lawsuit in the Ontario Superior Court of Justice over the murder. He sees a parallel between what happened to his dad, Arpad Horvath, in 2014 and the government’s feeble COVID-19 response.

“Governments were caught with their pants down, and we’re paying for it with lives,” said Horvath, a writer and actor who lives outside of London in Dorchester, Ont. “Seniors are at the bottom of the list. It really offends me. Seniors helped build this country. We should look out for them. After Wettlaufer, instead of sitting back, they should have taken action.”

Even before the Wettlaufer inquiry, a deadly 2014 fire in a seniors home in L’Isle-Verte, Que., laid bare the neglect in Canadian seniors homes. It killed 32 residents, including almost everyone in a part of the home without sprinklers. Coroners, fire chiefs and seniors advocates had long called for sprinklers in seniors homes after earlier tragedies, such as blazes in two different Montreal homes that killed 14 in the 1990s, but Quebec and most other provinces and territories failed to act. (After three inquests and 45 fire-related deaths in Ontario since 1980, in 2013 the provincial government required most seniors homes to install sprinklers but gave some up to 12 years to comply.) Canada has the worst record of any country outside the U.S. for fire deaths in seniors homes, with four fires in the top 12 deadliest blazes recorded from 1950 to 2004, according to the U.S. National Fire Protection Association.

And a decade before Wettlaufer and L’Isle-Verte, a 2004 Ontario inquiry into the SARS epidemic, which killed 44 Canadians, revealed seniors homes were vulnerable to a future disease outbreak. “The [Canadian health-care] system is stretched even when dealing with business as usual, with high rates of absenteeism and overtime,” warned a report submitted to the inquiry by four McMaster University nursing experts. “Such a system is extremely vulnerable to additional pressures,” they said, adding that long-term care homes were particularly at risk.

Now scrambling to cobble together a COVID-19 response after years of neglect and missed opportunities, health authorities are ad-libbing with improvised moves. Quebec asked teachers in the health sciences and nursing to volunteer in seniors homes, called on retired nurses and doctors to come back to work, requested 1,000 members of the Canadian Armed Forces to help out in homes and offered doctors $211 an hour to work with seniors regardless of their tasks. The premier later backpedalled on doctors’ pay after an outcry over the fact that MDs would make 10 times more than orderlies, who earn $20.55 to $22.35 an hour.

Ontario is also relying on the army and other volunteers, including doctors and nurses, to help with personal care at seniors facilities. It also adopted a controversial order in council on March 27 allowing homes to hire untrained workers, skip reporting of patient complaints to the province and flout rules requiring minimal hours of care for each resident. Government inspectors who oversaw the homes have also been reassigned to other tasks during the COVID-19 pandemic, such as helping homes find staff and protective equipment.

Amazingly, the changes meant that while other Canadians were being encouraged to call snitch lines to report noncompliance with COVID-19 distancing rules, the complaint process was being suspended for residents and families to report problems that could put seniors at greater risk from COVID-19.

The Ontario long-term care ministry said no one was available for an interview for this story. “These are extraordinary times which call for extraordinary responses,” the ministry said in an April 16 email from spokeswoman Lidia Piccolo. “Ontario was short on long-term care staff before COVID-19 hit, and now we have needed to grow our workforce — fast.”

 

Taking the Fight to the Courts

 

After all the potentially avoidable deaths, unheeded warnings and ignored reports, seniors may be wondering what may finally spur action. Residents and families are already pursuing one idea: the courts.

Applications to launch class-action lawsuits against the troubled Résidence Herron and Sainte-Dorothée long-term care homes were filed in Quebec Superior Court in mid-April. The lead plaintiff in the Herron case is Barbara Schneider, whose mother Mary Schneider, 93, died April 10 from COVID-19. The application, for $5 million in punitive and moral damages covering about 130 residents and their families, faults the home for “inhumane and degrading maltreatment” of residents.

Back in Saint-Jean-sur-Richelieu, Daniel Pilote said the Champagnat home appears to be COVID-free for now. All he can do is wait in his room until it’s over. He is “absolutely” considering an amendment to his class-action lawsuit to address what he calls a horrendously inadequate coronavirus response. “COVID showed how the system functions in long-term care,” he said.

In B.C., Anita Coueffin-Cairns said families who lost loved ones at the Lynn Valley home are talking about their own class action case. “They weren’t prepared for this at all and, if they had been, this wouldn’t have happened,” she said. “We want them to be better prepared. The best way to teach people is to hit them where it hurts.”

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