Canada: How Quebec elder care homes became coronavirus hotspots

Montreal, Canada – Natalie Stake-Doucet says the long-term care home she works at has no hot or cold zones any more – the entire facility, which houses about 180 residents in the Canadian city of Montreal, is hot.

“You ask anybody in long-term care, we knew exactly what was coming,” she told Al Jazeera in a phone interview. “We got no expertise that the hospitals had, we got no equipment, we got nothing. So when it hit, it spread like wildfire because we had very little means to contain it.”

Stake-Doucet is referring to COVID-19, the infectious respiratory disease that has killed thousands of people around the world.

In Canada, the province of Quebec has been hard-hit by the global pandemic: As of Thursday, more than 21,800 cases of COVID-19 and 1,243 deaths were reported, a large portion of which were in and around the largest city, Montreal.

The virus has been particularly devastating for elderly people – people over age 60 account for about 97 percent of all deaths in Quebec so far – and has highlighted systemic problems in the healthcare system, including underfunding and chronic staffing shortages.

More than 63 percent of all the deaths in the province have been in long-term care facilities that house elderly and disabled residents, known as CHSLDs, according to their French acronym. Some CHSLDs are publicly funded, while others are private – though all must conform to provincial regulations. Another 16 percent of deaths have been in private nursing homes.

COVID-19 has spread rapidly in dozens of CHSLDs across the province, fuelled in large part by a lack of staff and shortages in personal protective equipment and supplies.

Stake-Doucet, a registered nurse and president of the Quebec Nurses Association, came forward to work in a CHSLD this month when the province pleaded for help amid what Premier Francois Legault described as a “national crisis” in the facilities.

She said at least two-thirds – about 120 – of the residents at the CHSLD where she works have COVID-19, and the under-staffed facility is struggling to stem the spread of the disease. Eight residents recently died in a single day.

“Every day I see my colleagues cry because [a] long-term care home is like a big family,” Stake-Doucet said. “Long-term care homes are supposed to be a place where you die peacefully surrounded by the people that you love, and that’s not at all what’s happening right now.”

31 dead in one home

As COVID-19 began to spread across Canada, elderly care homes emerged as the sites of major breakouts of the infectious disease.

The country’s first coronavirus-related death was reported at Lynn Valley Care Home in North Vancouver, for example, while dozens of people died at a nursing home in the small town of Bobcaygeon, Ontario.

But the breadth and scope of the problem in Quebec’s long-term care facilities has shaken the province – and the situation at one private CHSLD in Montreal’s West Island area, where 31 residents have died since March 13, raised major questions and concerns.

“We should feel ashamed of ourselves and our governments that let this s*** happen,” Montreal resident Paul Cargnello, whose grandmother passed away at CHSLD Herron, posted on Facebook.

The daughter of another resident who died at CHSLD Herron filed a class-action lawsuit against the home on April 16, seeking two million Canadian dollars ($1.4m) in punitive damages “for the unlawful interference with residents’ rights to personal security and dignity”.

When the local health authority (CIUSSS) visited the home on March 29, they discovered “the place had been completely deserted” by staff, who left largely “due to a lack of resources, most notably personal protective equipment”, the lawsuit states.

“The residents were found in completely inhumane conditions: some were unclothed, severely malnourished, dehydrated, without their medication and left in their feces and urine, creating an odour that permeated the facility.”

Legault, the provincial premier, said what happened there was “unacceptable”.

Montreal police, the Quebec coroner’s office and the Quebec government have launched separate investigations into what led to the deaths at CHSLD Herron.

The owners of the facility have acknowledged that CHSLD Herron was in crisis. “It was total chaos. We were running left and right. We have about 100 employees and, from one day to the next, more than half were missing,” Katherine Chowieri, one of the co-owners and managers of Groupe Katasa, told La Presse newspaper.

“Maybe, yes, there are things we could have done better, but the CIUSSS [local health agency] must also take its share of the responsibility. It can’t just fall on us,” Chowieri said.

Taking responsibility

Meanwhile, Legault has called on doctors to come forward to help take care of CHSLD residents – but some healthcare professionals have said they are running into bureaucratic hurdles or that they were turned away.

During a news conference on April 17, Legault said he took “full responsibility” for not increasing the salaries of CHSLD orderlies quickly enough, a step he said would have helped fill vacant posts and bolstered the facilities’ capacities.

“I know there are many Quebecers who are asking themselves, ‘How could we have gotten into the situation we’re in, where we didn’t take care of our elders, the most vulnerable?'” Legault said.

“We came into this crisis ill-equipped, and evidently the situation deteriorated for all sorts of reasons. The virus got in. Today we’re up to 1,800 people [workers] who are missing from the CHSLDs, so that adds to the existing problem we had in filling those positions before the crisis.”

Prime Minister Justin Trudeau said last week that 125 military medics would be sent to Quebec to help.

On Wednesday, Legault asked the federal government to send 1,000 soldiers to strengthen the workforce at CHSLDs. “It’s not ideal, but at least it will be arms to help us,” he said.

Meanwhile, residents of another CHSLD and their families have filed an application to launch a class-action lawsuit after at least 56 residents died from COVID-19 at a home in Sainte-Dorothee, just north of Montreal.

More than 75 percent of all residents (150 people) contracted the virus, and the legal filing alleges that the residents “are victims of systemic mistreatment”.

On Tuesday, three Quebec medical orders – the Quebec College of Physicians, the Order of Nurses of Quebec, and the Order of Nurses and Auxiliary Nurses of Quebec – announced they planned to launch a joint probe of CHSLDs across the province.

‘Dying alone, neglected’

But no one should be surprised that CHSLDs have been pummeled by the COVID-19 pandemic, said Paul Brunet, chair of the Conseil de la protection des malades (CPM), a group that defends the rights of patients in Quebec hospitals and long-term care homes.

Brunet told Al Jazeera that the facilities were not a priority until the situation reached a boiling point, despite reports from other countries in February and early March that showed how the virus was spreading rapidly inside care homes.

His group in 2018 filed a 500-million Canadian dollar ($354m) class-action lawsuit alleging that patients were being widely mistreated at public CHSLDs. The complaint was given the go-ahead last year, and hearings are expected to be heard in a few months.

“Nothing was done until the crisis began,” said Brunet, about COVID-19.

“If you’re already in a problem of management, recruitment, and sustaining the personnel and keeping them with you because they’re not well paid, guess what? When a crisis like this occur[s], you are in [an] even worse and bigger problem.”

A ban on visitors entering Quebec’s long-term care centres, put in place in mid-March to prevent the spread of COVID-19, may have also exacerbated the problem. Brunet said thousands of family members could no longer provide the care that the under-staffed facilities also typically cannot, such as making sure the residents ate regularly.

“I have complaints of patients and families who are saying that their mother or father is dying alone, neglected, in their diapers,” he said, adding that he feared the death toll would continue to mount both from COVID-19 and a lack of care.

He called on the government to stop talking about launching inquiries – “there [are] plenty of reports on how to treat patients, how to feed them, how to wash them, how many orderlies should there be, how many nurses” – and to finally act.

Montreal nurse Stake-Doucet agreed. CHSLDs need better staffing ratios as well as the equipment they need to run efficiently, she told Al Jazeera, and the government needs to listen to front-line workers and build a system in which people can get accountability.

“It’s hard to feel like you’re not doing enough,” she said.

“It’s like being in this dark bubble. Have you ever had the image like in Le Petit Prince [The Little Prince]? The little prince, he’s alone on his planet. You feel kind of as if you were alone on a planet … It’s hard on the heart and the soul a little bit.”