Québec Ombudsperson Marie Rinfret released her findings on how the COVID-19 crisis in residential and long-term care centres (CHSLDs) was handled during the first wave of the pandemic on November 23, 2021. In her special report tabled in the National Assembly, she made 27 recommendations to the Ministère de la Santé et des Services sociaux and to the Minister aimed at implementing far-reaching measures to act on the causes of the crisis and to improve residents’ living conditions.
The Québec Ombudsman’s findings are based on an impartial and independent investigation. The Progress Report released in December 2020 highlights firsthand witness statements. The special report tabled today includes an analysis of accounts by experts and government authorities in key areas (health institution management, geriatrics, crisis management, epidemiology, and infection prevention and control).
"Our investigation made it possible to dig deep and understand why CHSLDs were doubly hit—under siege during the pandemic, and unable to deal with the outbreaks and deaths. Our report brings into sharp relief the frailty of services, structures and communication channels," said Marie Rinfret.
Some of the causes of an unprecedented human crisis
As they braced for COVID-19, which would spread across Québec, government authorities were quick to make hospitals the focal point. To free up hospital beds, many patients were transferred to CHSLDs. These living environments, already short-staffed, did not have the resources needed to accommodate the sudden influx of people who were already fragile. As a result, decisions were made by authorities who did not have the wherewithal to adequately gauge the ability of CHSLDs to fulfil this unusual mission.
Other factors contributed to service decline and disorganization, including the authorities’ underestimating CHSLD residents’ vulnerability to the virus. The effects of staff absenteeism due to COVID-19 had not been foreseen either. The complex nature of the jobs of healthcare teams should have quickly sounded the alarm about why things went awry and required solving urgently.
When planning for the pandemic, the Ministère de la Santé et des Services sociaux had not considered how serious it was that CHSLD staff knew very little about best practices in infection prevention and control during major outbreaks. Storming these living environments, the virus only confirmed this ignorance, which was exacerbated by lack of personal protective equipment, as well as by outdated premises.
Moreover, lack of managers in each CHSLD often slowed the response "on the ground" to ever-changing instructions from health authorities.
The Québec Ombudsman’s recommendations
Given the extent of the crisis during the first wave and its dramatic repercussions in Québec, the Québec Ombudsman recommended that the Ministère de la Santé et des Services sociaux put in place various mechanisms, especially:
- A risk assessment and management policy concerning CHSLDs;
- A detailed plan for strengthening CHSLDs’ ability to apply infection prevention and control measures;
- A personal protective equipment supply strategy;
- A provincial plan for deploying emergency personnel within the health and social services network to make the most of back-up resources;
- Protocols with professional orders, federations and associations, unions, and educational institutions for deploying extra staff in exceptional circumstances;
- A Québec strategy to combat staff shortages and to promote health and social services trades and professions;
- A Québec action plan to recognize the complexity of care and service provision in CHSLDs.
All reforms must include the introduction of reliable and performant information systems.
The Québec Ombudsman recommends that the Minister of Health and Social Services propose annual acts of commemoration of COVID-19 victims in CHSLDs and of the people who worked with them directly or indirectly. It is important to remember what these people went through so that their experiences are the catalyst for sustainable action and change.
The Québec Ombudsman has asked the Minister to provide it with a progress report about implementation of the recommendations as at March 1, 2022, and then according to a follow-up schedule to be agreed upon. It intends to discuss this follow-up in its Annual Report until the recommendations have been implemented to its satisfaction.
Source: Office of the Québec Ombudsman (Protecteur du Citoyen du Québec), Canada