Staffing still Achilles heel of Quebec's fragile network of long-term care homes

Quebec hospitals have so far borne the brunt of the Omicron wave, with an unprecedented surge in COVID-19 patients, but the province's network of long-term care homes is also dealing with another round of outbreaks from the highly transmissible variant.

While the situation in long-term care institutions, known as CHSLDs, is nowhere close to the crisis that unfolded in the spring of 2020, the number of outbreaks has climbed in recent weeks.

The number of deaths in CHSLDs has also increased, with 40 reported last week alone — the most since last February.

One orderly who works at CHSLD Saint-Margaret in Westmount, Que., said staffing remains the main issue nearly two years into the pandemic.

"That's the main problem right now," said the worker, who asked not to be named for fear of reprisal from her employer.

Saint-Margaret is one of more than 300 CHSLDs dealing with a confirmed case of COVID-19, according to the latest data available. There were also confirmed cases in more than 500 private seniors' residences, known as RPAs.

Most outbreaks have remained small, however, and the worker noted that protocols have improved, and there is more protective equipment available.

Contrast that to the first months of the pandemic, from late February to early July 2020, when more than 4,800 in care died, accounting for 85 per cent of total COVID-19 deaths in the province at the time.

Quebec's health and welfare commissioner, Joanne Castonguay, released her final report on Wednesday documenting the failures that led to devastation in CHSLDs in that first wave. 

Early booster helps counter 5th wave

Dr. Leighanne Parkes, an infectious disease specialist and microbiologist at Montreal's Jewish General Hospital, is cautiously optimistic CHSLDs and RPAs will fare much better in this wave than earlier in the pandemic.

"So far, we are holding on," said Parkes, who specializes in infection prevention and control at both the hospital and long-term care facilities overseen by Montreal's west-central health authority.

Unlike the first wave which ravaged long-term care facilities, the outbreaks are generally more manageable now and patients are not as severely ill, she said.

Parkes credits the push to give long-term care residents a third dose of vaccine last fall, before the highly contagious Omicron variant took hold, for helping reduce the number of serious illnesses and deaths in CHSLDs. According to the Health Ministry, of 36,463 CHSLD residents, nearly 90 per cent have received a booster shot.

Although Parkes believes the health authority has learned from its mistakes, she said there are still large, sweeping infrastructure changes required across the system. That's hard to do in the middle of a pandemic, Parkes said, but better ventilation, optimal distancing and improved patient-staffing ratios will need to be addressed in the future.

She acknowledged the network of homes remains vulnerable as the pandemic drags on.

At last count, more than 2,800 workers across the province's network of CHSLDs were absent from their jobs, according to figures provided by the Health Ministry — about  half of them after testing positive for COVID-19.

"The situation is still under control, but it's still fragile," said Annick Lavoie, the head of a group representing private CHSLDs, known in French as l'Association des établissements privés conventionnés (AEPC).

The group recently conducted a survey among members in which half reported they don't have the "necessary support" from local health authorities — for example, continued difficulty in procuring N95 masks.

The strain in hospitals has also prompted some regions, including Quebec City and the Laurentians, to transfer more patients from hospital into CHSLDs.

Caregivers offer relief

Joyce Shanks, whose father is a resident of Maimonides Geriatric Centre in the Montreal suburb of Côte Saint-Luc, said low staff numbers still haven't been addressed at that institution. As a result, she said, residents sometimes don't get adequate care, such as attention to their personal hygiene.

"This staffing issue has been skirted around for nearly two years, and it is only worse now because so many people are sick, including a lot of the staff," she said in an email.

In contrast to the pandemic's early days, the province now permits caregivers to go into long-term care facilities, which has allowed families to provide a helping hand when staffing levels are particularly fragile.

If residences find themselves in trouble, there are contingency plans and places to call to get backup in a more timely manner, said Parkes.

Natalie Stake-Doucet, a registered nurse who worked at CHSLD Yvon-Brunet during the first wave, isn't convinced long-term care staffing has improved since then.

Now the president of the Quebec Nurses' Association and working at a vaccination clinic, Stake-Doucet said many CHSLDs are almost entirely dependent on private agencies to ensure staffing — particularly overnight.

While she pursued her doctoral studies, Stake-Doucet said, she briefly worked for a private agency herself. 

"I remember many times, we were two nurses on a floor, and both of us were from agencies. There was nobody that was regular staff," she said.

Stake-Doucet said she hopes caregivers and the vaccine are enough to carry long-term care facilities through this wave.

"Is it a naive hope? Is it a desperate hope? I don't know," said Stake-Doucet, who still struggles with the memories of what she experienced in the early days of the pandemic.

"It was a tragedy of proportions that I never thought I would see in my lifetime."