The Quebec government has placed hospitals “at the center of the crisis” of COVID-19 and has indeed taken “no concrete and specific preparation action” for CHSLDs before mid-March 2020, concludes the Protectrice du citoyen. in its report on the first wave of the pandemic.
She contradicts in her report the version of the facts given last week by the former Minister of Health, Danielle McCann. This had assured that the CEOs of the CISSS and CIUSSS “had to set in motion” the plan to fight a pandemic “from January”, to properly prepare the CHSLDs.
However, Marie Rinfret reveals in her report that “when the strategy was developed in response to the pandemic, no risk analysis adapted to the Quebec accommodation model and its particularities was carried out”. “This is how the CHSLDs were not taken into account by any scenario”, writes the Protectrice du citoyen in her report. COVID-19 in CHSLDs during the first wave of the pandemic – Targeting the causes of the crisis, taking action, remembering.
In the 72-page document, she details the multiple flaws in the preparation of CHSLDs by the Quebec authorities. It concludes that workers in long-term care “have experienced, unfairly and disproportionately, the consequences of the inaction of the public authorities in the face of shortcomings in CHSLDs”.
In her progress report filed in December 2020, Ms. Rinfret already argued that CHSLDs had been in the blind spot of pandemic preparation. In its final report, it calls on the Quebec government to be accountable and indicates that “the status quo is unthinkable, as it is for the people who live in these living environments and their relatives ”.
Its investigation underlines from the outset that a first clinical steering committee on the subject of COVID-19, set up in early March 2020, dismissed the general management of the Ministry of Health and Social Services (MSSS ) responsible for CHSLDs. “The attention of Quebec,” she continues, “was turned towards Italy,” where hospitals were overwhelmed by the influx of infected people.
Result: thousands of beds have been freed in hospitals, in particular through transfers of hospitalized people to CHSLDs. “Between March 1 and March 31, 2020, there is a significant increase of 31% in CHSLD admissions compared to the other monthly periods of the year 2019-2020,” notes Ms. Rinfret. This “represents 1,714 people admitted to CHSLDs”, she adds.
His statement, based on figures from the MSSS, once again directly contradicts the testimony of former Minister McCann at the coroner’s public inquiry into CHSLDs. Ms McCann claimed last week that there were “down to 1000” such transfers in March 2020, the equivalent of 20% more than in February.
“I really want to clarify that it was not a massive transfer of the elderly to CHSLDs. And it was clear that the CEOs had to have the resources to welcome them. I wanted to clarify the point, ”insisted the former minister.
However, the Ombudsperson noted rather that the transfer of patients out of hospitals “has weakened CHSLDs by placing them in overcapacity for the care of vulnerable elderly people”. She also underlines that network actors “concerned about the situation” called “the senior authorities of the MSSS” on this subject. These people “consider today that[elles] have not been heard [e] s, in that the strategy of offloading hospital activities remained the priority ”.
CHSLDs poorly equipped by Quebec
Ms. Rinfret notes that the “problem” is “not to have properly assessed the capacity of CHSLDs to play the radically different role expected in a pandemic context”. She adds that they were not “equipped and adequately protected in the light of their lack of robustness to face such conditions, also considering the great vulnerability of the people who reside there”.
Ms. Rinfret further emphasizes that “the population accommodated in CHSLDs was not considered to its fair potential for vulnerability to COVID-19”. She adds that the government waited until the second week of April to present reinforced protection measures in living environments.
“At one point,” she notes, “the authorities, poorly supported by the information transmitted, minimized the outbreak in the CHSLDs. It was not until the second week of April – a moment which coincided with the revelations of the Montreal Gazette sur CHSLD Herron – that the government has presented reinforced protection measures in living environments.
Otherwise, “no reinforcement measures have been deployed in CHSLDs in terms of PCI [prévention et contrôle des infections] before the crisis, ”she emphasizes. During the first wave, the CHSLDs received “at about the same time as the hospitals, similar directives”, she also illustrates. Except that CHSLDs did not have the same capacity as hospitals to implement measures such as the establishment of hot and cold zones, she points out.
As a very first recommendation, Ms. Rinfret asks Quebec to “put in place a policy for the assessment and management of risks concerning residential and long-term care environments”. It also recommends “formalizing the mechanisms for consultation and communication between the general directorates of the MSSS in the context of a crisis”, to put an end to work in isolation. She adds that it is imperative to “develop and [de] implement a detailed plan to strengthen the capacity of CHSLDs to apply rigorous infection prevention and control measures ”.
The challenge of personal protective equipment
The Protector of the Citizen illustrates in several places the impacts of the lack of organization, communication or information within the MSSS. “Due to the lack of a centralized information system, the MSSS was reduced to having to rely on the CISSS and the CIUSSS to fill out requests manually and obtain information that did not reach them in a timely manner,” notes Ms. Rinfret. “This has been the case, for example, for information related to human resources, outbreaks, materiel management, equipment inventories and information of an epidemiological nature. “
Its report recalls, among other things, that one of the “first concerns” in January 2020 was to count the inventories of personal protective equipment (PPE) available in the network. “This exercise had to be done manually given the absence of centralized data,” notes Ms. Rinfret. “According to the information available, it was not appropriate, at that time, to make massive purchases,” she also notes.
Except that “the supply of equipment quickly became a major challenge”, especially after the World Health Organization declared a global shortage of PPE. In general, “the apprehended shortage of PPE has truly compromised the authorities’ ability to take all the required precautions, at the appropriate time, for the protection of CHSLD staff and residents,” writes the Protectrice du citoyen. “The watchword was clearly to monitor its use to reduce it to a minimum, rather than taking additional precautions. “
The report recommends “constituting, maintaining and managing a provincial reserve” so that Quebec gives itself “leeway in the event of a sudden increase in needs or a sudden break in international supply chains”. When the pandemic struck, Quebec had no national reserve of material, as recommended since 2006 by the Quebec plan to fight an influenza pandemic.
The labor problem
At the dawn of the pandemic, “the CHSLDs had no room for maneuver in terms of human resources and this problem had been known to the authorities for several years,” notes Ms. Rinfret. However, “During preparations for the pandemic, the MSSS did not develop any quantified scenario anticipating the phenomenon of absenteeism linked to the virus ”.
The shortage was such that “upon returning from the spring break, the MSSS could not, according to him, withdraw the personnel who had traveled, even if public health recommended it”.
To remedy this shortage and the problems it causes, the Ombudsperson is making her own recommendations. In particular, it suggests launching a national strategy to fight the shortage of manpower and promote professions in the field of health and social services, and to put in place a Québec plan for the deployment of manpower. emergency in the network and establish protocols for the deployment of additional manpower in exceptional circumstances with professional orders and unions, for example.
The impacts of the Barrette reform
Ms. Rinfret also reviews the many effects of the reform led by the former Minister of Health, Gaétan Barrette, in 2015.
“All in all, the health crisis has reinforced a ‘top-down’ management approach (”top-down ”), a concept that emerged at the turn of the 2015 reform, and of centralization of powers. This has generated a certain paralysis of living environments constantly bombarded with revised and modified orientations, ”she writes.
She insisted on the fact that “the CHSLDs had no local governance structure allowing them to optimally apply the directives” of the government. “The 2015 health system reform created larger structures without providing them with sufficient managers,” she underlines.
She also recalls that “the reconfiguration of the health and social services network in 2015 was not followed by the required changes in terms of IT” and that, “for lack of a centralized information system, the MSSS has been reduced to having to rely on the CISSS and the CIUSSS ”for information.
The Ombudsperson also judges that the 2015 reform and its vast restructuring “were a blow to the management and expertise in PCI in establishments”, since “PCI expertise has mainly developed in hospital settings. rather than in CHSLD ”.