The pandemic has shown that the model of fully private seniors’ centers is a thing of the past, says coroner Géhane Kamel, who is calling for the “deprivatization of the system” and a shift towards home care.
“Private CHSLDs are unfortunately an unviable solution if we want to offer a quality of care worthy of what the elderly deserve,” writes Ms.me Kamel in his report on the many deaths that occurred in seniors’ residences at the start of the pandemic. These should all be bound by agreements with the state, she argues.
“Investment in home support, the other poor child in the health system, is certainly an avenue to explore”, argues the coroner, citing as an example some “solutions” presented in the past by the former PQ minister. Rejean Hebert.
Launched in June 2020, its investigation focused mainly on the deaths of 53 people in public and private residences during the first months of the pandemic – at the CHSLD Herron, in particular. These deaths were all obscure or possibly the result of negligence. The works of M.me Kamel also included a “national component” on government action and the choices made by decision-makers in the context of the pandemic.
Blais “credible”, McCann absent, Arruda flayed
The coroner concludes that the minister responsible for seniors, Marguerite Blais, is the one who has delivered the most “credible” explanation for the belated attention given by the government to residences for seniors. “I believe, to date, that she has tried to make herself heard, but that the emphasis on hospital settings was so great that her voice or that of her office only had an echo late in the day. »
As for the role of the Minister of Health at the time, Danielle McCann, the report barely mentions her.
On the other hand, the former national director of public health of Quebec, Horacio Arruda, comes out flayed from the exercise. “During his testimony, [il] argued that CHSLDs were less likely to be hit by COVID-19 than hospitals,” wrote Ms.me Kamel, emphasizing that this “opinion” was “not based on any concrete evidence”. “They thus justified the government’s decision to prioritize available resources in acute care settings and not to increase preventive measures to fight against possible transmission by inhalation of aerosols in long-term care settings. »
Always about the Dr Arruda, the coroner suggests that we should give more independence to her function in the future. “Doubt sets in” as soon as it is assumed that the big boss of Public Health “modulates his words or his recommendations […] in order to be in line with government priorities,” she wrote. However, whether this impression is true or not, it must be dispelled, according to the coroner.
“Infantilized” caregivers
The Ministry of Health, for its part, made a serious mistake by preventing caregivers from visiting CHSLDs. “One of the reasons cited by the MSSS for restricting the access of caregivers was the protection of caregivers, being themselves vulnerable, referring to the fact that most of them are elderly. However, this information is not documented and is, if anything, infantilizing for the families,” argues Ms.me Kamel.
“Overnight, seniors living in residences saw themselves cut off from the outside world during the first wave, and many died without being able to communicate with their loved ones. It is a human drama that makes you dizzy. »
Worse still, the coroner is sorry for the circumstances in which palliative care was given. “Time and time again, the caregivers and the families indicated during the hearings that their consent had been obtained at the end of a summary discussion which, obviously, made it null and void, because it was not informed”, can -we read in the report.
“In fact, once the palliative sedation was initiated, no further questioning or diagnostic maneuver was done. Death was awaited and no caregivers came to review or question the diagnosis. We closed the bedroom door and only came in to make sure everything was calm and peaceful,” she wrote.
“A few residents have had the right to a visit from a family member, many have not even had this chance. For a coroner, that many residents died without having had the right to a doctor’s visit during their final illness is not only sad, but disturbing. »
Working in silos
Those who hoped to see this report clearly identify culprits will be disappointed. With the exception of some bad decisions made by the government, it is primarily the failure of a system that is noted in this report.
“What happened that we did not act on this preparation? The most likely thesis that recurs throughout the backstory is working in silos,” points out Géhane Kamel.
Thus, the civil security authorities did not play their role and clinical planning was done in a “separate” environment in the ministries, while “the available data were clearly insufficient to allow real-time management”. From the outset, even if communication was “the sinews of war”, the investigation “brought to light information systems which did not speak to each other and which were obsolete”.
However, the coroner says she is “convinced that all necessary efforts have been made to respond” to the lack of personnel.
No less than 4,836 people died of COVID-19 in settings dedicated to seniors during the pandemic; 3,675 of them were housed in CHSLDs.
The report contains a total of 23 recommendations for the Government of Quebec (10), the Ministry of Health (8), the Integrated Health and Social Services Centers (4) and the College of Physicians (1).