Preliminary Remark: as noted on several occasions on this blog, Canada refuses the use of hydroxychloroquine-based early treatments for COVID-19, which have already been shown to work well with elderly people and in nursing homes. Fatality rates are considerable in Canadian nursing homes, but it’s most likely avoidable. With HCQ-based treatment, at the Resort nursing home in Texas, mortality among residents was limited to 1 resident out of the 56 residents who tested positive. The others recovered. 33 staff members had been infected and all but one were quickly back at work. (see article)
A report about 5 long term care facilities in Ontario found its way in the media. It is dated May 20 and is signed by CJJ Mialkowski. Brigadier General, Commander.
The five long term care facilities had been identified as in urgent and immediate need of personnel to provide humanitarian relief and medical support.
The report was written following two weeks of observation.
“… we have sought to make observations that are strictly factual and are not meant to assess or pass judgment…,” reads the letter accompanying the report.
“The purpose of this letter is to ensure that these observations do not go unnoticed by our chain of command, the Province of Ontario, and most importantly at the individual LTCF …”
Particularly in the provinces of Ontario and Québec, there is a profound crisis in long term care facilities, where thousands of elderly have already died from COVID-19, many in horrific, inhumane conditions.
The situation remains out of control. There are not only numerous residents being infected, but also staff members.
In Ontario, as of May 29, 1636 residents had died in long term care homes; there were 1304 active cases of positive residents, and 1048 confirmed cases of COVID-19 positive staff.
See the stats for Ontario.
See the most recent list of infected facilities for Québec, where the situation appears even worse than in Ontario.
The Canadian armed forces were brought to provide help.
According to media reports, the current position of the Canadian minister of defence is that this help will not be extended, and provinces are asked to find their own solutions.
The Defence Minister Harjit Sajjan refused to say how many Canadian Armed Forces members have contracted COVID-19, citing “operational security reasons.”
Below are some excerpts. This is not a summary. The report itself is very summarized and should be read in full.
Eatonville Care Centre
Infection Control / Isolation: “COVID-19 patients allowed to wander. This means anyone in the facility (staff, residents and visitors) is at risk of being exposed and passing it throughout the home, as the resident’s location is not predictable, full appropriate PPE is not possible.”
Infection Control / PPE Practices: “facility staff often wear PPE outside of rooms and at the nurses station.”
Standard of practice / quality of care concerns: “poor palliative care standards – inadequate dosing intervals for some medications, some options limited based on level of staff administering medication …” “poor adherence to orders” … “no consistent safety checks” … “generally very poor peri-catheterization care reported”
Supplies: “general culture of fear to use supplies because they cost money (fluid bags, dressings, gowns, gloves, etc.)” “key supplies often under lock, not accessible by those who need them for work” “ Expired medication: much of the ward stock was months out of date.”
Staffing: “new staff that has been brought … haven’t been trained or oriented” “severely understaffed during day due to residents comorbidities and needs”
Inappropriate behaviour: “CAF member have witnessed agressive behaviour which ACC staff assessed as abusive/inappropriate.”
Hawthorne Place Care Centre
Infection control: “numerous fans blowing in hallways (increased spread of COVID-19)” “little to no disinfection had been conducted at the facilities” “significant gross fecal contamination was noted in numerous patient rooms” “insect infestation … ants … cockroaches” “delayed changing soiled residents leading to skin breakdown” “N95s provided to staff without fit-test”
Standard of practice/Quality of care concerns: “forceful agressive transfers” “forceful feeding / forceful hydration” “patients observed crying for help with staff not responding (30 min to over 2 hours)” “staff report residents having not been bathed for several weeks”
Supplies: “wound care supplies insufficient or locked away – high turnover of staff and lack of familiarity with LTC led to poor practices due to supply shortage”
Ambiguity on local practices: “palliative care orders not chartered/unkown to agency staff thus often not observed”
Staffing: “… safety concerns regarding patient ratios (1 registered nurse for 200 patients)” “little or no orientation for new staff resulting in low adherence to protocols or a significant awareness policy”
Infection control: “lack of cleanliness … cockroaches and flies present … rotten food smell noted …” “inappropriate PPE use noted throughout all staffing levels (doctors included)”
Standard of practice / quality of care concerns: “patients being left in beds soiled in diapers” … “mouth care and hydration schedule not being adhered to” “respecting dignity of patients not always a priority.” “caregiver burnout noted among staff”
Supplies: “liquid oxygen tanks not filled therefore not usable” “limited and inaccessible wound care supplies” “poor access to linens, soaker pads, etc.”
Staffing: “lack of training for new/agency staff”
Altarmont Care Community
Standard of Care/Quality of Care Concerns: “inadequate nutrition” “significant number of residents have pressure ulcers” “many of the residents had been bed bound for several weeks” “a non-verbal resident wrote disturbing letter alleging neglect and abuse”
Holland Christian – Grace Manor
Infection control: “Staff moving from COVID+ unit to other units without changing contaminated PPE” “wearing same pair of gloves for several tasks from one patient to another”
Again, these are just a few excerpts. Find the report at the bottom of this article.