Alberta’s nursing homes weren’t ready for Covid: auditor

Alberta’s response to Covid outbreaks in continuing care homes in 2020 was hampered by “insufficient preparedness, severe care staffing shortages and outdated infrastructure,” auditor general Doug Wylie stated in his findings.

The performance audit released yesterday covered the province’s 355 publicly funded continuing care homes.

“If there’s one key message that I hope you take from this report, it’s this: we must do a better job for our parents and our grandparents who are living in continuing care facilities here in Alberta,” Wylie said. “The findings in this report are simply sad.”

The audit covered March through December 2020 and focused on planning, communication and resource availability in care homes, as well as how compliance with policies was monitored and enforced. In those first two waves of the pandemic, there were 379 outbreaks that led to more than 8,300 Covid cases and 1,000 deaths.

Wylie made eight recommendations split between Alberta Health Services (AHS) and Alberta Health, all of which were accepted by the agencies.

“Our report focuses on processes, but really what it does is it demonstrates the results when you have weaknesses in processes — the human impact is profound,” Wylie said.

The audit only covered AHS facilities and those contracted by the province. It did not include licensed supportive living, seniors’ lodges, home care or other residential care and treatment facilities.

Short-staffing that predated the pandemic led to a deficiency in care, per the AG.

Wylie said despite the challenges, front-line staff were dedicated, focused and showed “indefatigable spirit.”

“What we hope is that management will apply that same indefatigable work to the recommendations and to correct the findings and weaknesses that we identified,” Wylie said.

The watchdog was “shocked” to find 85 per cent of the province’s 31,600 continuing care workers were part-time or casual, many of whom worked at two or more facilities. Health-care aides made up 59 per cent of the front-line workforce, but did 91 per cent of the work with patients.

“I’d expect to see a model like that in a fast food franchise, not in organizations that are caring for vulnerable Albertans,” Wylie said.

John Zabos, the principal for the audit, said there were residents who were dangerously dehydrated, receiving insufficient meals or inadequate pain management, and who were not receiving hygiene services and resided in rooms that hadn’t been cleaned for days.

In the summer, homes with no air conditioning reached dangerously high temperatures. In some cases more than half of staff were out sick, leaving others to work 16 or more hours per day, leading to “severe emotional and psychological distress.”

“What we saw was nothing compared to what the inspector saw, which was nothing compared to what the staff went through, which was nothing compared to what the residents and their families went through,” Zabos said.

Staffing shortages were made worse by visitor restrictions. Care that had been done by family members or volunteers had to be picked up by staff. Staff working in homes with outbreaks were restricted to working at single sites.

Wylie recommended the province adopt a single-site staffing model and re-examine the appropriateness of utilizing mostly part-time and casual work. He also called for paid sick leave, better training, and mental health and post-traumatic support for staff.

While the general public got Covid test results within a day or two, long-term care residents and staff were waiting up to 17 days, per the audit. It recommended AHS work with Alberta Precision Labs on a streamlined process that builds redundancy in the system.

Although Alberta had pandemic plans in place, they were insufficient and poorly communicated.

Pre-pandemic, only some of the facilities took part in provincial pandemic exercises, and front-line staff weren’t included.

Half of contracted facilities audited showed no sign of recently reviewing their plans, nor did they align with AHS’ provincial pandemic plans — a requirement of their contracts. Thirty per cent of the plans were not facility-specific, as required by continuing care standards.

Wylie recommended updating and expanding pandemic planning for the continuing care sector and for the updated plan to undergo simulations with all facilities and staff.

During the first wave of the COVID-19 pandemic, the orders from the chief medical officer of health caused confusion and frustration on the front-lines. But, AHS and Alberta Health quickly established two-way communication channels and the audit found AHS guidance for facilities was “robust, consistent and made widely available.”

The audit found shared rooms and old buildings led to some of the most severe Covid outbreaks. On that front, Wylie recommended Alberta Health develop a priority list for updating existing buildings. That includes an assessment of the adequacy of HVAC and filtration systems; size of resident rooms and extent of shared accommodations; the capacity of buildings to permit adequate isolation; and the ability of facility entrances and exits to be secured.

Health Minister Jason Copping accepted all of the audit’s recommendations, declaring that improvements are already underway and more will be announced in Tuesday’s budget.

“These improvements have relevance and provide benefits far beyond the COVID-19 response, including helping the continuing care system to be better prepared for future pandemics and other smaller communicable disease outbreaks such as seasonal influenza,” Copping said.

AHS also accepted the four recommendations aimed at the health authority and is beginning to implement them. They include tracking resident illnesses and staff absences during communicable disease outbreaks.

“It is clear from this report, and from our own learnings, that while significant work went into protecting continuing care residents immediately during the first wave, more must be done to better protect and care for them moving forward,” said Mauro Chies, interim AHS president and CEO.

Since April 2020, AHS has added 1,093 new continuing care beds, with an additional 335 expected to open before the end of next month and 466 more opening this spring.

The audit showed in Calgary and Edmonton, more than half of Covid cases in residents and staff — and nearly half of all deaths — were in for-profit facilities, which account for over 40 per cent of publicly funded beds.

The least number of cases and deaths were in AHS-operated facilities, which have over 10 per cent of the beds in the Edmonton and Calgary zones.

Friends of Medicare executive director Chris Gallaway said the problems highlighted are systemic.

“Ultimately, it all comes back to Alberta’s approach to long-term care which treats seniors as commodities, prioritizing profits over providing care,” he said.

Public Interest Alberta executive director Brad LaFortune called on the province to adopt national long-term care standards, reinstate an independent seniors advocate, improve working conditions and bring all homes back into public hands.

NDP Health critic David Shepherd said Alberta’s response was among the worst of any province, and throughout the pandemic current Premier Danielle Smith advocated for the government to follow the lead of Florida and South Dakota, which “let the virus rip,” leading to higher deaths.

“It’s frightening to contemplate,” Shepherd said.

Any new investments in the continuing care system should be in public facilities, argued the NDP MLA. However, he stopped short of promising to nationalize the industry, saying such deals would be complex and he does not have access to all the relevant information.

Shepherd noted the NDP had called for paid sick leave for workers but was voted down by the government, calling the government’s acceptance of the recommendations “cynical.”

Alberta Union of Provincial Employees vice-president Mike Dempsey told AB Today the union had been raising the alarm about severe care staffing shortages and poor working conditions, but the government has refused to heed their advice.

“It’s clear from the Auditor General’s report the UCP government has been failing Alberta’s seniors and continuing care workers — and is on the path to make things worse with more cuts and privatization,” he said.