Long-term care report drops

Health Minister Adrian Dix apologized yesterday for the delay in releasing the report his ministry commissioned last spring on its Covid response in long-term care.

“The report should have been released earlier,” Dix said, adding that he only learned of its existence 10 days ago.

The ministry hired Ernst & Young to conduct a review of how the ministry responded to the first Covid wave and to provide recommendations on how to improve going forward. The consulting firm reviewed ministry policies and operational documents as well as provincial, federal and international data related to the pandemic.

Interviews were also conducted with over 40 stakeholders, including seniors’ associations, care home operators and front-line staff. Family members of long-term care residents are not mentioned in the firm’s review.

The ministry received the report on October 22, 2020.

Dix characterized the report’s findings as “overwhelmingly” favourable of the Health Ministry — however the report highlights pre-existing and emergent issues that hampered the efficacy of its response.

Problems with infection control, PPE procurement and communication
While the report highlights the ministry’s “comprehensive response” to reducing transmission in LTC homes, staffing challenges and PPE shortages impacted the effectiveness of that effort.

The report also highlighted “gaps” in infection control and emergency preparedness protocols. Many facilities failed to maintain adequate stockpiles of PPE, despite receiving funding from local health authorities.

When faced with PPE shortages during a global surge in demand, many facilities were left to fend for themselves and ended up buying supplies from unauthorized sources, including “hardware stores, counterfeit supplies, [and] private individuals” — some of which did not meet existing safety standards.

Provincial health orders and ministerial policies could be “confusing, inconsistent, or lacking in detail,” per the report, which led to inconsistent implementation of the rules. Health authorities also interpreted health orders differently, leading to responses that varied region by region.

Private facilities perceived to have received less support
The oversight, management and support provided to long-term care providers varied depending on whether they were publicly or privately run, per the report.

Health authority-operated facilities received support in managing staff, procuring PPE and delivering infection control training, but private sites “felt that they were left to manage independently unless an outbreak occurred,” EY determined.

While the province executed a single-site staffing order in the spring to help stop the spread of Covid between homes, there was “no provincial view of LTC staffing to enable coordination of the single-site policy.”

This disproportionately impacted staffing levels at private facilities. More workers chose to work for health authority-run facilities — due to better salaries and benefits — leaving private facilities short-staffed and forced to rely on overtime to cover shifts.

The ministry’s wage levelling policy helped, although some operators complained that communication was “lacking and inconsistent.”

EY also said the health ministry has a limited understanding of the cost and quality of individual LTC operations.

Recommendations and blowback from care association
The report makes a total of 19 recommendations to the ministry. Some — such as implementing a centralized supply chain, addressing staffing issues and improving data-sharing — were already implemented or in the works by the time the report was delivered.

Plans for a new quality assurance and funding framework for the sector are expected to be completed by the end of the 2021-2022 fiscal year.

The BC Care Providers Association (BCCPA) criticized the delay in releasing the report, suggesting that because it was “filed on the eve of election day” its recommendations were “not acted upon in a timely fashion.”

“Taking action on recommendations provided in these reports could have mitigated some of the impacts of the current wave of the pandemic,” the association said in a statement, noting that many of the issues in the EY report were also put forward in a report issued by the BCCPA in November 2020.

The BCCPA wants “regular and consistent information sharing” with B.C.’s public health agencies: “the long-term care sector is the most impacted by COVID-19, yet little if any contact between the Provincial Health Office and the sector has happened despite repeated invitations to consult with one another.”