Bonnie Sandler, who for more than 10 years has been a consultant for seniors seeking suitable care facilities, was stunned by how our Quebec government handled the COVID-19 pandemic.
“The government should be prepared for all kinds of emergencies, and we’re now finding out how ill prepared we were,” Sandler said in a phone interview.
Everyone familiar with long-term care facilities knew they were understaffed, and that was why many families hired private caregivers.
“This allowed the system to function because private caregivers have been feeding the patients – even if it takes an hour – spending time with them, connecting with them. As soon as you take away that extra staff, the system is bound to collapse. And it did.
The decision announced by Premier François Legault on March 13 to suddenly ban family and private caregivers from long-term care facilities – “with so little thought and planning” – was “the worst decision possible,” Sandler says. She believes it contributed to “killing many seniors.”
“People are dying because of dehydration, they may be starving, because their family member or caregiver was not there to pass them a glass of water or slowly feed them.
Yes, she accepts that limits had to be placed on those entering senior residences and long-term care facilities to prevent infection, “but it had to be planned and thought out.”
“This was a frightening decision that was bound to have serious consequences. People were dying alone, without family,” she said.
A month later, in the wake of appeals from families, the government loosened restrictions when on April 14, Legault announced that a single, pre-existing primary caregiver, determined and approved by CHSLD administrators, would be allowed to visit and care for a patient. They would have to test negative for COVID-19 and follow hygiene procedures. This affects an estimated ten per cent of residents of long-term care facilities.
According to Dr. Horacio Arruda, Quebec’s director of public health, the situation would have been far worse had health authorities not decided to cut off visits, to residences, hospitals, and intensive care wards. Even asymptomatic people can spread the virus, and that fact was not known when the pandemic started, he has noted.
Sandler says the reversal of the ban should have started long before calling on the federal government to dispatch army personnel to beef up depleted staff in long-term care homes.
She attributes the high infection rate in long-term care homes to the fact that many of its residents live two and four to a room and share one bathroom.
The system was broken even before this pandemic, Sandler stressed, with a “one to two-year waiting list to get a bed in one of these facilities.”
Patients in hospital, when told of the waiting list, who don’t want to go into transit beds, often will use all their savings to go into a private, expensive home waiting for that coveted bed.
As for the continuing orderly shortage, she asked, why did we not value their work by improving their wages and working conditions?
“At $15 an hour, how many of us would be doing the work that they’re doing, the changing, and cleaning, and washing. We have these wonderful people who are doing this work and they are under-paid, under-appreciated, and under-staffed.
While some larger long-term care homes can isolate those who are infected in hot zones, the challenge is to have trained staff and specialized equipment to provide required care in these residences to those who contract the virus and keep them out of hospitals.
“Staff from CLSCs need to be more present in these facilities. There has to be stronger guidelines and supervision to make sure they are being enforced, and, of course, more staffing.”
“I feel like a whole population is being wiped out – our elderly, the most fragile, the most vulnerable, the ones we’re supposed to care for, who cared for us all our lives. We’re doing a terrible job.
“And I blame it on Legault, his immediate, impulsive, quick decision, without any apparent thought about the inevitable repercussions.”
When families ask her if they should remove a parent from a long-term care facility, Sandler says it’s a case-by-case decision and depends on whether the family is able to provide the level of care a loved-one requires.
“Care is different for each person in a CHSLD. You might need two-people to transfer or move the patient, you might need a hospital bed, or a bedside commode, and not everybody can do the work of an orderly, the cleaning, the showers.
“Clearly it would be easier for people with money, who can rent a hospital bed and hire staff, but you’re setting up a nursing room in your house. For someone living alone, it would be difficult, but not impossible.”
Also, dealing with someone who is fragile can have an impact on the caregiver.
“They might be safer in your home in some ways, but the caregiver has to have support as well. We know it’s not that safe in a CHSLD, but there is no easy answer.”
As for seniors who call her for placement suggestions, Sandler notes that it is unclear whether CHSLDs are taking new residents as they send more of them to hospital for treatment for dehydration and other health issues.
However, as an example one autonomous/intermediate residence indicated it was accepting new residents, who will be tested for fever, and isolated for the first 14 days.
“And there are some private, very expensive CHSLDs that are functioning well. If someone were in crisis and had the means and finances, I might consider that as a recommendation.”