Report into COVID-19 response in B.C. long-term care homes reveals confusion, mixed messaging

A third-party report reviewing how the province handled COVID-19 in long-term care homes in the first wave of the pandemic reveals gaps in infection prevention and control, confusion from operators over who was in charge, and a lack of co-ordination between health authorities.

More than 650 of B.C.’s 1,154 COVID-19 deaths have been in long-term care facilities. There are currently 29 active outbreaks in long-term care and assisted living facilities, with 1,009 residents and 579 staff ill.

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The report, by Ernst & Young, focused on four areas — governance and decision-making; policy; operations; and workforce — and made 14 short-term and five long-term recommendations. It also called for improved government oversight of the long-term care industry, which it said revolves around a funding relationship flowing through health authorities.

As a result, the Health Ministry has a limited view into cost and quality performance, the report said.

The report revealed inconsistent messaging related to essential visitors in seniors’ homes, a lack of co-ordination between privately run and health authority-operated care homes, and gaps in training in infection prevention and control and emergency preparedness for a pandemic.

Those in health authority-operated facilities generally reported receiving better support than those in privately owned and operated facilities.

In the first wave, there were gaps in the ability to manage and oversee, distribute and centralize personal protective equipment supplies at a provincial level. Some care operators were left to source their own PPE supplies, the report said, and these supplies did not always meet clinical safety standards.

As well, orders and guidelines from provincial health officer Dr. Bonnie Henry were sometimes interpreted differently across the province’s five health authorities, “which led to operational variation across the province.”

Some operators didn’t know which governing bodies — the provincial health officer, the Health Ministry, the provincial health authority, or the regional health authorities — had the final word.

The review did praise several initiatives, including an order that limited health care workers to working at a single site in order to reduce transmission between facilities, the creation of a health emergency command centre, and the restriction of visitors and resident outings.

However, it noted the single-site order exacerbated long-standing staffing shortages and the restrictions on visits affected the mental health and well-being of seniors.

In late spring 2020, the Health Ministry commissioned Ernst & Young to interview more than 40 stakeholders — including the Health Ministry, B.C. Centre for Disease Control, care home operators and the Hospital Employees’ Union — on success and challenges.

The intent was to prepare for a potential second wave of COVID-19 this winter.

The report was completed last fall and stakeholders and the Opposition Liberals have questioned why it was not released sooner.

B.C. Health Minister Adrian Dix said Monday the Ernst & Young report, submitted to the government in October, “should have been released earlier” and took responsibility for its delay.

Dix said that his government has acted upon the report’s recommendations.

Henry said long-term care is complex, with more than 530 long-term care homes in B.C., all operated by different entities.

“So yes, it was confusing. It is still confusing,” she said.

Guidelines and orders have been interpreted differently by the various health authorities, which then communicate with long-term care homes and communities, she said. “We are trying very hard to come out with consistent provincial approaches.”

The single site order, she said, took months to sort out as it was not universally accepted and there were 95 different contracts to understand with thousands of people involved in multiple different facilities.

“We had a lot of challenges in helping owners and operators of facilities to understand who their staff were, as well,” Henry said.

B.C. seniors advocate Isobel Mackenzie said Monday she will potentially be conducting many reviews of how the pandemic was handled with respect to seniors.

To date, she has committed to reviewing how many care homes had outbreaks, if there were characteristics that predicted greater probability of an outbreak, and things that could have been done. In the Lower Mainland, where community spread of the virus was spiking, some care homes had outbreaks and others didn’t. Mackenzie also wants to know why some outbreaks spread and others were contained.

Terry Lake, a former provincial health minister and the chief executive officer of the B.C. Care Providers Association, said the report is largely similar to one his organization published in mid-November.

Lake said the report was filed on the eve of the provincial election and should not have been delayed and stakeholders who contributed to the report, including his association, should not have received it at the same time as the public.

“We would’ve actually got these things done to provide a better response to the second wave,” he said. “Sitting on this report and not putting these recommendations in to place immediately has had deadly impacts.”

— With a file from The Canadian Press

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