Amid a vaccine shortage in Canada, at least one board member and the family of some managers at a Toronto-area nursing home are being accused of inappropriately keeping COVID-19 vaccinations for themselves.
A health-care union claims a nurse was required to inoculate at least 10 individuals who were not care-home residents or front-line staff at Villa Leonardo Gambin, a non-profit home managed by Sienna Senior Living in Vaughan, Ont.
The union filed a grievance against the home on Thursday.
“I believe that they got the vaccine because they know somebody who’s a manager at a long term care home who gave them priority access to the vaccine,” Charlene Nero, secretary treasurer of Laborers’ International Union of North America Local 3000 told CBC News.
The union further asserts that one of the home’s medical staff left the premises with approximately five doses of the Moderna vaccine “for what appeared to be [their] personal use.”
“If these allegations are proved to be correct, this is just completely unacceptable,” said Dr. Samir Sinha, the director of geriatrics at Sinai Health in Toronto.
“We have so many people who are vulnerable of dying from COVID.… This actually means we’re wasting doses and we’re actually costing lives.”
The care home said the doses were administered to avoid wasting open vials of vaccine.
4th outbreak at home
The 168-bed home is in its fourth outbreak. It has lost 25 residents to COVID-19 since the pandemic started.
The nurse was instructed to record that the vaccines were given to essential caregivers on paperwork, Nero said.
“She was actually offered the opportunity to call her own family members in, who are not yet on the priority list for vaccines and have them vaccinated,” Nero said. “She declined.”
The matter has also been raised to both Public Health Ontario and York Region Public Health, which says it is now looking further into the matter.
It also says public health officials will now be on-site at a subsequent clinic planned at Villa Leonardo Gambin.
Board says vaccines were set to expire
A statement from the board chair at Villa Leonardo Gambin, Andrew Iacobelli, confirmed that the vaccine was “offered to non-front-line staff who work or volunteer for the residence … including myself,” but only after “all of the available staff and residents” received the vaccine.
Iacobelli confirms he received the Moderna vaccine.
“We further extended the remaining unused vaccines to family members of staff and volunteer board members, [who] are often present in the home”.
Iacobelli claims the leftover vaccine with a limited shelf life “would go to waste” and thus “a decision to prevent this from happening was made.”
“We took all steps possible to ensure team members and residents were offered and encouraged to take the vaccine before deciding to provide it to others.”
He also says allegations that vaccine doses were removed from the residence are taken “very seriously and we are taking all the necessary steps to look into this matter.”
WATCH | Nurse told to inoculate at least 10 individuals who were not care-home residents or front-line staff
A nurse at a Toronto-area long-term care home says she was told to give COVID-19 vaccines to at least one board member, and family members and friends of several managers. Her union has filed a complaint with public health authorities. 2:59
However, staff who are not front-line would not even normally be permitted inside a home during the province’s pandemic lockdown.
His statement did not say which non-front-line staff received the vaccine. It also does not explain how these individuals learned of the opportunity or happened to be in the home which, during the pandemic, is locked down to anyone other than front-line staff and essential visitors. Board members and their families would not ordinarily be exempt.
Nero says the union is also concerned about people entering the care home, which she describes as a serious breach of infection control measures.
“There’s supposed to be an absolute lockdown in terms of people visiting. If you have an ill family member who is a resident at Villa Gambin, you can only have one designated essential caregiver who can go in.
“As a result of the personal relationships of these folks to senior management at the home that was allowing them to jump the queue,” she said.
Moderna vaccine vials contain 10 doses each, so the maximum wastage per vial would typically be nine, after one is administered. The union alleges as many as 15 doses were improperly used or taken.
York Region Public Health said in a statement that “once a vial has been punctured, it cannot be moved from the service delivery location and must be used within six hours.”
The health unit said its procedure when there is leftover vaccine is now to reach out to medical first responders to attend a home to receive end-of-vial doses.
It’s not clear whether that is a new policy, or one that has existed when this vaccination clinic took place.
To counter some of the drivers of coronavirus transmission among essential workers, governments across Canada should prioritize safety, say experts who’ve looked closely at avoiding outbreaks among the most vulnerable.
Canada’s worst outbreaks continue to hit residents of long-term care homes, where short staffing can make it difficult to care for vulnerable people sick with COVID-19. To keep them safe will require addressing long-standing staffing shortages on top of stockpiling personal protective equipment and changing how the long-term care sector is led.
Farinaz Havaei, an assistant professor in the school of nursing at the University of British Columbia, says she found a combination of good planning, strong leadership and a focus on safety contributed to how a large B.C. long-term care facility successfully kept COVID-19 at bay at the start of the pandemic.
“Their [leadership] decisions were essentially driven by prioritization of safety rather than being driven by budget and finances, which was really important,” Havaei said. She and her team analyzed surveys and reviewed administrative data and interviewed leaders, workers and family members for the research.
In contrast to the horrors reported by the military at some devastated long-term care facilities in Quebec and Ontario in the spring, Havaei said staff at the B.C. facility went above and beyond in caring for residents.
The workers spent quality time with those under their care, reading them books, painting their nails and facilitating virtual connections with family members.
WATCH | A daughter’s devotion to helping her mom recover from COVID-19:
When her 98-year-old mother was diagnosed with COVID-19, Mary Sardelis moved into the retirement home to save her life. She said what she saw was ‘no man’s land.’ 7:52
Havaei is now planning a provincewide study of B.C.’s single-site employment policy for long-term care workers, which requires staff to work in only one high-risk site.
To Havaei, more flexible paid sick leave policies and ensuring adequate 24/7 staffing in long-term care homes go hand-in-hand with keep residents safe.
“My personal opinion is that staffing is the cause, or is probably one of the root causes, of this whole situation,” of having to call in the military to deal with outbreaks in long-term care homes during the first wave, she said.
She says several factors exacerbate the challenges staff face in long-term care homes:
Crowding of residents.
Residents may lack the cognitive ability needed to follow handwashing and other infection prevention measures.
On top of their regular workload, staff became the eyes and ears of family members who weren’t allowed to visit or provide care.
Havaei points to a body of research, including her own, that’s established a link between burnout of nurses and higher likelihood ofadverse events for patients or residents.
“They are more likely to make some sort of a patient-adverse event, like making a medication error, having their patient fall, violating infection prevention control guidelines that potentially result in urinary tract infection and so on,” she said.
During the second, worsening wave of COVID-19 across much of Canada, nurses and personal support workers at long-term care homes face those everyday challenges on top of the coronavirus. About 40 per cent of all long-term care homes in Ontario alone are dealing with an active COVID-19 outbreak.
Havaei wonders whether stretching staff too thin in such a high-risk environment contributes to lapses in infection control that can allow the virus to take hold.
In B.C., health-care workers top the list of workers’ compensation claims followed by long-term care, a much smaller industry proportionately.
Work both improves health and can sicken
Victoria Arrandale, an assistant professor at the Dalla Lana School of Public Health at the University of Toronto, studies how to reduce exposure to hazards in the workplace, including COVID-19. It’s a field she was drawn to after suffering an ankle injury at a pulp mill in her home province of British Columbia, plunging her into the world of filing a workers’ compensation claim.
“I just got hooked on thinking about how work does impact people’s health,” Arrandale recalled. “It improves people’s health because it provides stable income, hopefully, but it can also make people sick.”
Arrandale said paid sick leave is an important policy because it can help prevent the introduction of the coronavirus into the workplace.
From a population-level perspective, Arrandale would like to see more detailed collection of workplace data during contact tracing, as in Ontario’s Peel Region and Hamilton, and as Toronto is moving toward.
“We’ve got good information on health care, but having it for every [sector] would allow us to better understand where the workplace burden of COVID is arising,” Arrandale said. “There may be groups of people who we’re not recognizing that could be more precariously employed or racialized groups, women.”
Having a more complete picture could improve understanding of where and why workplace outbreaks occur to better target prevention measures, such as staggering shifts and breaks, providing alternative lunch spaces or splitting up people who are all working in a row while still achieving workplace goals, she said.
Health-care workers and nursing home residents should be at the front of the line when the first coronavirus vaccine shots become available in the U.S., an influential government advisory panel said Tuesday.
The U.S. Advisory Committee on Immunization Practices voted 13-1 to recommend those groups get priority in the first days of any coming vaccination program, when doses are expected to be very limited. The two groups encompass about 24 million people out of a U.S. population of about 330 million.
Later this month, the Food and Drug Administration will consider authorizing emergency use of two vaccines made by Pfizer and Moderna. Current estimates project that no more than 20 million doses of each vaccine will be available by the end of 2020. Also, each product requires two doses. As a result, the shots will be rationed in the early stages.
Tuesday’s action merely designated who should get shots first if a safe and effective vaccine becomes available. The panel did not endorse any particular vaccine. Panel members are waiting to hear the FDA’s evaluation and to see more safety and efficacy data before endorsing any particular product.
Experts say the vaccine will probably not become widely available in the U.S. until the spring.
The panel of outside scientific experts, created in 1964, makes recommendations to the director of the Centers for Disease Control and Prevention, who almost always approves them. It normally has 15 voting members, but one seat is currently vacant.
The recommendations are not binding, but for decades they have been widely heeded by doctors, and they have determined the scope and funding of U.S. vaccination programs.
In Canada, the National Advisory Committee on Immunization, or NACI, has released preliminary recommendations that prioritize the elderly and others at severe risk of illness, including health-care workers, front-line staff and those with lower access to health care, such as Indigenous populations.
In the U.S., it will be up to state authorities whether to follow the guidance. It will also be left to them to make further, more detailed decisions if necessary — for example, whether to put emergency room doctors and nurses ahead of other health-care workers if vaccine supplies are low.
Devastating toll in homes
The outbreak in the U.S. has killed nearly 270,000 people and caused more than 13.5 million confirmed infections, with deaths, hospitalizations and cases rocketing in recent weeks.
As the virtual meeting got underway, panel member Dr. Beth Bell of the University of Washington noted that on average, one person is dying of COVID-19 per minute in the U.S. right now, “so I guess we are acting none too soon.”
About three million people in the U.S. live in nursing homes, long-term chronic care hospitals and other long-term care facilities. Those patients and the staff members who care for them have accounted for six per cent of the nation’s coronavirus cases and a staggering 39 per cent of deaths, CDC officials say.
Despite the heavy toll, some board members at Tuesday’s meeting said they hesitated to include such patients in the first group getting shots.
Dr. Richard Zimmerman, a University of Pittsburgh flu vaccine researcher who watched the hearing online, said he thought it was “premature” to include nursing home residents as a priority group. “[The panel’s] vote seems to assume that these people will respond well to the vaccine. … I don’t think we know that,” said Zimmerman, a former ACIP member.
Committee members were unanimous in voicing support for vaccinating health-care workers, according to CDC officials.
That broad category of an estimated 21 million in the U.S. includes medical staff who care for — or come in contact with — patients in hospitals, nursing homes, clinics and doctor’s offices. It also includes home health-care workers and paramedics. Depending on how state officials apply the panel’s recommendations, it could also encompass janitorial staff, food service employees and medical records clerks.
Trump cabinet members say governors should make the call
The government estimates people working in health care account for 12 per cent of U.S. COVID-19 cases but only about 0.5 per cent of deaths. Experts say it’s imperative to keep health-care workers on their feet so they can administer the shots and tend to the booming number of infected Americans.
For months, members of the immunization panel had said they wouldn’t take a vote until the FDA approved a vaccine, as is customary. But late last week, the group scheduled an emergency meeting.
WATCH l Canadian vaccine committee member speaks to challenges:
As Canada prepares to distribute millions of doses of COVID-19 vaccines in January, Chair of the National Advisory Committee on Immunization Dr. Caroline Quach-Thanh and David Levine, who managed the H1N1 vaccine rollout for Montreal, say this vaccination campaign won’t be without challenges. 3:56
The panel’s chairman, Dr. Jose Romero, said the decision stemmed from a realization that the states are facing a Friday deadline to place initial orders for the Pfizer vaccine and determine where they should be delivered. The committee decided to meet now to give state and local officials guidance, he said.
But some panel members and other experts had also grown concerned by comments from Trump administration officials that suggested differing vaccine priorities.
Dr. Deborah Birx of the White House coronavirus task force said in a meeting with CDC officials last month that people 65 and older should go to the head of the line, according to a federal official who was not authorized to discuss the matter and spoke to The Associated Press on condition of anonymity.
Then last week, U.S. Health and Human Services Secretary Alex Azar stressed that ultimately governors will decide who in their states gets the shots. Vice-President Mike Pence echoed that view.
Asked whether Azar’s comment played a role in the scheduling of the meeting, Romero said, “We don’t live in a bubble. We know what he said. But that wasn’t the primary reason this is being done.”
Jason Schwartz, a professor of health policy at the Yale School of Public Health, said it makes sense for the panel to take the unusual step of getting its recommendation out first.
“Without that formal recommendation, it does create a void from which states could go off in all sorts of different directions,” said Schwartz, who is not on the panel.
The panel will meet again at some point to decide who should be next in line. Among the possibilities: teachers, police, firefighters and workers in other essential fields, such as food production and transportation; the elderly; and people with underlying medical conditions.
When Von took his mother out of his home and placed her in Craiglee Nursing Home in Scarborough, Ont., he and his wife, Mary, thought they were doing what was best for her.
But instead of loving care, Von’s mother, Kostadinka, was met with physical and emotional abuse at the hands of at least four different care workers, caught on a camera they had hidden in her room.
“It was like a horror film,” said Mary. “I will never be able to unsee those things.”
What they didn’t know at the time was that the home had a long and repeated history of staff physically abusing the residents. They didn’t know — but the government did.
WATCH | Son says he ‘couldn’t believe’ what hidden camera caught workers doing to his mother:
This man installed a hidden camera in his mother’s room at a long-term care home in Scarborough, Ont. The videos showed different employees physically and verbally abusing the 82-year-old. She was “holding onto the bed rails for dear life,” her son said. 5:00
A data analysis of the most serious breaches of Ontario’s long-term care home safety legislation reveals that six in seven care homes are repeat offenders, and there are virtually no consequences for homes that break that law repeatedly.
CBC Marketplace reviewed 10,000 inspection reports and found over 30,000 “written notices,” or violations of the Long-Term Care Homes Act and Regulations (LTCHA), between 2015 and 2019 inclusive. The LTCHA sets out minimum safety standards that every care home in Ontario must meet.
Marketplace isolated 21 violation codes for some of the most serious or dangerous offences, including abuse, inadequate infection control, unsafe medication storage, inadequate hydration, and poor skin and wound care, among others. The analysis found that of the 632 homes in the Ontario database, 538 — or 85 per cent — were repeat offenders.
Jane Meadus, a lawyer with the Advocacy Centre for the Elderly, said the high number of repeated incidents shows that non-compliance with the law has been normalized within care homes.
Meadus said lack of proper care can lead to bedsores, for example, which residents can die from.
“If that person was in your home, if you were caring for your parent and they had these giant bedsores, you would likely be charged criminally for that,” she said.
“A home has never been charged criminally for what I think is criminal behaviour.”
‘We couldn’t believe what we saw’
Craiglee Nursing Home was one of at least 248 homes that have been written up twice or more for abuse and 101 homes that have repeatedly failed to report abuse.
Craiglee also had repeated violations for neglect, lack of infection control, medication errors, and poor skin and wound care.
Unaware of the home’s history, Von and Mary entrusted the home with Kostadinka’s care in 2017 when her needs became more than a two person job.
Marketplace has agreed to tell their story using only their first names because they fear retaliation against them and their business.
When they saw Kostadinka’s health declining, the couple put a camera in Von’s mother’s room as a precautionary measure in April of 2019, not expecting to see any problems. The camera ran for weeks before they were able to see what it had captured.
“We couldn’t believe what we saw,” said Von. “Abuse, torture, her holding onto the bed rails for dear life.”
The videos showed several employees yanking on Kostadinka’s arms, swatting her hands, or rubbing spilled food in her face. Although the videos have no audio, employees could be seen yelling at Kostadinka as she lay in bed, unable to move without their help.
More residents abused after videos submitted to ministry
After Von and Mary saw the extent of the abuse, they decided to call police. A personal support worker was arrested and ultimately entered into a three-year peace bond, agreeing not to work with vulnerable people. Kostadinka was moved to a different care home, where she died late last year.
The home would not agree to an interview with CBC. But Candace Chartier with Southbridge Care Homes, Craiglee’s parent company, offered a statement.
“We strongly condemn the actions of the individuals involved,” Chartier said in the statement. She said the home investigated Kostadinka’s abuse in July of 2019 and reported it to police, after which one staff member was criminally charged and “several others were terminated.”
Chartier said they also “re-educated all staff in the home on [the] zero-tolerance policy” for abuse, and enhanced their training.
The Ontario Ministry of Long-Term Care’s inspection report from September 2019 that detailed Kostadinka’s abuse revealed a lack of staff training on abuse policies. Yet, four months later, another report revealed 9.2 per cent of actively working staff had still not completed the mandatory training. Six months later, another incident of staff-to-resident abuse was documented in yet another report. There have also been incidents of financial abuse and resident-on-resident abuse.
Von said he was “disgusted” to learn that even after he sent video evidence of his mother’s abuse to the ministry, there have been more written notices at Craiglee for abuse.
“What does it take?” said Von. “We brought it to the ministry’s attention, brought it to the director of care’s attention, we brought it to the authorities, to the police.”
“Everything my mom endured was all for naught.”
Family fights for criminal charges for nursing homes
While physical abuse is fairly clear, neglect can take on many forms such as lack of hydration or failure to provide baths. Two hundred and twenty-six homes had repeat offences for failing to “ensure that residents are not neglected by the licensee or staff,” but many more incidents were filed under different codes for specific acts of neglect, like improper skin and wound care — 278 homes had repeat offences.
Beverley Haines died in February of this year, only six weeks after she moved into Hope Street Terrace in Port Hope, Ont., because of large bedsores she sustained at the home. Sparky Johnson and Sherry Schernitzki, Haines’s niece, are fighting to have the home’s administration held criminally responsible for her death.
The partners, now separated, said that on the day Haines moved from a hospital into the home in January 2020, the staff identified a “hot spot,” or patch of red skin. These spots must be monitored or treated so they don’t get worse, and the pair left with confidence that it would be taken care of.
But the pair weren’t informed that the hot spot had become an open bedsore until 23 days later. At that point, it had already progressed to a wound the size of a saucer with bone exposed.
“If the treatment had started when this bedsore was small, it should never ever have gotten to that,” said Schernitzki.
“It’s horrific. It’s criminal,” said Johnson.
The home had been written up for lack of proper wound care before. Reports from 2016 and 2018 both found the home was not following proper protocols for caring for “altered skin integrity.”
WARNING: GRAPHIC IMAGE
Johnson called the ministry to report the bedsore, but was told an inspection would take some time. She made another call to police, and an investigation was launched.
She began documenting problems at the home, including multiple instances where Haines was left in bed all day, lying on her back on the open bedsore.
The ministry published a report in June finding the home’s records didn’t show proper monitoring of the bedsore, which should have included repositioning every one to two hours to ensure she wasn’t lying on the wound.
“It was an excellent report, but what happens now? Who follows up?” said Schernitzki. “There are no consequences.”
By the time that report was released, it was too late to address the issues within it. Haines died on Feb. 29. The family says they were told by the investigating coroner that she died of sepsis from the bedsore.
The couple felt strongly that the home was criminally negligent, but the police investigation was closed after Haines died without charges being laid. They continue to fight, filing a complaint with the Office of the Independent Police Review Director, a civilian body that oversees complaints about police in Ontario. The case has since been reopened.
The home said it is “deeply saddened about the passing of this resident” and that its “utmost priorities are the safety and well-being of our residents.”
‘No tolerance’ for abuse, says minister
Most homes have not faced any punishment for failure to comply with the law. Only two Ontario homes have been shut down in the last decade for repeatedly failing to meet safety standards. Other sanctions available to the ministry appear to be ineffective in preventing future repeat offences.
Marketplace host David Common called into a press conference with Minister of Long-Term Care Merrilee Fullerton earlier this week to ask her to speak to the fact that despite orders that are available to inspectors, homes still appear to make the same behaviours repeatedly.
“There’s no tolerance whatsoever for negligence or abuse,” she said, noting that she feels her government is prioritizing serious offences in their inspections.
“They must be dealt with in a fulsome way.”
‘No consequence,’ says former inspector
But a former inspector said that in her experience, issues weren’t dealt with in a fulsome way, and that’s part of the reason why she left the job.
Rebecca de Witte, who worked as an inspector for three years up until March of 2017, said she felt identifying problems in the homes wasn’t helping get rid of them.
“When you arrive, everything looks really good. And then as time goes by, old habits crop up again,” she said.
She said she would often inspect a home and find the same problems that she saw when she had last been there.
“There is no consequence if the homes completely ignore everything you find,” she said.
Federal government proposing new rules
In its speech from the throne in October, the federal government promised to work with the provinces and territories to set out a national standard of care for long-term care, and would amend the Criminal Code in order to “explicitly penalize those who neglect seniors under their care.”
For de Witte, governments need to focus on the big picture instead of what she calls “band-aid” fixes.
“Funding for air conditioning isn’t going to help long-term care, but changing the buildings will,” she said. “Pandemic pay isn’t going to help long-term care, but changing the funding model will.”
Meadus wants to see criminal charges for negligence and monetary penalties for repeat offenders.
“If the home is not able to provide safe care they shouldn’t be in business,” she said.
Click here to see the methodology of our investigation and statements from those featured in our story.
There are five seniors’ care facilities in Canada where more than 40 per cent of residents died during the height of the COVID-19 pandemic, a CBC News investigation has found.
Four of the residences with fatality rates higher than 40 per cent are in the Montreal area, and one is in Ontario.
Another 19 facilities, mostly in the Montreal and Toronto areas, lost between 30 and 40 per cent of their residents between March 1 and May 31.
CBC News collected and examined data for an exclusive national analysis to identify the residences with the highest rates of COVID-19-related deaths.
The analysis reveals what the worst-hit residences had in common, which could prevent fatal mistakes from being repeated in the event of a second wave of the pandemic.
Here is what we found.
Laval the hardest-hit region
A third of the homes where 30 per cent or more of residents died during that period are in the Montreal suburb of Laval.
The city is also home to six of the 10 residences with the highest COVID-19 fatality rates in Canada for the same period.
“The whole region has suffered a lot,” Marie-Pierre Lagueux, director of nursing care at CHSLD de la Rive, a privately run nursing home in Laval, said in a statement in French.
The facility had the highest COVID-19 mortality rate in the country, at 44 per cent.
In Laval, staff shortages, already a problem pre-COVID, were exacerbated when large numbers of care aides and medical personnel became sick, Marie-Eve Despatie-Gagnon, a spokesperson for the Laval health board, said in a statement in French.
When members of the Canadian Forces were called in to help at some of the hardest-hit care homes, they noted high rates of absenteeism among staff generally, and that the resulting lack of care had a significant and noticeable effect on the personal hygiene of residents.
The Laval health board has also been criticized by unions for cycling care workers through multiple residences, which could also have spread the infection.
Despatie-Gagnon said the health board has since taken steps to correct this, including recruiting more personnel to work in care homes and adjusting the schedules of care workers so it is possible for them to work in only one residence.
At CHSLD de la Rive, Lagueux said, there were many factors that influenced the high rare of death — notably, underlying health conditions. She said residents received good care, with two doctors onsite 14 hours a day who communicated with families.
Staff shortages may also have led to sick employees being pressured to work and infecting frail residents — the allegation at the heart of a proposed class-action lawsuit against the Laval health board and the care home that saw the highest number of COVID-19 deaths.
The lawsuit alleges that on March 22 a care aide and a nurse at the Sainte-Dorothée care home told their employer they had flu-like symptoms and asked to be tested for coronavirus. They claim they were told they did not have enough symptoms to warrant testing, and continued working for several days, during which time a resident they were exposed to tested positive. The employees themselves tested positive March 29.
The lawsuit has not been certified by a judge, and none of the allegations have been proven in court.
By the end of May, 93 people had died at Sainte-Dorothée.
Families asked for hospital care
One of them was Anna-José Maquet, who was 94. Her son, Jean-Pierre Daubois, is the lead plaintiff in the lawsuit.
He said in an interview with CBC News he was relieved to receive a call from the facility the evening of April 2, when he was told his mother was doing well and there were no COVID-19 patients on her floor.
The next day, shortly before noon, Daubois said, his sister received a call saying her mother was doing poorly and she should come right away.
Daubois was shocked to see the state of his mother, who he said had no underlying health conditions.
“It was a terrible sight,” he said. “It’s tough to describe how hard it was for her to breathe. The effort was so big that she was kind of breathing from the belly.”
Daubois says he asked if there were any machines at the residence that could help his mother breathe and was told all the ventilators were at the hospital.
“No equipment was brought there, nor my mother brought to the hospital. So she died that night.”
Care homes in Quebec were also under a government directive to avoid transporting residents with suspected or confirmed cases of COVID-19 to the hospital without a doctor’s approval.
Montreal lawyer Patrick Martin-Ménard, who is representing the plaintiff in the lawsuit, said he has heard similar stories from families of other deceased care home residents throughout the province.
“Many people who [wanted] a higher level of care, in fact, were forced to stay in the [nursing home] and did not receive the level of medical care that they would have received had they been transferred to a hospital,” he said. “Now, did that contribute to a higher death rate? I think it’s entirely possible.”
The Laval health board’s Despatie-Gagnon disputes this, saying all residents of the board’s publicly run nursing homes who needed hospital care received it.
The question of whether to transfer COVID-19 patients to hospital was something health officials at some of the hardest-hit Ontario homes also grappled with.
At Pinecrest in Bobcaygeon, medical personnel said hospitalization for frail, elderly residents would have been a painful, stressful ordeal that was unlikely to change the outcome.
“When the infection takes hold in their lungs in this elderly population, we can just keep them comfortable. Realistically, a ventilator is not an option,” Dr. Stephen Oldridge, a physician who treats residents at Pinecrest, told CBC News in April.
Mary Carr, Pinecrest’s administrator, said the decision of whether to transfer a resident to the hospital rests with an attending doctor at the local hospital, who does an assessment over the phone.
“Where a transfer is determined by physicians not to be clinically indicated at end of life, we are equipped to provide compassionate end-of-life care in the home,” she said in an emailed statement. “Some of the hardest conversations we have with families are the ones that reckon with a resident’s quality of life versus their longevity, but this is not a conversation we shy away from.”
At Orchard Villa, a Toronto-area nursing home where more than a quarter of residents with COVID-19 died, families also alleged they faced challenges having their loved ones transferred to the hospital.
In at least one case at that facility, the daughter of one resident with COVID-19 says she forced Orchard Villa to transfer her father to hospital. He recovered after being treated in hospital for malnutrition and dehydration.
A spokesperson for Lakeridge Health, the regional health authority that has since taken over management of Orchard Villa from Southbridge Care Homes, said she was unable to comment on the allegations because they were not responsible for the facility at the time.
Infection control measures lacking
The hardest-hit care homes and seniors’ residences were places that did not identify and isolate infected residents and staff early on.
There were reports of personnel moving between infection zones without adequate equipment or observing proper procedures, or the physical placement of infected residents in proximity to others, from several of the most affected facilities, particularly Sainte-Dorothée , CHSLD De La Rive,Pinecrest, and Almonte Country Haven in rural Ontario.
Carr, Pinecrest’s administrator, said the virus posed “unique challenges” for the facility — its relatively small size and physical layout made it difficult to isolate infected patients. She said staff “have been in close, daily contact with local and provincial public health authorities to share information and implement precautionary measures.”
In Laval, infection control specialists have now been stationed in different care homes to make sure proper procedures are observed, Despatie-Gagnon said.
Outside Quebec and Ontario
Of the 182 nursing homes and residences that reported more than 10 deaths, just eight were outside Quebec and Ontario: four in B.C., in the Vancouver area; three in Alberta, in the Calgary area; and one in Halifax.
None had a fatality rate higher than 16 per cent as of May 31.
B.C.’s ability to bring a “SWAT team” of provincial public health officials into care homes when the first infection was detected was a key reason outbreaks in that province did not spread to the same extent as those in eastern Canada, said Isobel Mackenzie, the province’s seniors’ advocate.
“They were in there right away,” she said. “And I think it was actually helpful for them to see the chaos in the first outbreak because they quickly realized, holy moly,” she said.
The province was home to the country’s first coronavirus outbreak at the Lynn Valley Care Centre in North Vancouver.
“Our leadership, because of their expertise in infectious disease, understands 24 hours is going to make the difference [in] containing this … you’ve got to move very quickly.”
Funding model not a factor
In some parts of the country, such as Laval and eastern Ontario, for-profit long-term care and retirement homes have had higher numbers of COVID-19-related fatalities than public or non-profit facilities.
But that was not the case across the country.
The seniors’ residences with more than 30 per cent fatalities were evenly split between for-profit and not-for-profit homes. This was also true of all facilities that reported 10 or more deaths.
What we don’t know
A New York Times investigation found U.S. nursing homes where the majority of residents were Black or Hispanic were twice as likely to be hit by COVID-19 as those whose residents were mostly white.
The equivalent data does not exist in Canada, making it impossible to say whether the same holds true in this country.
CBC News has tracked the number of deaths in long-term care and seniors’ residences since the pandemic started in March. Our analysis included all facilities that had reported more than 10 deaths as of May 31. There are 182 such facilities across the country.
A CBC-Radio Canada team verified the number of deaths per facility with individual health boards, provincial governments and, in some cases, the residences themselves. We then used publicly available data on the number of beds per facility to obtain a rate.
The long-term care home where more people have died during the coronavirus pandemic than anywhere else in Ontario is facing new scrutiny.
Families who asked that their loved ones be transferred to hospital from Orchard Villa Retirement Community in Pickering, east of Toronto, say they were told hospitals were closed to residents of long-term care homes and that COVID-positive residents would need to remain — and possibly die — in the home.
But an investigation by CBC’s Marketplace and The National reveals that was never the case.
More than a month into the long-term care lockdown across Ontario, Cathy Parkes learned COVID-19 had reached her father’s long-term care home.
In a call with Paul Parkes soon after the outbreak was announced, his voice was weak, making her think he was already in the grips of the virus.
“My brother managed to reach him briefly on Easter Sunday and he said he couldn’t speak at all,” said Parkes.
She said she spent the day trying to reach someone at the home, finally getting hold of a nurse at 9:15 p.m. He told her he couldn’t swab her father until he had a fever. But overnight, her father’s temperature began to rise.
The next day, Parkes went to Orchard Villa and stood outside her father’s window, looking in. She could see that her dad was in bad shape. She asked that the 86-year-old be moved to hospital.
‘He was not OK’
“I knew as soon as I saw him that he was not OK,” she said. “I kept saying, Dad, turn your head and look at me. He couldn’t do it.”
She got hold of the nursing staff by the evening and asked that he be moved to hospital.
But the charting report from that night confirms that the staff member advised against it. Parkes said staff assured her that her dad was doing better and had eaten most of his lunch that day.
“I thought that’s not possible,” said Parkes. “I was there at 12:05 at lunchtime and he was comatose.”
CBC’s The National and Marketplace examined the outbreak at Orchard Villa through a whistleblower’s account on the front lines and extensive interviews with family members of residents. They found that families were given false information and led to believe that the home had a handle of the situation when it didn’t.
Exclusive hidden camera footage shows that even two years ago, the home was underprepared for an emergency of this scale, and an analysis of five years of inspection reports paints a picture of a home with well-known problems that may have set the home up for failure.
‘He was not being fed’
Parkes, whose father died of COVID-19 at the home on April 15, is not the only one who says she was discouraged from seeking hospital intervention on behalf of their loved one at Orchard Villa.
Raquel John-Matuzewiski said she was told the same thing.
WATCH | A daughter ignored the advice from a nursing home and believes she saved her dad’s life:
Raquel John-Matuzewiski was told if her COVID-19 positive father had worsening symptoms, he would go into palliative care at the home because the hospital was not accepting patients from care homes. CBC learns that wasn’t true. 2:33
Two days after the death of Parkes’s father, John-Matuzewiski’s father, Chester John, tested positive for COVID-19.
A week later, when John-Matuzewiski saw that her father, 79, wasn’t doing well, she also asked about having him transferred to hospital. She said she was told that if his symptoms worsened, her father would start palliative care in the home because the hospital was not accepting patients from long-term care.
But when a FaceTime call revealed a sharp decline for her father in just 24 hours, John-Matuzewiski said she called the nursing station and insisted he be transported to hospital immediately. The home obliged.
Malnourished and dehydrated
“I no longer felt that … my dad’s wellbeing and safety could be entrusted to them,” John-Matuzewiski said.
But when John-Matuzewiski arrived at hospital, she learned her father’s poor condition wasn’t just because of COVID-19. He was also suffering from malnourishment and dehydration.
“It told me, obviously, that he was not being fed or being nourished or hydrated the way they had told me he had been for weeks,” she said.
After John was put on an IV and a feeding tube, he recovered and is in stable condition at Lakeridge Health Ajax Pickering Hospital.
Lakeridge Health, the health authority that runs the hospital, told CBC in a statement that there was never any period of time that it was not accepting long-term care patients.
Citing “privacy reasons,” Orchard Villa’s executive director, Jason Gay, wouldn’t comment on why families were advised against sending loved ones to hospital.
“We cannot comment on individual resident matters for privacy reasons so unfortunately, we cannot respond to most of your inquiries,” Gay said in a statement. “Our team at Orchard Villa reached out to health partners and the government early and often and all assistance provided was welcomed.”
‘They’re lying to you’
Parkes said the night she tried to send her father to the hospital, the nursing staff told her that everyone who had tried to go to hospital was rejected. Either the paramedics wouldn’t take them or they would arrive at the hospital and be sent back.
But she had contacted the hospital earlier and had been told they would take them.
Yet Parkes said the nursing staff still insisted the hospital was mistaken. “[They told me] ‘No, they won’t. They’re lying to you.’ “
Parkes decided to sleep on it and ask again the next day. But by then, it was too late. Her father had died.
“We weren’t given the chance for him to survive,” she said. “I think if my dad had been in the hospital, he might have had a chance.
“I think everything in this situation was done wrong — everything that could be done wrong was done wrong.”
WATCH | Orchard Villa told families a nearby hospital wouldn’t accept their parents during the pandemic:
Families at Ontario’s worst-hit nursing home say they feel the home misled them about COVID-19 care options. David Common investigates whether Orchard Villa staff discouraged families from sending their loved ones to the hospital and refused outside help when it was offered as the outbreak ramped up in the home. 8:42
Families of residents at Orchard Villa are left with many questions: Why were they discouraged from calling an ambulance? Why didn’t the home seek help earlier? Did management really think they had things under control?
If they did, they shouldn’t have, according to a care worker whom CBC has agreed not to name for fear he may lose his job.
“I would start my … evening shift from three to 11 and I’d find the breakfast and lunch trays sitting in front of the patients,” said the worker.
He said staff were only helping to feed patients who had required help feeding before the pandemic hit. The rest were fending for themselves.
Whistleblower haunted by what he saw
“The patients who were sick with COVID, they had no energy … the food would be sitting there right in front of them.”
He said it was “disheartening” to see because the residents were hungry, but they didn’t have the strength to pick up a fork and feed themselves.
“Imagine what it’s like … you put food in front [of them] and they can smell it, they can see it, but they can’t have it,” he said. “Not only were they hungry, it’s a carrot dangling in front of their face, you know?”
The worker is no longer working in the home, but the experience still haunts him.
“Now that it’s over and I’ve been out of it for a while, I’m actually having PTSD kind of symptoms,” he said.
The worker said he reached out to the Ontario Ministry of Health, and the prime minister’s office as well, urging them to talk to the front-line workers about what’s going on in these homes and how to fix it.
But according to Orchard Villa’s inspection reports from 2015 through 2019, the provincial government had already been alerted to the fact that the home was not prepared to deal with what reports call “community disasters.”
For every year that there is a retirement home inspection report posted on the Retirement Homes Regulatory Authority website, there is a violation noted for Orchard Villa’s emergency planning.
“A review of the emergency kit revealed that the only resources, supplies and equipment vital for emergency response set aside were three flashlights,” said an inspection report from 2015.
The next year, according to a report, the home still didn’t have a fulsome emergency plan, and there was “no evidence” of procedures for dealing with a community disaster or emergency evacuation.
A followup report later that year found no violations, but another emergency response plan violation was recorded in the next report in 2018. Inspections from 2017 and 2019 were either not conducted or their reports weren’t posted on the RHRA’s website.
When the undercover journalist asked about the inspection reports posted on the wall, an administrator said it had recently been written up for not having a plan to deal with a community disaster.
“The licensee provided an emergency plan which did not contain community disasters,” she read with a laugh. “So we took corrective action to complete.
“Quite often they can usually find something,” she said.
When the journalist visited the long-term care side of the home, staff appeared to violate their own rules about infection control.
“We’re not allowed to give tours during an outbreak,” said the staff member. “I’ll give you a quick glance.”
The journalist wandered the halls for 30 minutes without being made aware there was an outbreak before she was offered a tour.
Other reports in the years leading up to the pandemic from both the retirement and long-term care regulatory authorities might have tipped off the provincial Ministry of Health and Long-Term Care that this home might struggle in a pandemic.
They reveal that staff weren’t trained in infection control, that there were multiple incidents of neglect and there was chronic understaffing, including 14 shifts within a span of five months where there were no registered nurses on duty.
Residents lying on bare mattresses
Despite these reported incidents, Ontario Premier Doug Ford said he was shocked by a report released a month after members of the Canadian Armed Forces were ordered into five Ontario long-term care homes, including Orchard Villa, to help facilities that were struggling.
The report confirmed that a hydration schedule was not being adhered to and that residents were lying on bare mattresses, left in soiled diapers in bed and being fed while lying in bed, which, according to the report, “appeared to have contributed” to the choking death of a resident.
“The people that were really sick were just dehydrated, I’m not convinced that COVID killed a lot of people,” said the health worker. “And the reason I know that is because once the military started feeding them and making sure they’re getting fluids, people were rebounding faster.”
The government has since assigned Lakeridge Health to take over management of the home and appointed other health authorities and hospitals to manage six others in Ontario.
‘She was so dehydrated’
As shocked as the premier might be by the military report, many of the findings were predictable for family members with loved ones who lived at Orchard Villa.
Marie Tripp said she noticed issues right away when her mom, Mary Walsh, was admitted to Orchard Villa in April 2019. That’s why she was there every day to take care of her mom long before the COVID-19 lockdown locked her out.
“I continuously was asking for doctor’s appointments for mom, for followups…. Something as simple as getting her hair done wasn’t even done for two months,” she said. “I’d asked the same nurse over and over again all these questions [and she said] ‘I’ll get to it, I’ll get to it’ and it got to the point that nobody was getting to anything.”
Tripp said after her mom wasn’t given pain medication for three days following skin cancer surgery, she decided to install a camera in her room to monitor her care in the hours that she couldn’t be there with her.
With the camera on, Tripp developed serious questions over how the home was handling the COVID-19 situation. When she was watching the video feed, she noticed her mom’s breathing was shallow and laboured. She called the home and had her put on oxygen immediately. In another instance, she saw Walsh’s food and water left out of her reach. Tripp said calls to the home often went unanswered for hours.
‘Just trying to get help’
Tripp and her daughters went to visit her mom at the window of the home and saw that she was malnourished.
“My mom was so dehydrated, she had the call button in her hand and she was trying to drink from the call bell,” she said.
“I knew she was dying and I knew they wouldn’t let me in till the last hours,” she said “The only thing we could do was bang on that window — I was afraid my girls were going to break it — just trying to get help for Mom.”
Walsh died on April 20 at the age of 89.
WATCH | A daughter talks about why she monitored her mother’s care through a camera:
Marie Tripp says she witnessed her COVID-19 positive mother desperate for water and in urgent need of oxygen before mother’s ultimate death in the home. 4:24
Ralf Leswal said he was also in the home every day for years before COVID because he didn’t trust that his wife, Karen Leswal, would be fed if he wasn’t.
Karen Leswal had been living at Orchard Villa for 15 years before she caught COVID-19. She had Huntington’s disease and needed a lot of care, which her husband felt he needed to bolster.
Leswal would visit the home every night to feed his wife dinner. He said it would take an hour to feed her and make sure she was hydrated.
“Nobody under normal conditions has that time to give to a resident.”
Leswal said the home “never had enough staffing,” a sentiment shared by inspectors who documented short-staffing issues in reports from 2016, 2017 and 2018.
‘To the worker, it’s all about time’
He said the home wasn’t meeting the care needs of residents even before the pandemic.
“I cleaned my wife’s room personally because the standard of housekeeping was ridiculous,” said Leswal.
“To the worker, it’s all about time. If you spend 10 minutes on one resident, that means you’ve got to spend less on the next resident, right?” he said. “They’re not even paying attention sometimes to the resident they’re working with because they’re thinking, ‘Oh, I got to be here, I got to be here, I got to be here.’ ”
Leswal was shut out of the home for 43 days before he got a call on April 27 saying his wife was palliative and that he should come to say his goodbyes. She died on April 30 at the age of 69.
“I really don’t know whether she died from COVID or whether she died of a combination of being malnourished, mistreated,” he said. “I have no idea.
“I knew my wife would some day pass,” he said. “But … she didn’t die on her terms.”
Orchard Villa wouldn’t comment on the death for “privacy reasons.”
After eight weeks of intervention from Lakeridge Health, and seven weeks of help from the army, Orchard Villa is now COVID-free.
But with a 78-person death toll, families are left wondering how many might have been saved had the home been adequately prepared or sought intervention sooner.
For her part, John-Matuzewiski won’t be taking her father back to Orchard Villa after he’s discharged from hospital.
“I told them that the day he was admitted [to hospital],” she said. “The trust has been broken.”
A failure to make safety upgrades to their buildings in the past two decades appears to have left many long-term-care homes particularly vulnerable to the deadly spread of COVID-19.
Since the pandemic began earlier this year, almost half of Ontario’s long-term care homes have suffered outbreaks. For some facilities, a handful of residents fell ill and eventually recovered. For others, as many as 45 per cent of their residents died.
Data analyzed by Marketplace reveals the structure of the buildings themselves may be a contributing factor that helps explain this disparity.
Ontario changed its structural safety standards back in 1998 — mandating, among other things, that nursing home bedrooms should house no more than two residents.
Homes that didn’t meet the new standard were allowed to keep running as-is, with an expectation they would upgrade eventually. The vast majority of homes that haven’t yet upgraded are run by for-profit companies.
While non-profit and for-profit homes have been equally likely to experience outbreaks, those outbreaks have proven deadlier in for-profit homes.
Only a third of the 78,163 beds in Ontario facilities remain at the 1972 standard, referred to as C, but they account for 57 per cent of the province’s 1,691 reported COVID-19 deaths (as of Tuesday morning) in long-term care homes.
Buildings that operate at the C standard may have four-person shared wards and communal dining rooms where hundreds of people are brought together for meals.
Experts say such out-of-date features make infection control much more difficult.
Diana Anderson, a medical doctor and architect from Montreal who has worked on hospital design projects in the U.S., Canada and Australia and specializes in environments for geriatric patients, says the four-person wards, in particular, pose a number of risks.
“You’re bringing more pathogens in from the outside based on how many people are coming in and out of that space,” she said. “Not only do you have staff, you have family members and loved ones of the three other roommates with you.”
She says sharing a washroom means more opportunities to spread viruses between residents in the same room, plus it makes staff less likely to wash their hands between patients when they aren’t passing by a washroom each time.
The four-bed wards are one of the main reasons Dilys Patterson, 62, pulled her 93-year-old mother, Joan, out of Camilla Care Community in Mississauga, Ont. She did so immediately after the first case of coronavirus was confirmed there on April 6.
Now, 67 residents are dead — the second highest death toll in a long-term care home in Ontario. Of the 297 homes in the province that have had an outbreak, Camilla has the 11th highest death rate, with 28 deaths per 100 beds. And Camilla is still dealing with an active outbreak.
“I got a call saying that there was one case and I couldn’t sleep that night because I know the facility is very crowded,” Patterson said. “I woke up and I just said, ‘I have to do something.'”
Patterson has had to take a leave of absence from her job in retail to take care of her mother full time, but she won’t be able to stay home with her forever. She’s hoping to get her mother into a newer home, she said.
“I would like her living in something much safer, but then the problem is there’s no beds there, right? How do you stomach putting your loved one in a place that you know is dangerous?”
Camila Care’s parent company, Sienna Living, told Marketplace in a statement that it hasn’t upgraded the facility because of the cost. The company said it has been advocating for increased funding from the government, as “construction funding has remained mostly unchanged since 2014, with no annual adjustments for inflation or rising construction costs.”
Four-person rooms have been considered below standard since 1998. However, the updated rules only applied to new homes being built. Since then, standards were upgraded again in 2002, and most recently in 2015. Beds that exceed the 1972 standard are classified as “B”, “A” or “New” depending on how far they are from meeting current standards. There are approximately 1,300 Ontario beds that don’t meet the 1972 standard, which are classified as “D” beds.
“Politicians have said they are committed to change, but they’ve been sitting on this for 22 years,” Patterson said. “That doesn’t show me that they’re very interested in addressing these issues.”
She said she is concerned not only about the close quarters typical in older homes, but also the time and effort that’s required to feed everyone in a big dining hall.
“At Camilla, everyone had to go downstairs to get their meals, and it was just chaos,” she said. “Everyone had to gather in front of the elevator and get taken down, they had to be received at the dining room, at ground floor, and then the whole process had to be reversed again.
“[That’s] a lot of time and energy for staff — devoted staff — just schlepping people around.”
How design can affect health
When Marketplace reviewed data from homes that lost 20 per cent of their residents or more to the coronavirus, it found 65 per cent of those homes had C-level accommodations.
The fact that so many Ontario homes only meet a 1972 structural standard is an “interesting timeline,” said Anderson, the doctor and architect.
She said it wasn’t until the 1980s that architecture shifted to what’s called evidence-based design, which means incorporating research on the relationship between physical space and health into the design of a structure.
In geriatric settings, she said, studies have shown building design has an impact on health outcomes for infection control and fall prevention.
“There is quite a convincing data set for the move toward single rooms,” she said, pointing to a medical journal study published in 2019 that showed the benefits of the single-room model for hospitals in slowing the spread of infections.
In 2010, long-term care homes in Ontario were given 15-year licences based on the structural standards they had at the time. Many homes have upgraded since then, with non-profit homes accounting for only 12 per cent of the province’s 24,695 beds still classified as C level, with another eight per cent in long-term care homes owned by municipalities.
However, 80 per cent of the C-level beds that remain are run by for-profit homes. Those beds account for 49 per cent of the total for-profit beds, meaning almost half of the beds in for-profit facilities are still at the 1972 standard or below.
Why the delay?
So why do for-profit companies own the vast majority of beds in older facilities, and why haven’t more of them upgraded their facilities?
It depends on who you ask.
The Ontario Long Term Care Association, which represents 70 per cent of care homes in Ontario, is advocating alongside Sienna and others for more funding for redevelopment. The association said in a statement that current funding “does not reflect historic increases in the cost of construction.”
However, the Ministry of Long-Term Care said in a statement it has invested $ 1.75 billion “specifically to bring aging long-term care homes up to modern standards and build badly needed new capacity.”
“We are putting our money behind this,” the ministry said.
It’s about money, lawyer says
In the view of elder advocate and lawyer Jane Meadus, it really comes down to profit.
Meadus has been specializing in long-term care issues for 25 years. She says that when the Long-Term Care Homes Act came into law in 2010, there was an expectation that in the following 15 years, the older homes would all upgrade to meet modern standards, and while many non-profit homes have done so, many for-profit homes have not.
“They would have to use some of their profits to rebuild,” she said. “They’re able to keep their homes occupied at a high rate … and so there isn’t any particular impetus for them to build because they fill their beds anyway.”
She said more pressure needs to be put on these homes to meet modern standards.
“We have building codes for everything else,” she said. “And when you look at the profits that are coming out, frankly, the amount of money that is being paid to the executives, you know, they’re doing it on the backs of people, and on the province’s dime.”
The provincial government has called for a commission into Ontario’s long-term care system to understand the impacts and responses to the COVID-19 outbreak. It is scheduled to begin in September.
The ministry said there are currently 686 older long-term care beds in the construction phase of redevelopment, and an additional 11,727 at various stages of planning for redevelopment. It also continues to receive applications to redevelop older beds under the most recent call for applications, the ministry said.
In the meantime, the OLTCA says, it is asking the ministry for immediate support to make emergency renovations to older buildings to make them “better suited to the level of infection control required for a pandemic.”
It says the changes under consideration include removing carpeting, creating larger spaces for physical distancing in common areas, and converting three- and four-bed rooms to one- and two-bed rooms only.
The data about deaths in the province’s long-term care facilities was pulled from Ontario’s COVID-19 website on Friday, June 5, and compared to the profit status for each home available on Ontario’s long-term care reports website, as well as structural classification data that was obtained by CBC from the Ministry of Long-Term Care.
Where death numbers were indicated as <5 on the provincial website, they were corrected to 1. As of June 9, the total confirmed long-term care deaths listed on the provincial website is 1,720, as reported by the Ministry of Long-Term Care, and 1,575 as reported by the Public Health Ontario daily epidemiologic summary. The total deaths that are assigned to specific homes on the website as of June 9 is 1,691, so that is the death number used to calculate percentages.
Structural data was compared on a per-bed basis. A small number of homes have more than one bed classification (i.e. one wing of “C” beds and one wing of “A” beds). We don’t know which wing the deaths occurred on, so when analyzing death counts in C and D homes, we assigned the home the lowest standard of beds that were operational there.
Out of the 1,691 deaths, 12 fell into this category: 11 deaths at Chartwell Aurora, which is majority C-standard home, and one death at Craiglee, which has an even split between C and New beds with fewer beds in the A category.
Jacqueline Mitchell hasn’t been able to hug her 94-old-mother since March, and now, in the face of a shocking Canadian Armed Forces (CAF) report into the state of five Ontario long-term care homes, she is aghast.
Mitchell’s mother has Alzheimer’s disease, and has been a resident at Etobicoke, Ont.’s Eatonville Care Centre since 2017. That’s one of the homes listed in the report, which details disturbing observations made by military members who were called in to help after some of the province’s long-term care facilities were overrun by COVID-19 outbreaks.
The CAF report outlines instances in which members spotted equipment used on both infected and non-infected patients without being disinfected, as well as rotten food, cockroach infestations and a startling disregard for basic cleanliness.
“It is scandalous. It is shameful. It is shocking,” Mitchell said. “Our senior generation is living in that, and that is a national atrocity.”
There are many signs the provincial government knew, or should have known, what’s happening inside these homes, but it took military intervention to bring the details to light.
WATCH | Minister of Long-Term Care discusses military report:
Merrilee Fullerton, Ontario Minister of Long-Term Care, says the province is committed to fixing long-term care homes in need of help after a report by the Canadian military on conditions in five facilities. 2:02
For weeks, Ontario Premier Doug Ford has been saying the province’s long-term care system is “broken.” And on Tuesday he said that he saw firsthand the limitations of the system when his brother, former Toronto mayor Rob Ford, was in palliative care before his death in 2016.
That, to Mitchell, signalled an acknowledgement on the premier’s part that something was very wrong with the system.
“That should have alerted him on a personal basis to what was happening in these homes.… He should not be surprised,” she said.
Since the first weeks of the pandemic, Ford has been advocating for the need to put an “iron ring” around Ontario’s long-term care homes, with the province touting measures it has enacted to keep people safe, like limiting visitors and preventing most caregivers from working at multiple homes. The province then asked for the military’s help late last month.
As of Tuesday, the Ministry of Long-Term Care was reporting 1,538 deaths linked to COVID-19, while the Public Health Ontario Daily Epidemiologic Summary listed 4,892 cases among residents.
In a statement issued Tuesday, Opposition NDP Leader Andrea Horwath slammed the government’s response, and called for the resignation of Minister of Long-Term Care Merrillee Fullerton.
“It’s shocking that the Canadian Armed Forces needed to lift the veil when Doug Ford and Merrilee Fullerton ought to have known about these horrific conditions, and did nothing to take the homes over,” Horwath said. “The premier cannot pass the buck, finger-point and express outrage about what his own government is doing on his watch.”
System ‘neglected and ignored’ for decades
Fullerton said it was the novel coronavirus that pushed some of the province’s long-term care homes to the brink.
“This is something that everyone has known about for years. Our population is aging. Long-term care was ignored. Long- term care was neglected,” she said.
“We were shining a light on this. We were looking at fixing a system that had been neglected and ignored for decades — and then COVID … tipped the homes that were having difficulties with staffing already right over the edge.”
WATCH | Marissa Lennox of CARP says the system has long been broken:
CARP Chief Policy Officer, Marissa Lennox, says long-term care is something people don’t want to think about, and that the system has long been broken. 10:08
Ford said Tuesday that it took a constant, watchful eye from the military to truly uncover the scope of the problem.
“Yes, inspections happen and these folks come in there, but it took the military to be there 24/7,” the premier said, adding it’s impossible to know the extent of the problems plaguing the system “until you live, breathe, eat it … until you’re there around the clock, at nighttime and during the day.”
Fullerton said Tuesday that the province conducted nearly 3,000 inspections last year at long-term care facilities, spurred by so-called critical incidents and complaints reported to an “action line” for families, residents and staff.
But a recent CBC News investigation found that last year just nine out of 626 homes in Ontario actually received resident quality inspections (RQIs), which are unannounced and more comprehensive than those arising from incident reports.
CBC News reviewed inspection reports from the last five years for all long-term care homes in the province and found that while most received an RQI in 2015, 2016 and 2017, the number dropped to just over half in 2018 and nine last year.
‘Immediate attention’ needed
In a news release issued Tuesday, Ontario Nurses’ Association (ONA) president Vicki McKenna said the association has contacted the Ministry of Labour about working conditions in long-term care homes, but the ministry has written few orders and has “rarely been on site to conduct physical inspections.”
“This sector needs immediate attention,” she said. “Government must act now to halt these outbreaks.”
ONA’s statement also notes that a number of long-term care reports have been issued in the last two decades that continue to make the same recommendations to improve the sector: more staffing, more funding, better training and increased resources.
A 2017-2018 public inquiry into the safety and security of residents in long-term care homes found “systemic vulnerabilities” in the system. The Ontario Health Coalition has for years been issuing reports about problems in long-term care, including understaffing and excessive violence.
The Ontario Personal Support Workers Association also said in a statement that these are not new problems.
“We have been working through these difficult conditions for years,” the statement reads. “They have worsened over the last three months.”
Laura Tamblyn Watts, CEO of national seniors’ advocacy organization CanAge, told CBC News in an interview it’s very telling that the state of these long-term care homes could shock even soldiers who go on peacekeeping missions.
“How much more do we need for this government and our provinces and territories to take needed action?” she asked.
The Canadian military has drawn the curtain back on horrific allegations of elder abuse in five Ontario long-term care homes, with precise, graphic reports of residents being bullied, drugged, improperly fed and in some cases left for hours and days in soiled bedding.
Within the military’s shocking catalogue of abuse, neglect and cruelty is an accusation that delinquent care led to the death of a resident.
Soldiers were called into the facilities as part of an effort to backstop the provincial system, which has been overwhelmed by novel coronavirus cases.
What they found has been recorded in assessments of each of the homes — in Pickering, Scarborough, Etobicoke, North York and Brampton — and presented in a report to the Ontario government.
“It’s gut-wrenching,” said a grim-faced Premier Doug Ford Tuesday. “Reading this report is the hardest thing I have done as premier.”
According to the report, conditions in two of the seniors homes — Orchard Villa in Pickering and Eatonville Care Centre in Etobicoke — appeared to be nothing short of horrid and inhumane as ill-trained, burned-out and, in some cases, neglectful staff coped with the growing care needs of elderly residents.
It was in Orchard Villa that troops observed the choking death of one senior, who was lying down while being fed.
“Staff were unable to dislodge food or revive the resident,” said the report, which went on to conclude that the practice of not having patients sit up “appeared to have contributed” to the patient’s death.
In the same centre, according to the report, troops had to send a senior to hospital after the resident fractured a hip and was not cared for by staff. Other patients were “left in beds soiled, in diapers, rather than being ambulated to the toilets.”
‘Cockroaches and flies present’
“Cockroaches and flies present,” one assessment said. “Rotten food smell noted in the hallway outside. CAF members found multiple old food trays stacked inside the bed table.”
Staff members were overwhelmed and burned out, the report said.
“Respecting the dignity of patients is not always a priority,” it said.
The report details conditions at five facilities where troops have been helping out:
Orchard Villa in Pickering.
Altamont Care Community in Scarborough.
Eatonville in Etobicoke.
Hawthorne Place in North York.
Holland Christian Homes Grace Manor in Brampton.
At the Eatonville Care Centre, soldiers reported “witnessing aggressive behaviour” by staff — reports that prompted an investigation by facility management.
It was there that troops also reported seeing the drugging of patients whom staff claimed were “difficult or agitated.”
“But when you talk to them they just say they’re ‘scared and feeling alone like they’re in jail’ — no agitation or sedation required,” the report said.
At the Altamont Care Community in Scarborough, said the report, residents faced “inadequate nutrition” because most of them were not getting three meals a day — and when they did, “underfeeding was reported.”
It was also there that a “non-verbal resident wrote a disturbing letter alleging neglect and abuse” by a personal support worker. The letter was given to the military medic by the senior and the allegations were reported to the facility’s management.
PM calls findings ‘deeply disturbing’
Several of the assessments noted unsafe conditions that could help spread COVID-19, including instances where patients who had tested positive for the virus “were allowed to wander” and staff members left with inadequate personal protective equipment.
In his daily media briefing today, the prime minister said he was aware of the assessments and was saddened, shocked, disappointed and angered by what he’d heard.
“It is deeply disturbing,” Justin Trudeau said.
The allegations were first reported in an online story Tuesday morning by Global News.
The military compiles daily situation reports on the deployment and the allegations first surfaced in those assessments in early May, within two weeks of troops beginning the deployment.
Watch: Ontario premier calls military report on long-term care homes ‘heartbreaking’ and ‘gut-wrenching’
Doug Ford promises accountability and justice after the report describes ‘extremely troubling’ conditions in the homes. 1:26
Troops are obliged to report cases of abuse and mistreatment to the military chain of command or, if they are a nurse or a doctor, to their own health certification bodies.
The overall assessment, dated May 14, was compiled by the commander of the 4th Canadian Division, Brig.-Gen. Conrad Mialkowski, and forwarded on to National Defence Headquarters.
It did not arrive on Defence Minister Harjit Sajjan’s desk until a week later later, at which point other federal ministers were notified.
The Ontario government wasn’t formally notified until Sunday and the premier said he learned about the situation Monday night.
The report notes that the military’s concerns were raised with the management of each of the homes in “collegial manner” in a series of teleconferences, starting on May 4.
In the House of Commons today, the Conservatives accused the Liberal government of foot-dragging. The federal NDP, meanwhile, called for a thorough investigation of every allegation “and criminal charges where appropriate.”
‘Anger, sadness, frustration’
The Department of National Defence refused to comment, saying that the Ontario government is responsible for the institutions.
“On reading the deeply disturbing report, I had obviously a range of emotions of anger, of sadness, of frustration, of grief,” Trudeau said. “It is extremely troubling, and as I’ve said from the very beginning of this, we need to do a better job of supporting our seniors in long-term care right across the country, through this pandemic and beyond.”
Watch: Prime Minister Justin Trudeau on ‘deeply disturbing’ reports out of long-term care homes
Prime Minister Justin Trudeau spoke with reporters including the CBC’s Tom Parry on Tuesday. 3:02
Trudeau said the report underscores the need to improve standards of care for seniors in long-term care homes across the country, and said the federal government will support the provinces’ efforts to do that going forward. Long-term care falls under provincial jurisdiction.
“We need to do a better job of caring for the people who built this country,” Trudeau said. “The greatest generation saw us through World War Two. We need to be there to support them properly through this global crisis.”
Over 1,675 troops have been brought in to backstop five long-term care homes in Ontario and a further 25 in Quebec. Their duties include helping residents with day-to-day needs, cleaning the facilities and meal distribution.
It is unclear whether similar abuse allegations have been levelled at long-term care facilities in Quebec. The federal Public Safety department has said a similar assessment is being prepared for that much larger operation.
Class action suit filed against Pickering home
Trudeau said Ontario and Quebec have asked that the deployment of troops in long-term care homes be extended until the end of June.
A Department of National Defence slide deck presentation, released along with the assessments, shows the Ontario government has a total of 27 seniors homes “critically affected” by the pandemic and provincial authorities want the military to move to different facilities as existing ones are stabilized.
A class action lawsuit was filed on Monday against the Orchard Villa, alleging the spread of COVID-19 in the home was “a needless tragedy which has now caused 77 deaths and over 200 infections of residents.”
A copy of the statement of claim was obtained by CBC News. None of the allegations have been proven in court.
“Orchard Villa was not prepared for the outbreak of COVID-19 and did not have adequate policies and procedures in place to prevent the spread of COVID-19,” said lawyer Gary Will, who filed the class action suit.
“The results of this incompetence were devastating to the residents of Orchard Villa.”
Sylvia Lyon, of Pickering, Ont., lost her mother Ursula Drehlich, a resident of the home, on April 23 and will act as the lead plaintiff in the case.
The suit alleges Orchard Villa continued to allow residents to sit together for meals after the Ontario government had issued strict guidelines on physical distancing in late March.
Five Canadian Forces soldiers have been infected with the novel coronavirus while serving in Quebec and Ontario nursing homes — four in Quebec and one in Ontario — the Department of National Defence confirms.
One of the soldiers was performing duties at the Villa Val des Arbres in Laval, a suburb of Montreal, said a former soldier and veteran’s advocate who has been tracking the military’s pandemic deployment.
That infected soldier, who has not been identified, was part of a team of military members who arrived at the seniors home on April 20 in response to an urgent request for assistance from the Quebec government, said Sylvain Chartrand of Canadian Veterans Advocacy.
After the soldier tested positive for the novel coronavirus, the entire team was removed from the home. It’s not clear whether they were told to isolate themselves.
A second case is said to be a military dentist who also took up duties in one of the long-term care centres — possibly in the Montreal area, the current epicentre of the COVID-19 outbreak in Canada.
National Defence did not provide details about the other three confirmed cases.
“The safety of the soldiers is a concern to the veterans community and me personally,” Chartrand said. “We must absolutely must make sure that all treatment benefits within the military are available but, more importantly, that Veterans Affairs Canada provides treatment compensation for any foreseeable consequences of this virus.”
Watch | Brig.-Gen. Gervais Carpentier on Canadian Armed Forces members who have tested positive for COVID-19:
Brigadier-General Gervais Carpentier speaks with the CBC’s Rosemary Barton about Canadian Armed Forces members serving in long term care facilities who have tested positive for COVID-19. 12:04
Prime Minister Justin Trudeau confirmed news of the infections at his Friday morning media availability but did not provide details.
“There are always risks in what they do and they go into that knowingly and willingly, and that is why we offer them our deepest gratitude every day,” Trudeau said.
“At the same time, we need to make sure that we are doing everything we can to protect them, so we will look at the protocols in place and see if and how they can be strengthened … ensuring that cases of COVID-19 don’t spread throughout the [Canadian Armed Forces] and others who are serving their country.”
Watch | Prime Minister Justin Trudeau reacts to military cases of COVID-19:
Prime Minister Justin Trudeau spoke with reporters on Friday. 1:22