Military report reveals critical care gaps in Quebec nursing homes

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Orderlies showed up late or disappeared during their shifts. Boxes of surgical masks and narcotics went missing. Long-time employees quarrelled with newcomers and repeatedly ignored safety instructions.

While devoid of the graphic details of a similar military report on Ontario’s long-term care homes, the Canadian Armed Forces report released Wednesday on facilities in Quebec portrays a dysfunctional eldercare system that could not handle the COVID-19 crisis.

The pandemic has killed some 2,700 Quebeckers living in long-term care homes and has led to thousands of nurses and orderlies missing work, forcing the government of Premier François Legault to ask for assistance from the Canadian military.

The 60-page report summarizes the observations of more than 1,000 military personnel deployed at 25 Quebec seniors’ homes.

While some homes were praised for having efficient management, the military detailed a litany of poor medical practices or management issues at other locations.

At Montreal’s Grace Dart Extended Care Centre, where 61 patients have died, personal protective equipment (PPE) was an issue. “Prevention and control of the contamination didn’t follow the guidelines set by [the local health authority]. On our arrival, the use of PPE was a major problem,” the report said.

Even after the military held briefings with the staff, “breaches of security were still observed.”

There was a lack of on-duty physicians, and some employees arrived late or would go missing during their shifts for 30 minutes to two hours, the document said.

It also noted that some workers left their positions at night because the military personnel were present.

At Vigi Mont-Royal, a private Montreal facility where 70 residents died, “the increase in required PPE seems to have made several members of the medical personnel flee,” the report said.

The military said Vigi Mont-Royal had trouble controlling the distribution of PPE and medications. For example, a shipment of 20 boxes of surgical masks and one of narcotics disappeared.

“We noticed that [safety] guidelines were not followed by some civilian employees despite constant reminder by our military … each day we witnessed employees who didn’t follow the protocols set up by the facility.”

Vigi Mont-Royal also had problems because a manager sent to help by the local health board contracted COVID-19 and had to be replaced, according to the report.

“A day doesn’t often go by without an incident perturbing the operational routine,” the report said of the facility.

At the Saint-Laurent LTC in Montreal, where 43 residents died, the military witnessed animosity between the regular employees and new workers who came to help.

“The friction stemmed mainly from the amount of hours of work, management of the facility, attendance and the great lack of nurses. One coordinator threatened to stop work if more nurses weren’t hired. We noticed many employees went missing without warning during their shifts.”

Poor work habits were also noted at the De La Rive LTC in Laval, where 41 died.

“The military constantly has to reiterate the disinfection protocols to civilians who are changing equipment,” the report said. “Also, residents moving between zones make the infection prevention more complicated.”

At the Floralies-de-Lasalle private care home, where nine died, there was no central information management system, so when regular staff fell ill, replacement workers had trouble finding details about patients.

The most common issue was a lack of staff.

“On our arrival, the personnel was overwhelmed, understaffed, exhausted and facing an important number of COVID-19 symptomatic residents,” the report said of the Yvon-Brunet home, where 72 people died.

The facility badly needed nursing help in the evening and for tasks ranging from changing incontinence diapers to preparing food trays.

The report for Quebec was written in a more generic fashion than Ontario’s document, and a laconic paragraph hints at deeper clinical issues.

“According to our observations, the scope of the crisis resulted in many good practices being ignored so as to deal with more urgent problems,” the report said, without elaborating, about the Auclair LTC, where 29 residents have died.

In the same understated manner, the report said most of the homes had missing staff, which “had a direct impact on the hygiene of the residents.”

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