Staffing still Achilles heel of Quebec's fragile network of long-term care homes

Quebec hospitals have so far borne the brunt of the Omicron wave, with an unprecedented surge in COVID-19 patients, but the province's network of long-term care homes is also dealing with another round of outbreaks from the highly transmissible variant.

While the situation in long-term care institutions, known as CHSLDs, is nowhere close to the crisis that unfolded in the spring of 2020, the number of outbreaks has climbed in recent weeks.

The number of deaths in CHSLDs has also increased, with 40 reported last week alone — the most since last February.

One orderly who works at CHSLD Saint-Margaret in the Montreal enclave of Westmount said staffing remains the main issue nearly two years into the pandemic.

"That's the main problem right now," said the worker, who asked not to be named for fear of reprisal from her employer.

Saint-Margaret is one of more than 300 CHSLDs dealing with a confirmed case of COVID-19, according to the latest data available. There were also confirmed cases in more than 500 private seniors' residences, known as RPAs.

Most outbreaks have remained small, however, and the worker noted that protocols have improved, and there is more protective equipment available.

Contrast that to the first months of the pandemic, from March to August 2020, when 5,157 elderly Quebecers in care died, accounting for 90 per cent of total COVID-19 deaths in the province at the time.

Later today, Quebec's health and welfare commissioner, Joanne Castonguay, will release her final report documenting the failures that led to devastation in CHSLDs in that first wave. 

Dr. Leighanne Parkes, an infectious disease specialist and microbiologist at Montreal's Jewish General Hospital, is cautiously optimistic CHSLDs and RPAs will fare much better in this wave than earlier in the pandemic.

"So far, we are holding on," said Parkes, who specializes in infection prevention and control at both the hospital and long-term care facilities overseen by Montreal's west-central health authority.

Unlike the first wave which ravaged long-term care facilities, the outbreaks are generally more manageable now and patients are not as severely ill, she said.

Parkes credits the push to give long-term care residents a third dose of vaccine last fall, before the highly contagious Omicron variant took hold, for helping reduce the number of serious illnesses and deaths in CHSLDs.

Although Parkes believes the health authority has learned from its mistakes, she said there are still large, sweeping infrastructure changes required across the system. That's hard to do in the middle of a pandemic, Parkes said, but better ventilation, optimal distancing and improved patient-staffing ratios will need to be addressed in the future.