As I was saying, I support the comments that Ms. Estabrooks has just made. I completely agree with her analysis.
Since we have less time to address you, I'm going to focus instead on a number of facts that should outrage all Canadians.
In this first crisis, Quebec experienced true “age-icide”. I use that word deliberately, because that is really what it is all about, in my opinion. In Quebec, 10% of people living in a CHSLD died during the first wave. In Ontario it was 2.3% and in British Columbia it was 0.6%. Of all the European countries, only Spain has figures somewhat similar to ours. In that country, 5.3% of people living in long-term care facilities died from COVID-19. The death toll was twice that in Quebec.
Why did Quebec experience such a massacre? Several reasons can be cited. I will list some of them, so that what Quebec went through never happens again, in this province or elsewhere.
It became clear that in Quebec, living conditions in facilities like CHSLDs had been neglected over the past three decades. First, CHSLD management and governance have been completely “swallowed up” by much larger health care facilities. As early as 2003, the boards of directors and executive management of CHSLDs were eliminated, and CHSLDs were merged with hospitals and local community service centres in all Quebec communities. This first major reform in 2003 caused the CHSLDs to lose their own administrative entity.
New structural reforms came in 2015. This is when the integrated health and social services centres, or CISSS, were created. Rehabilitation centres and youth centres were integrated and establishments across an entire region were merged. In Quebec, we therefore ended up with very large groups with several missions: the hospital mission, of course which is still predominant; the frontline services mission; the CHSLD mission; the rehabilitation mission, and that of youth centres.
New Brunswick and Alberta also experienced a major merger of this kind that places the hospital at the centre of institutions and marginalizes the other missions of these huge complexes. We are therefore left with CHSLDs that no longer have their own management. Investigator Yves Benoit, who produced a report on the situation at CHSLD Sainte-Dorothée, says the following: More than five reporting lines stand between the CEO of the Laval CISSS and the managing first responder (coordinator) of CHSLD Ste-Dorothée.
If you count the ministry, that makes six reporting lines. For example, it could take several days or even weeks to submit a problem to hospital management and get a response. A significant loss of agility was having an impact on how these facilities were managed.
Staffing shortages, especially of personal support workers, are the second major problem. Over the past few years, the work of PSWs has been devalued, not only due to inadequate pay, but also, I would argue, because the human element has been removed from what they do. Putting a time limit on each of their tasks has obscured the PSW's role, which is to provide residents with emotional support. The PSW's value lies therein. The quality of the work environment has deteriorated over the last five years, in the wake of the major reforms in 2015. Over half a billion dollars in excess wage insurance, overtime hours and the use of freelance labour show that things have deteriorated.
The third major issue is the deterioration of medical and nursing care. Physicians have been steered towards clinical practice. They have therefore abandoned CHSLD practice. Similarly, nurses have been steered towards hospitals, where greater needs arose. As a result, medical and nursing care in CHSLDs no longer made it possible to monitor patients properly and, above all, to treat them in the event of acute deterioration.
The fourth major reason is facilities are obsolete. Some facilities have multi-bed rooms, shared bathrooms, or ventilation and air conditioning problems, and some do not have a spare room to provide end-of-life care or isolation rooms for treating infections.
The pandemic has been mismanaged due to the focus on preparing hospitals to receive patients with the virus and massive transfers to CHSLDs of patients at the end of acute care. Priority was also given to hospitals in terms of infection prevention and control, resulting in a lack of both these in CHSLDs. Staff have been moving freely, and they still are, unfortunately. This has contributed to outbreaks and spreading the virus. Problems arose with availability of equipment, and priority was again given to hospitals. Visits by family caregivers, who provide residents not only with emotional support, but also with necessary, even essential, day-to-day care, were not permitted.
Designation of hot spots came late once outbreaks were under way, and staff could not get tested in those facilities. These oversights led to a major crisis. Imagine if it were 10% of children in schools, 10% of children in daycare centres, 10% of an indigenous community. People would be horrified, everyone would stage un rebellion. However, we had no “Old Age...” or “Old Lives Matter” movement for seniors in the first wave. I fully agree with Ms. Estabrooks that this pandemic brought thinly veiled ageism to the fore.
I'd like to thank the Canadian Armed Forces for coming to help limit the damage of this pandemic in our residential facilities.
Thank you, Madam Chair.