MONTREAL -- The Collège des médecins du Québec (CMQ), the Ordre des infirmières et infirmiers du Québec (OIIQ) and the Ordre des infirmières et infirmiers auxiliaires du Québec (OIIAQ) jointly conducted an investigation on the quality of health care provided by their respective members at the CHSLD Herron and the Institut universitaire de gériatrie de Montréal (IUGM).

We chose these two institutions, one private and the other public, because 64 deaths, almost equally distributed in the two CHSLD, occurred in a very short period of time at the start of the pandemic. One year later, on a Quebec-wide basis, the pandemic will have caused 100 times more deaths in CHSLD.

Our investigation covered the period from December 1, 2019 to April 15, 2020 in order to obtain a portrait of the quality of practices before and during the first wave of the COVID-19 pandemic. Nearly 200 people were interviewed, including about 40 managers, almost as many orderlies, 50 nurses, 37 nursing assistants and 6 physicians.

Protective equipment: shortage and confusion

Although our investigation did not reveal any apparent shortcomings on the part of the doctors, nurses and nursing assistants on duty, it did highlight the lack of compliance with infection control and prevention measures.

Also, the multiplication of daily directives from the Ministry of Health and Social Services, which were often contradictory, led to confusion about the wearing of personal protective equipment among health care personnel. This equipment was often missing.

CHSLD Herron

The lack of collaboration of the owners/managers of the CHSLD Herron with the health authorities, their lack of knowledge of the health network and staffing problems had a major impact on the continuum of care. The ratios were absolutely insufficient, with, for example, one resource for every 57 residents in the evening, and only one for every 138 patients at night. 

Contrary to what was conveyed, the physicians, nurses and nursing assistants did not abandon the residents or desert this CHSLD; rather, they were asked not to report to work if they had symptoms of COVID-19 or if they had been in contact with a person who tested positive. Their replacement was not arranged. As a result, patients were left to fend for themselves. 

IUGM 

The investigation shows that despite the exceptional circumstances and the issues surrounding the lack of infection prevention and control resources and all the difficulties encountered, the care provided was adequate despite the significant increase in its intensity. The teams were experienced, supported by competent management and advisory support staff. 

Recommendations 

The CMQ, the OIIQ and the OIIAQ hope that the conclusions of this investigation will encourage the government to give itself the necessary means to guarantee the same level of quality of care to all seniors in CHSLD. 

We are asking that the rules for issuing permits to operate a private CHSLD be reviewed so that the authorities have the legal levers to intervene and assume their responsibilities towards patients, among other things by ensuring the presence of competent personnel, and in sufficient numbers. 

We must therefore rethink the formula to ensure the continuum of care for our seniors. This is a societal project to which our members want to contribute, along with the government, if it chooses to move in this direction.

But it is, first and foremost, a collective responsibility.

Dr. Mauril Gaudreault is the president of the College des médecins du Quebec.

Luc Mathieu is the president of the Ordre des infirmieres et infirmiers du Quebec.

Carole Grant is the president of the Ordre des infirmières et infirmiers auxiliaires du Québec.