Quebec's senior care system is flawed and disorganized: report

New report says poorly organized services, absence of a real strategy for dealing with an aging population, contributed to toll taken by first wave of COVID-19.

Montreal Gazette 4 minute read September 3, 2021

QUEBEC — Poorly organized services for seniors in long-term care homes, a lack of reliable basic data and the absence of a real strategy and funding for dealing with an aging population were factors in the tragic events of the first wave of COVID-19, a new report says.

But health and social services commissioner Joanne Castonguay says it’s difficult to pin the blame on anyone because nobody in government seems to be keeping track of how the system is working.

And when the first wave of the pandemic hit in March 2020, it was too late to fix things, and even then, wrong decisions were made.

“What we can already conclude is that there were many missed opportunities at the beginning of the crisis to take the right decisions; the consequences of these missed opportunities were extremely serious,” Castonguay writes in a preliminary report released Thursday.

“These problems, as well as their solutions, have been known for a long time and the crisis exacerbated them.”

Mandated by the Legault government in August 2020, Castonguay is carrying out a sweeping investigation into how the health-care system performed in the first wave of the pandemic.

While the government has been criticized by the opposition parties for not going further and holding an independent public inquiry into the pandemic, Castonguay does not hold back her criticism, which is based on 100 interviews of 150 people inside the system.

If there is blame to be doled out, she says, it is “collective,” because successive governments have paid little attention to flaws everyone knew about and were the subject of a multitude of reports going back as far as the Clair report in 2000.

The shortcomings, past and present, explain in part the excessive number of deaths in the first wave if the pandemic, she says.

The report says that as of Aug. 13, 2020, 60,704 Quebecers had been infected by the deadly virus and 5,745 had died. Of this total, 5,157, about 90 per cent, were residents in long-term care centres (CHSLDs or private seniors residences).

In Quebec, six per cent of people age 75 or older live in a CHSLD, but they are also people who have lost some or most of their autonomy, making them the most dependent on the services provided.

Yet the commissioner notes health spending has not kept up with the costs of paying for such intensive care. Per capita government spending for people over 65 dropped between 2010 and 2018 owing to the growth of their numbers.

Castonguay concludes Quebec has no global system for evaluating the quality of care received by seniors and situations are handled on a “piecemeal basis.”

Worse, services are “disorganized,” with seniors having to deal with multiple intervenors, each with their own way of doing things, different directives and different objectives.

Finally, reliable data on the state of the long-term care system and the health situation of its residents is very limited.

That was abundantly clear in the first wave when government officials struggled to get the bureaucracy to cough up such basic information as the amount of personal protection equipment on hand to the number of actual cases per CHSLD.

Castonguay takes aim at various attempts to overhaul the system including the latest, in 2015, by former Liberal health minister Gaétan Barrette. He merged many establishments under new CISSS and CIUSSS umbrella local health authorities.

The result in the CHSLD network was the loss of local management, shortages of workers, lost mobility and the disappearance of data banks.

Health and Social Services Minister Christian Dubé thanked Castonguay for the report and said many of her recommendations were put in place in time for the second and third waves, including the appointment of local managers for each CHSLD.

More orderlies have also been hired.

But Paul Brunet, president of the Conseil pour la protection des malades, said Castonguay’s report revealed little.

He questioned Castonguay’s independence, given that she was appointed by the Legault government. The reports he wants to see are those of the provincial coroner and Quebec’s auditor general.

“The minister will probably not thank them as much as he does Castonguay,” Brunet said.

Castonguay’s final report is due out in December 2021.