Back at the end of May 2020, I interviewed a 29-year-old male clinical nurse who answered the call for aid in our CHSLDs. I would like to offer a snapshot of the insights given by this nurse, aka “Louis.”

Prior to the pandemic, Louis ran a private clinic that had seen a drastic downturn in patients due to coronavirus fears. Like many other health care providers, he adapted to this “new normal” by switching from in-person services to telemedicine, while also having to downsize his staff. At first, he offered his skills at the local hospitals’ emergency rooms. After two weeks of labouring in an essentially empty hospital, Louis applied to work in two overloaded CHSLDs.

Louis offered to be dispatched in these affected long-term facilities for four weeks. One where he spent the majority of his full-time hours, and the other where he offered to be on call for, as needed. Both Montreal care homes were considered red zones, which designates long-term residences with high levels of coronavirus infection.

Despite recent measures of PPE protection, he advised me that in the care homes he was dispatched to most of the residents had been infected before this PPE ever arrived. So the virus still ravaged these seniors with a mortality rate of 20 to 30 percent. What changed was that the new and existing labour pool was better protected now than when they’d been forced to pay for their own PPE out-of-pocket. Also, he feels that most CHSLDs are not structurally built to enable the isolation of Covid-positive patients. Unlike the hospitals where he had plied his craft with few Covid-19 patients present, here they were overrun by infected residents. With, no separate wing to place them in, and no way to isolate the virus in one area of the facility. So that once it got into a CHSLD it inevitably spread to all of its residents.

He also confirmed some of the stories in the news about mismanagement of the personnel, speaking on a specific situation. He spoke of a nurse who found out on-site that she’d be working alone for the entirety of her 12-hour round. Instead, of being one of four persons working that shift, based on the number of residents in that facility. Not only that, the care homes’ manager attempted to have her stay for a double shift as well. These are the sorts of situations that caused burnout of the CHSLDs’ personnel in the first few months of the pandemic. And the type of negligence that had been prevalent in private care homes in Quebec thus far. Due to the pandemic and the hygienic procedures to follow for her and the patients’ safety, there was no way for her to get around to seeing all of the inhabitants, while providing adequate, three-hour-plus daily care, for each of them. The facility was fully aware that she would be unable to appropriately tend to these seniors, and still, they orchestrated this situation for her and replicated it for many of the other staff. Louis has further corroborated that these long-standing practices of short-staffing are part of what has led to the neglect of care home residents, prior to Covid. But the pandemic is exacerbating these issues further, by increasing the tasks required for public health, while the initial problems remain. Even, with additional temporary staff, government oversight, and heightened public scrutiny.

Unfortunately, the supplemental bodies being added to a generally understaffed palliative care system made up of doctors, nurses, and army members (at one point), cannot mend the situation if all failing elements are not addressed. He confirmed with his experience working there that the manpower available can only do so much, without the proper resources to bring about real, long-term change. Innovations need to be applied systematically in the public and the private sector, to ensure that our most vulnerable citizens will not be overrun by any future iteration of infectious diseases. Louis hoped at this time that these modifications were coming, to ensure that the Quebec tragedy of over 2,400 resident deaths in CHSLDs in less than two months of the pandemic being declared, would never be repeated. And, that it would continue to diminish in the coming months.

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