Alberta’s Auditor General notes continuous care centers need an urgent overhaul
Alberta needs a staffing strategy for nursing home continuity to prevent the worker burnout and inadequate care that was evident at the start of the COVID-19 pandemic, says the province’s auditor general.
In a report released Thursday, Auditor General Doug Wylie said drastic staff shortages, buildings that don’t meet modern standards and delays in getting lab test results made the pandemic more difficult to manage at the province’s 355 publicly funded care facilities.
“The pandemic has been a tragedy for so many in our society,” Wylie told reporters at a Thursday news conference in Edmonton. “But the residents of care facilities and those who cared for them … they were deeply affected.”
The COVID-19 in Continuing Care Facilities report shows that people suffer when plans and systems go awry, Wylie said.
“We have to … do a better job for our parents and our grandparents who live in foster homes here in Alberta,” he said.
Critics say the report underscores systemic weaknesses they highlighted before the pandemic hit the province in March 2020.
Wylie’s office reviewed Alberta Health and Alberta Health Services (AHS) pandemic preparedness plans for all long-term care or designated assisted living facilities that receive public funding.
You’ve looked at how these facilities fared from March to December 2020.
During that period, more than 8,300 residents and ongoing care staff tested positive for COVID-19, and 1,042 of them died, including five staff members.
Seniors are particularly vulnerable to the virus that causes COVID-19. Although only eight percent of cases in the province were under ongoing treatment in 2020, 65 percent of Albertans who died after being infected were living in one of the facilities, the report said.
The data also showed that residents at AHS-operated facilities were the least likely to contract COVID-19 in 2020, while for-profit homes had disproportionately more cases.
Wylie’s team found that Alberta Health and AHS’s pandemic plans had flaws. They left people in the healthcare system improvising strategies and workarounds.
The accounting firm made eight recommendations, including creating an updated pandemic plan that takes into account the full range of continuity of care. It should be routinely updated and simulated, according to the agency.
In a statement, Alberta Health Secretary Jason Copping said the government accepts all recommendations and is working on them.
The auditor says the province needs streamlined lab testing during outbreaks and a plan to improve aging facilities, in addition to a new employment strategy. They also need to do better tracking of resident and staff illnesses during outbreaks, the report said.
Of the 31,600 people working in continuing care centers in early 2020, 85 percent of them were working part-time or casually.
Wylie said Wednesday it’s a shocking number, similar to a staffing plan for a fast-food franchise.
Critics have long bemoaned a system that relies on workers working two or more jobs to earn a living wage.
When Alberta’s former chief medical officer of health instituted a single-site rule to prevent staff from inadvertently carrying infections from one facility to another, the pool of available caregivers was reduced by a third, according to the report.
The Comptroller said the province needs to consider whether it is appropriate to rely on part-time workers, whether workers should receive mandatory benefits such as paid sick leave, and the introduction of minimum training standards.
Vulnerabilities in tests and buildings
Wylie’s office said COVID-19 testing was also unreasonably slow in continuing care early in the pandemic. While AHS said facilities could receive test results within four days of reporting an outbreak, it sometimes took as long as 17 days.
Shortages were encountered in supplying test kits to facilities and the laboratory attempting to decode incompletely labeled samples.
The investigator also found that buildings with shared rooms and confined spaces were sites of some of the worst outbreaks.
Almost a third of the long-term care facilities do not meet modern standards for buildings that are to be used as nursing homes or for medical treatment, the auditor’s office found.
AHS and Alberta Health were able to inspect facilities to ensure they were following public health orders, the report said.
What they found was sometimes troubling: “including dangerous dehydration, inadequate meals, inadequate pain management among residents, residents not receiving hygiene services, and residents’ rooms that have not been cleaned in days,” the report said.
Critics question the profit model of care
In an email, Copping’s press secretary, Scott Johnston, gave no timeline for implementing the auditor’s recommendations.
He said Alberta’s care buildings are, on average, newer than other provinces and the province is working to replace some that are aging.
Copping’s statement said the report will help the system prepare for other disease outbreaks.
NDP health critic David Shepherd said it was frustrating to see the recommendations reflect previous calls for action – including the opposition, a legislative committee and even previous examiner reports.
Shepherd said if a future NDP government were elected it would only open publicly run care centers with a more consistent staffing.
“Obviously this is a broken and flawed model rooted in the private delivery of public health care,” he said.
Wayne Morishita, executive director of the Alberta Continuing Care Association, which represents private operators, said hiring full-time staff is optimal.
“It’s a bit of a challenge in the industry to be able to do full-time work given the funding,” he said.
Morishita hopes next week’s budget will include more investment in ongoing care.