Communication problems, inconsistent infection control and disorganization are among the issues raised in an independent, third-party review on the impact of COVID-19 on B.C. care homes and assisted living facilities quietly commissioned by the NDP government last year.
The report, which was released by the province on Monday, was completed by professional services company Ernst & Young and dated Oct. 22, two days before the controversial snap election that was called by Premier John Horgan.
It praised some policies implemented in the first wave of the pandemic in the spring, but also found “there are now opportunities to be more co-ordinated to reduce the operational impact to LTC/AL providers and residents,” including more consistent infection prevention and control and better communication to operators and stakeholders.
“Health authorities also varied in their interpretation and implementation of operational orders and policies, which led to differences in practice in areas such as the process for decanting and/or isolating residents that tested positive,” noted the report’s authors. “Orders would sometimes be interpreted differently by (health authority medical health officers), which lead to operational variation across the province."
Among 19 recommendations, the report also said "accountabilities of the public health officer and MHOs in emergency situations were reported to sometimes be unclear, creating confusion about when the ministry should be consulting with public health versus the needs for Public Health Orders.”
Acknowledgement of problems and apology for secrecy
The province’s top doctor admitted not only were there communication problems during the first wave of the pandemic, there continue to be issues.
"Yes, it was confusing, and it's still confusing,” said Dr. Bonnie Henry. “Things have been interpreted differently in different health authorities and those messages go out to long-term care homes, to communities."
But she insists they’re trying to improve communication and consistency across the province.
“There are many things that were done, and many things that still need to be done," she told reporters Monday. “I think we have to remember that the health-care system we're talking about in this report is complex and long-term care has many different ways that it's delivered.”
For his part, the health minister took responsibility for the secrecy and lack of transparency but also tried to deflect from the harsher criticism it contained.
“It should've been released earlier,” acknowledged Adrian Dix. “I think that people working in our health services branch are working their guts out, are consumed with helping people in long-term health, as I am, and it's because of that I think they did not proceed to ensure the report was made public -- which is the appropriate thing to do in these circumstances, but also the courteous thing to do when you've asked stakeholders to contribute, and for that I apologize.”
Hints of confusion and disorganization behind the scenes
CTV News first asked the Ministry of Health about the report the morning of Tuesday, Jan. 19 and when no one responded we followed up with different communications staffers later in the afternoon. They advised they needed to fill a number of positions in the department and were having trouble keeping up.
On Thursday, a ministry staffer confirmed they had the report but characterized it as a “minor report” and on Friday, Dix himself described it as overwhelmingly favourable to the government.
Ironically, as the health minister tried to deflect from the timing of the report, dated two days before general voting day, he seemed to substantiate an impression the report gave that there was often disorganization and even chaos behind the scenes.
“The Ernst & Young report was only brought to my attention in the last 10 days and as soon as I saw it my response was probably the same as yours, that it should be out in public,” he said in a one-on-one interview with CTV News. “I would describe myself as not happy with (the timing)…I read a voracious amount on these files, but I will say this: the staff that are working have been flat-out. One of the reasons they asked Ernst & Young to do this report is to help them...in these days someone has to be compassionate and not frustrated in response.”
Nonetheless, Dix insisted the report “is positive,” though the whole point of such a report is to recognize issues and improve upon them. The report made 19 short- and long-term recommendations that government says were “immediately acted upon.”
“These are not perfect times, but I think a real effort has been made on all sides, not just the Ministry of Health side,” said Dix.
Ernst & Young also highlighted organizational problems within the Provincial Health Emergency Coordination Centre (HECC) that meant “planning and operations workstreams were not co-ordinated in supporting the planning, sourcing, purchasing and distribution of PPE” and there was “confusion around who was authorized to make key decisions, including direction to (health authorities) to enter into commitments to use funds specifically around additional PPE.”
In interviews conducted over July and August, they did find the rapid-response investigation and infection-control teams from Vancouver Coastal Health were effective and adopted by Fraser Health, then the rest of the province. They also referenced a quick response by the provincial health officer to outbreaks in long-term care and assisted living facilities, ordering a single-site work order that reduced cross-contamination by staff while levelling wages, restricting visitors and helping procure PPE.
But who got PPE varied widely: government-operated and –run facilities had quicker access to PPE than private facilities, which were left to find their own unless there was an outbreak, according to the report’s authors.
They noted “the strain placed on the long-term care system by COVID-19 highlighted pre-existing human health resource shortages.”
Several stakeholders who participated in the review over the summer expected to receive copies of the document when it was completed and were told that would be early in the fall. They didn’t get anything until the document was finally made public the afternoon of Monday, Jan. 25.
The CEO of the BC Care Providerse Association wasn’t terribly surprised by the contents of the report, though he was disappointed that it took so long to see them.
"The lack of coordination, the inconsistent messaging, the information differences that occurred in different health authorities, and between health authorities and the Health Ministry ... have been addressed but there's still confusion around policy, around approaches," said Terry Lake.
“Some of the confusion and mixed messaging has been better lately because we bring this up every single week in our meetings with the Ministry of Health. And I have to say, the Ministry of Health officials we deal with are excellent, but they have to (talk to) the health authorities or the provincial health officer and then we wait a week to find out the answer. There really hasn't been a co-ordinated, consistent approach to a pandemic and of course the deadly impact on long-term care."
The Seniors Advocate for B.C. pointed out that the report describes the provincial situation as stable, but that statement was outdated within weeks as cases started skyrocketing and growing exponentially after Thanksgiving. At the end of August, there had been 41 outbreaks at long-term care centres in B.C., most of them contained to a handful of cases; since then, there have been 175 outbreaks representing multiple infections each.
While Henry and Dix portrayed the surge of infections in long-term care and assisted living as a reflection of what’s happening in the community, Isobel Mackenzie pointed out some facilities only had one or two cases, while infections raged seemingly unabated in others.
“What’s the difference between them?” asked the advocate, pointing out the Ernst & Young report was based on interviews and feedback rather than hard data or statistics that could provide greater insight.
And while Mackenzie is conducting her own review of care homes, she thinks Monday’s resolution to the secrecy around the document is a positive thing.
"Transparency always has value because it builds trust, so whether the report is helpful being released at this point or not, people will debate that -- but I think it's important the ministry released that," said Mackenzie.
“In a vacuum of not knowing what was in the report, we could’ve found ourselves distracted by something we thought was an issue that really wasn’t so I think it was important that the ministry released it once people said they want to see the report…it shows the government is prepared to put forward a report it commissioned and talks about improvements government could make and mistakes that government did make and also highlights what they did well and I think it serves to strengthen public trust, which is crucial.”