The day after her co-worker died of the new coronavirus in April, Toronto long-term care home worker Karen Ellington says she and her colleagues finally got what they had been asking for: N95 respirator masks.
But, she said, there was a catch.
“We got one N95 and the statement (from the home) that was made was, ‘Don’t throw it away because we don’t know when you’ll be getting another one,’” Ellington told Global News.
“I think that’s maybe why everything spread as fast as it did, when it did. Because we didn’t have what we needed.”
Altamont Care Community, which is owned by Sienna Senior Living, was among the hardest hit nursing homes in the province, where at least 53 residents died. Sienna is among the largest long-term care operators in the country and its homes in Ontario have seen nearly 300 deaths.
Sienna maintains it has always had an adequate supply of personal protective equipment, including N95 masks, at all its residences.
Ellington, a personal support worker at Altamont, said a combination of severe understaffing and critical shortages of personal protective equipment (PPE) helped contribute to the outbreak that eventually saw the Canadian military take over the Scarborough facility near the end of May.
She was among dozens of staff at the home who became infected with the virus. Across Ontario, nearly 2,000 long-term care staff contracted the virus.
“I was lucky. All I had was a really bad cough,” Ellington said.
“But my husband got it. My daughter got it. He had more symptoms than I did.”
Ellington also testified as part of a complaint filed by the Service Employees International Union (SEIU) in April to the Ontario Labour Relations Board that alleged three Ontario facilities — Altamont, Eatonville and Anson Place — failed to provide adequate PPE as COVID-19 started to spread in March and April.
Allegations of a lack of PPE
Roughly 118 residents died at the three facilities from the virus. Responsive Management Inc., which owns Anson and Eatonville, has repeatedly said it had enough protective equipment for staff, including 630,000 surgical masks, 39,600 gowns and 4,300 face shields.
Submissions from Sienna and the province, released by the labour board, revealed that on Jan. 15, a provincial inspector conducted a workplace visit to investigate a respiratory outbreak at Altamont, between Dec. 18, 2019, and January 3, 2020, in which two workers had been affected.
Sienna said in a statement that it has “followed all public health directives with regards to the testing of team members and residents.”
“All LTC team members will be tested twice in June, per provincial direction,” said Sienna spokesperson Natalie Gokchenian. “We continue to actively retest residents so we can quickly identify anyone who becomes COVID-19 positive even if these residents may have tested with negative results previously.”
Canada did not have a test for the novel coronavirus until the middle of January. Its first confirmed case of the virus on Jan. 25 involved a traveller from Wuhan, China, where the virus first erupted in late December.
Sharleen Stewart, president of the SEIU, which represents some 60,000 front-line health workers, is among those calling for an immediate public inquiry into the over 1,700 deaths from COVID-19 at long-term care facilities.
“If that could have been the first indication that COVID-19 was in our province then, that we want the inquiry to be looking into,” she said. “Why wasn’t that flagged? Or was it?”
Ultimately, 62 staff at Altamont and 123 residents would become infected with the virus. Staff member Christine Mandegarian died from COVID-19 on April 16.
In its submissions to the labour board, Altamont also said that there was “always” sufficient protective gear at the home and that staff were trained on PPE use and infection control.
“Altamont has a sufficient and documented inventory of gowns, gloves, both N95 and surgical masks, face shields and other equipment,” the long-term care home said. “Employees are being provided with such in accordance with government directives, upon request.”
Additional inspections from the province in March and April found there was an adequate supply of PPE at Altamont, including N95 respirator masks, according to a joint submission from the Ontario Ministry of Labour.
The company also said the pandemic made it harder to train and recruit staff and that its owner, Sienna, took a number of steps to increase recruitment, including a $100 signing bonus
“Since April 15, 2020 the Employer has seen an increase in the number of new employees (particularly from agencies) who have declined to come to work at Altamont, citing recent news reports about Altamont,” the company said, adding that the SEIU’s “inflammatory remarks” were problematic.
2 companies own nearly half of the Ontario LTC homes worst hit by COVID-19
Stewart said the health and safety practices and access to proper protective gear have been like a “roller coaster” where homes, including Altamont, will provide N95 masks one day and then no masks or less-protective medical masks another day.
“There has been no consistency in infection and control measures throughout this sector,” she said. “The whole thing has been so inappropriately handled.”
‘Inability’ to control the spread
The Ontario Nurses Association sounded the alarm in April over what it called Altamont’s “inability” to control the spread of infection that was rapidly sickening staff.
“There is an urgent and pressing issue arising from the imminent danger to the registered nurses and other staff which if not immediately addressed could result in the irreparable harm of more deaths, and the further spread of COVID- 19 to residents and staff,” lawyers for the ONA wrote.
Ellington said as the outbreak of the virus spread throughout the home, it became “stressful” amid a battle with management over access to supplies, like surgical masks.
“Most times you’re working short-staffed,” she said. “You don’t have adequate supplies to work with … Towels and washcloths and stuff like that — we’re always in short supply.”
The province, meanwhile, asked the labour board to dismiss an application by the SEIU for the government to take direct control of the facility. The labour ministry argued there wasn’t enough evidence to support the union allegations of a pattern of bad behaviour.
“No evidence is tendered showing what training has been provided to workers and no details are provided on how this training is deficient. Further, no details are provided on what ‘practices and procedures to minimize the spread of Covid-19’ the staff ought to be trained on,” according to lawyers from the Ministry of Labour.
The labour relations board responded on April 24 by ordering the companies to “make all efforts to immediately obtain appropriate PPE” and by requiring mandatory weekly inspections at those facilities.
Canadian Forces step in
But as the COVID-19 pandemic continued to decimate nursing homes, the province would backtrack publicly following a scathing report from Canadian military personnel that revealed allegations of abuse and neglect inside five Ontario long-term care homes, including Altamont.
The report alleged that Altamont Care Community had staffing issues that led to inadequate nutrition at the facility and that most residents reported not having received three meals per day.
The report also noted a number of residents that had pressure ulcers “as a result of prolonged bed rest,” and indicated that at the time of the military’s arrival, many of the residents had been “bed bound for several weeks” and that there was no evidence of residents being moved to a wheelchair, repositioned in bed or washed properly.
Ellington denied some of the allegations in the report, saying that residents in her wing were always fed on time, but some residents didn’t eat because they were sick from COVID-19, which can make it hard to swallow.
“I wish they wouldn’t generalize and make it seem as if the entire home that was operating that way,” she said.
Why non-profit nursing homes provide better care for residents
However, she said some staff in two wings of the building were problematic.
“Not everybody is there for the residents. Some people are just there to collect their pay,” she said. “I’ll be quite honest with you.
“They don’t put the extra effort that others will put who really want to see (the residents) thrive and really want to see them better.”
One day after the report became public, Premier Doug Ford seized control of the homes named in the report, which contained what he called “gut-wrenching” conditions at the long-term care homes overrun by COVID-19.
“The reports they provided us were heartbreaking, they were horrific, it’s shocking that this can happen here in Canada,” Ford told reporters. “It’s gut-wrenching and reading those reports was the hardest thing I’ve done as premier.”
The Ministry of Long-Term Care said in a statement that the province has taken “aggressive measures every step of the way as the crisis has evolved at Altamont,” which have included restricting non-essential visitors and mandatory masking for all staff.
“These have included instituting active screening and restricting non-essential visitors; providing $243 million in designated emergency funding; implementing mandatory masking for all staff, increasingly aggressive testing and retesting,” said Gillian Sloggett, a spokesperson for the ministry. “(The province has issued) two emergency orders to shore up staffing supply, and others to limit staff workplaces, enable hospitals to redeploy staff into long-term care, and to strengthen management at homes in crisis.”
Past inspection reports as recently as November 2019, where a ministry inspector issued 14 written notifications for non-compliance, eight voluntary plans of correction and two compliance orders, revealed similar concerns as the military.
The report said staff failed to ensure prescribed drugs were administered to residents as required.
Coronavirus: Ford says he will not support ‘bad actors’ in long-term care COVID-19 deaths
The outbreak at Altamont was declared over by Toronto Public Health on June 12 and Scarborough Health Network (SHN) has been working as the temporary manager of the facility since June 8.
But for Ellington, who has been back on the job since May 28, she said although some things have improved in terms of additional PPE and staffing, she is worried the facility is not ready for a looming second wave of the virus, which experts have said could arrive by September.
She said that while there is a surplus of staff working on contract, she doesn’t know how long they will stick around if the management of the facility is transferred back to Sienna.
“The few staff that I’ve spoken to, they’re saying, well, if it’s anything like this, they won’t be staying in Altamont. They will be staying home,” she said. “At this very moment, no, we’re not ready.”
Ellington said the age of the building makes it difficult to care for patients. All of the facilities’ 159 beds are classified as “C” beds, meaning they are built to 1972 design standards that permit four beds in a room, according to structural data from Ontario’s Ministry of Health and Long-Term Care.
“It’s also a very old building,” she said, noting that the facility has issues with leaking roofs and constant flooding in the basement. “Every year, they’re rebuilding. And nothing changes.”
Sienna, meanwhile, said it’s “actively working to prepare for a second wave of COVID-19,” which includes addressing staffing levels and adding additional expertise.
“Recruiting new staff during the pandemic has been incredibly difficult for all long-term care homes throughout Ontario. These are challenging realities that we are working hard to address,” said a spokesperson. “As part of our six-point action plan, we will be providing further information to families on how we are preparing for a potential second wave.”
“We continue to work with our government and healthcare partners to advocate for the increased procurement of PPE through every channel and means available to us.”
Reflecting on the military’s role in long-term care homes
Earlier this month, families of elderly residents who died after contacting COVID-19 at the Altamont Care Community filed a $20-million case against the facility.
The suit alleges the home failed to “implement a proper infection prevention and control program” in response to COVID-19 and did not train staff properly.
“They failed to hire sufficient or adequate staff to ensure the proper supervision of the residents of Altamont and to prevent and/or control situations of danger, including the outbreak of COVID-19,” it alleges.
The case was filed in the Ontario Superior Court of Justice on behalf of all residents of the Altamont home.
“We are aware of the proposed class action and are in the process of reviewing the details of the claim. We intend to respond in due course through the appropriate court processes,” a Sienna spokesperson said in a statement to Global News.
Vigour LP who was also named as a defendant did not respond to repeated requests for comment.
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