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In response to 53 residents dying during an outbreak of COVID-19 this spring, Health and Wellness Minister Randy Delorey has ordered a review of Northwood’s Halifax facility.
Delorey has appointed infectious disease consultant Dr. Chris Lata from Sydney, N.S. and former British Columbia associate Deputy Minister of Health Lynn Stevenson to a quality-improvement committee established under the Quality-improvement Information Protection Act. Their report is due September 15 and their recommendations will be the only information that will be made public.
“Like all Nova Scotians, we are very concerned and saddened about what happened at Northwood and want answers for the families and friends who lost loved ones to this terrible virus,” said Delorey. “The recommendations will help Northwood and other long-term care facilities better prepare for future waves of this virus.”
Under the Quality-improvement Information Protection Act, none of the information gathered through interviews and data provided by workers, public health officials, managers, and representatives of families is admissible in court. Both Northwood Inc. and the province are the targets of a proposed class-action lawsuit on behalf of some people whose deceased family members were Northwood residents when they became infected with COVID-19.
Journalists asked Delorey why the government did not a choose a broader form of inquiry with binding recommendations under the Public Inquiries or Fatality Inquiry Acts. A dozen long-term care homes had cases and the province recorded a total of 63 deaths.
“This legislation allows us to get the review started and completed in a very timely fashion,” replied Delorey. “It provides a framework to get the experts on the panel and to get them to work as soon as possible. It also protects personal health information, and, for lack of a better word, protection for people who might be considered ‘whistle-blowers.’ There are limitations in terms of what information can be made public, but the focal point here are the recommendations. The recommendations will lead us to make changes to help us avoid and minimize infections from COVID and other diseases in the future.”
The report will cost $80,000. Meanwhile, for the next three months until the recommendations are received, the only change tDelorey is prepared to make at Northwood is to reduce its capacity. Out of 485 beds in the long-term care facility, 53 will remain unoccupied as a means of reducing double-bunking on shared rooms and improving the caregiver-to-resident ratio. More on that topic in a moment. But first, the terms of the Review.
Terms of Reference for the Quality-Improvement Review
The Committee is to review and analyze the Northwood COVID-19 outbreak to determine what factors contributed to the outbreak and spread of COVID-19 within the facility. These factors are to include, but are not limited to, the following:
(i) identify the information that was available to Northwood at all stages of the outbreak;
(ii) review the response to the information that was available at each stage, and in light of this, whether the preparation for, and response to, COVID-19 at Northwood was appropriate and timely during each stage of the outbreak (including pre-outbreak);
(iii) review staff scheduling practices and processes to determine whether staff movement throughout the facility contributed to the spread of COVID-19; and
(iv) conduct a review of best practice and available evidence related to effective measures that control the introduction and spread of COVID-19 in long-term care facilities and apply this evidence to Northwood’s physical design and operational procedures.
Prior to Delorey’s announcement, journalists got a background briefing from staff with the Department of Health and a lawyer from the Department of Justice. During the briefing — which was not for attribution — reporters learned that the directives issued to nursing homes by the Chief Medical Officer of Public Health will also be part of the review. Some of these policies — which permitted facilities such as Magnolia Manor and Northwood to bring in Continuing Care Assistants and staff who were working at more than one facility or who had not completed their 14-day period of self-isolation — may have led to additional spread. The directives allowed a handful of nursing homes which were particularly short-staffed during COVID-19 outbreaks to be exempted from the rules around infection control.
It’s not clear whether the (ii) reference dealing with “staffing scheduling and processes” will actually include examining whether staffing levels at Northwood were adequate before the virus arrived. That will be left to the experts to interpret.
Staffing issues well-known
Ironically, the same day the Health Minister was announcing a quality improvement review, the Chief of Infectious Diseases with the Nova Scotia Health Authority was participating as a panelist in a video conference hosted by CARP (Canadian Association of Retired Persons). Dr. Shelly McNeil said “it’s inevitable we will see more cases” and there will be “ongoing problems” unless the government funds additional beds and pays to hire more staff.
“It is very difficult to control an outbreak of an infection in a nursing home setting if it is not possible to cohort sick residents in one area of the facility and prevent healthcare providers moving between infected and non- infected residents,” said McNeil, who is also a professor at the Dalhousie Medical School.
“Ideally, to reduce the risk of transmission, staffing levels would be sufficient to allow staff to be assigned to care for only infected or uninfected residents. This would require significant increases in staff in most long-term care facilities but is an important consideration as the long-term care sector plans for a possible second wave of COVID-19.”
That didn’t happen at Northwood this spring. According to Delorey, if a predicted second wave arrives this fall, the one thing that will be different will be 53 fewer residents requiring care.
“A public inquiry is the only form of review that will ensure we have the right people at the table, compelling testimonies, and binding recommendations,” said Tim Houston, Progressive Conservative leader. “This review should be about saving lives — not about saving the premier’s reputation. Our caucus has heard difficult stories from many frontline care workers at Northwood and we owe it to them and to all the Northwood residents to continue to call for a public inquiry into the outbreak at their home.”
“Today’s announcement falls short of what families who lost loved ones at Northwood have been calling for,” said Gary Burrill, New Democratic Party leader. “A full, transparent public inquiry into shared rooms and staffing in long-term care is critical if we are to learn from this preventable tragedy. The problems in long-term care have been known for some time. It was clear before the pandemic that a lack of adequate investment was undermining the quality of care. Every resident of a long-term care facility needs to have their own room, and we need to have enough staff to care for residents. The Liberals could start on this today.”
An advocacy group called the Nova Scotia Health Coalition is urging the Health Minister to make public the full report of the Quality Review Committee.
“Fifty-three people died at Northwood and the public deserves to know the uncensored truth about what happened. Lives are at stake,” said Chris Parsons, Provincial Coordinator for the Nova Scotia Health Coalition and a former frontline worker at Northwood Manor. “It should not be up to the minister or the premier’s office to determine what the public can and cannot know about this tragedy.”
Separate and apart from the Quality Review at Northwood is an Infection Prevention and Control project being launched within the Department of Health and Wellness to improve “outcomes” for residents in all 140 licensed nursing homes and residential care homes for people with disabilities. It will consider overall infection prevention and control practices and review actions taken during the first wave of COVID-19.
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