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In a report released Tuesday, the Nova Scotia Government Employees Union (NSGEU) chronicles what it’s calling “government neglect and delay” that contributed to the deaths of 53 seniors at Northwood’s Halifax campus during the COVID-19 outbreak.
The 23-page ‘Neglecting Northwood’ report was written using Nova Scotia Health Authority and Department of Health and Wellness internal documents obtained through Nova Scotia’s Freedom of Information Act. The NSGEU report also included information from its own members who were deployed to the 485-bed nursing home during the outbreak.
Although originally prepared for the government’s Northwood Review Committee, the union decided to release the report publicly.
Residents at Northwood accounted for 53 of Nova Scotia’s 64 COVID-19 deaths. In June, the province announced a review to look into what happened at the Halifax facility. But under the Quality Improvement Information Protection Act (QIIP Act), the only parts of the review that will be made public are its recommendations.
Last week, NSGEU president Jason MacLean pulled out of the review rather than risk being fined and/or prosecuted for publicly sharing any information the process might reveal.
In an interview Tuesday, he said it serves the public interest for Nova Scotians to understand all the factors that left many vulnerable seniors at risk.
“What we shared as NSGEU is only the tip of the iceberg. Other entities have their own run-ins,” MacLean said.
“I’ve gotta tell you, the acute care system was well prepared for this. Home care and long term care were not prepared for this. We were lucky in home care. We were not lucky in long term care.”
While the report is described by its authors as barely scratching the surface of what happened at Northwood during this spring’s deadly outbreak, it lays out a series of missteps it says put the facility’s residents and staff at risk.
Those include: years of government cuts to long term care facilities; dismissing infection control concerns raised by Northwood and not funding initiatives that would have eliminated double and triple bunking in rooms; delaying the use of personal protection equipment; not responding quickly enough after the first COVID-19 case was identified.
“You have Northwood being the largest facility east of Montreal, and it’s double and triple bunking, which is way outside the norm for 2020,” MacLean said. “There are so many things that need to be looked at.”
Among the troubling exchanges outlined in the report is a May 2 email forwarded by NSHA’s senior director of Continuing Care, Susan Stevens. Writing to NSHA vice presidents Colin Stevenson and Vickie Sullivan, she noted that she was sharing information from one of her team members deployed to Northwood:
Things are certainly improving, but these concerns confirm for me we need a mechanism in place with DHW (Department of Health and Wellness) to identify resident care and safety and staff support and safety in homes with outbreaks and an ongoing monitoring mechanism.
‘Very concerning’ reports out of Northwood
Stevens shared some detailed information she’d received the previous week, feedback she described as “very concerning.”
“Just spoke with one of our employees who continues on site at (Northwood). She relayed that the availability of PPE is much better than it had been though access to sinks is troublesome (likely due to age of building / design),” the team member wrote to Stevens.
That employee reported staffing was an ongoing challenge because residents were “so sick and care is so much more now.” With three CCAs (continuing care assistants) in the evening for 30 residents, there were some nights where none of the CCAs knew the people they were caring for.
In addition to the staffing issue, the employee’s unit — 6 Centre — had 23 residents who’d tested positive for the virus and six who had tested negative.
“Many positive (residents) wandering about and sharing a room who are (positive). Some negative residents also wander about. Understandably, she worries about spread of the virus,” the team member wrote.
“Care is reportedly getting heavier as residents are more unwell. Reportedly three CCAs on in morning from 7-8:30 to get all residents cleaned up and ready for breakfast for 8:30 breakfast time.”
The employee also reported that residents “likely haven’t had a bath in a week as their hair is all greasy. They often wet but do not get changed.”
Most residents were described as in bed and “unable to help themselves.”
There was also a report of “significant delays” in dirty laundry pick-up and emptying of garbage at the facility.
“Reportedly garbage cans are overflowing and at one point yesterday, there were no bed pans or fitted sheets available on the unit,” the employee wrote.
A lack of communication about what was happening on the floor, particularly around reporting the deaths of residents, was also cited, leading to employees feeling a lack of “direct patient staff support.”
The employee noted how a resident had died shortly after she left for the evening, but she didn’t learn of the death until the end of her shift the next day.
“(He) never did make to an isolation room to see his one family member before passing,” she said.
In Tuesday’s report, the NSGEU notes that “it appears that the NSHA understood the problem, but the government was not listening.”
Weeks earlier, in an April 21 email, the Department of Health and Wellness’ chief design officer, systems innovation, asked if the provincial government needed to reconsider its COVID-19 approach. Jonathan Veale requested a discussion about the provincial response plan to long term care, essentially to “revalidate” planning assumptions and response plans.
“Our planning assumption that we will face an (sic) surge in hospitals may need to be revisited as we flatten the curve and observe low volumes / occupancy in hospitals. It also appears this wave of the pandemic will impact LTC more than hospital settings,” Veale wrote.
“What is the appropriate approach to caring for (COVID19) residents in LTC. Is our transfer policy still appropriate?”
NSGEU members ‘shocked’ during Northwood shifts
NSGEU members transferred to Northwood to help with the outbreak were described as “shocked” by what they found. On April 20, MacLean received an update outlining the experiences of the union’s employees who’d completed their first Northwood shifts. The first hand accounts from front-line staff highlighted several concerns.
They included: a lack of scrubs; residents roaming the facility without any identification like wristbands to indicate who was COVID-19 positive or negative; negative and positive patients living in the same room and using a common bathroom; and no separate, clean rooms for staff to put on and remove PPE without risk of infection.
After her first Northwood shift, one nurse told the NSGEU that she’d never “felt so completely unsafe as a nurse.”
The report concludes that while it “barely scratches the surface” of the Northwood crisis, it demonstrates the need for a “full, public airing” of the circumstances that led to the deadly COVID-19 outbreak.
The NSGEU has been calling for a public inquiry into COVID-19 deaths in all provincial long term care facilities since April. Opposition parties, many families and Northwood’s CEO Janet Simm have all said they’d support a full public inquiry into the tragedy at Northwood.
MacLean said Northwood recognized the infection control challenges when residents were living two or three in a room, but they were unable to secure the required government funding to convert to single rooms.
“Ultimately it’s going to cost money for us to improve the system because that’s what was denied to Northwood budget after budget, and we see what ended up happening there in terms of infection control practices,” MacLean said.
“We do need to learn from this and we need to make it better for anybody in the system now, or anybody that’s going to be in a long term care facility in the future.”
Continuing calls for an inquiry
MacLean said he’s dismayed the government’s review panel meets in-camera and receives information that must be kept secret.
“All you’re getting is an outcome and nobody understands the reasons why,” he said.
He believes a public inquiry is the best way to learn from the mistakes that were made, adding that those lessons will better prepare the province for a second wave and any future pandemics.
“My heart goes out to those families who lost loved ones…I just want to stand with the families, stand with the staff that work there, stand with our members who came from 8.4 who I believe are heroes in this whole story of Northwood,” MacLean said.
“I really, really want a public inquiry for all of their sakes because they deserve to have their stories be told and we as Nova Scotians need to listen to them in order to fix the system and improve it.”
When asked for comment about the ‘Neglecting Northwood’ report, a Department of Health and Wellness spokesperson provided an emailed statement.
“As always, the health and safety of residents and staff is our top priority. As well, we would like to acknowledge and thank all the staff who worked so hard to deliver care in these challenging circumstances. Our goal with the review is to determine what happened at Northwood and address anything that will help avoid or contain future outbreaks of COVID-19,” spokesperson Heather Fairbairn said.
“We expect that would be the NSGEU’s goal as well. The reviewers have begun their work, and doing so under the QIIP Act ensures a comprehensive review and timely results. The recommendations presented to the Minister will be made available to the families, and the rest of the public, when the review is complete.”
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