Health ministry slows down routine care home inspections during pandemic - 91��ɫU Centre for Aging Research & Education (YU-CARE)

Arthur White-Crummey&�Բ��;&�Բ��;•&�Բ��;&�Բ��;Regina Leader-Post

There are also 250 privately operated personal care homes with 4,600 beds in Saskatchewan. PATRICK LANDMANN / Getty Images

Saskatchewan’s health ministry has pulled back on routine inspections of private personal care homes as it looks at “virtual options,” partly due to concerns that inspectors could spread COVID-19 to vulnerable residents.But experts wonder whether a trust-based approach will be enough to protect Saskatchewan from the kind of devastating outbreaks killing Canadian seniors in other provinces.

The news comes just as Quebec steps up its own inspections amid a tragedy at a private care home west of Montreal, where 31 people died. Nearly half of Canada’s deaths from COVID-19 have occurred at seniors homes, though Saskatchewan has so far been spared a similar outbreak.

Starting this week, the Saskatchewan Health Authority (SHA) implemented new masking rules for its own facilities, . But there are also 250 privately operated personal care homes with 4,600 beds in Saskatchewan. They provide varying levels of care and are regulated under a licensing regime with routine annual inspections.

The Ministry of Health conducted six non-complaint-based inspections at those facilities over the entire month of March, when the threat of COVID-19 became palpable in the province.Brad Havervold, executive director of the ministry’s community care branch, said the low number stems in part from infection control measures.“When COVID came on stream, we’re very mindful that, when we’re putting in visitor restrictions, our staff going in there would be a visitor to that home,” said Havervold. “So we want to make sure that we’re doing that safely.”The branch is considering using video technology for inspections as a result.

“Things were evolving so quickly that we wanted to make sure that we weren’t introducing an additional risk,” said Havervold. “But it also allows us some time in that period to look at virtual options.”Havervold saidinspectors still visit facilities based on complaints to respond to pressing concerns. He was not able to say how many times that has happened over recent months, and the ministry could not provide a number within 25 hours of a request from the Leader-Post.Experts in seniors care and public health had trouble understanding the ministry’s reasons for holding back on routine inspections. Dr. Anne Huang, , said inspectors could be fitted with surgical face masks and subjected to temperature checks.

“I don’t think that’s a good reason for not having the inspectors enter these facilities,” she said.If anything, she suggested, the number of inspections should be increased.Tamara Daly, director of the Centre for Aging Research and Education at 91��ɫ in Toronto, does not believe virtual inspections would be sufficient for facilities that provide significant care to seniors.“It’s more than just looking at books,” she said. “It’s observation and conversation that is required in order to properly inspect.They need to be inspected.”There are currently four full-time and two part time inspectors on hand to do routine inspections. Daly said that does not seem like a “robust workforce,” given the number of homes in the system.

She acknowledged that there is a “balance of risk,” but argued that oversight is indispensable to ensure care homes are following the rules.The ministry has issued directives forcing personal care homes to ban visitors, screen staff, ensure two metres of social distancing and limit gatherings to 10. There are also longstanding regulations related to infection control, including around staff training and sanitation of surfaces.“If a home is not compliant with these things, it could actually, in fact, make infection more likely,” said Daly.Havervold argued that personal care home operators are “very honourable people” whose number-once concern is protecting residents. He said the ministry’s priority has been making sure they have accurate information to do precisely that.

“We’ve really ramped up our support for personal care homes,” he said. “So we’ve implemented a toll free line where personal care home operators and staff can phone in, 24 hours a day, and get a recorded message that provides the latest updates on information applicable to personal care homes.”That includes information on enhanced cleaning procedures, proper use of personal protective equipment and the clinical signs of COVID-19, according to the ministry.Care home operators appreciate that support. Colleen Nixon, manager of Gladstone Seniors Residence in 91��ɫton, said the ministry has been “really on top of it.”

She said Gladstone complied with directions, including by shutting the home down to visitors. It’s also done more. The home already had a pandemic plan in place and a stockpile of masks. Workers are wearing masks and gloves whenever they enter resident rooms, she said, and they are restricted from working at any other facilities.That goes beyond what the ministry is requiring. Continuous masking is still only under consideration for personal care homes.Huang said there is no good reason for a different approach depending on whether a home is run by the SHA or a private company. She said both should be subject to similar standards.

“I think that’s only fair to the residents or their families,” she said.Daly said there is no reason to wait to limit workers to just a single home, as British Columbia has already done for both private and public facilities.“I think that that should have been something that happened almost immediately, as soon as governments understood that COVID was a risk,” she said.“We know from SARS that health care workers can bring this from facility to facility. We already learned that lesson. We don’t want to learn that lesson again the hard way.”Huang was also concerned to hear that the ministry is not requiring personal care homes to submit specific plans for COVID-19 prevention. As part of their regular licensing renewals, homes are required to submit a plan about how they would control an influenza outbreak.

“We’ve not specifically gone out to the 250 homes and said, ‘What are you doing today?’ ” Havervold explained. “They are required to do that as part of their standard business.”Again, he said, the focus is on getting out the information.But Huang said that leaves the ministry with little information about whether the homes are really prepared. She called it “a huge gap.”“That means that we have no way of knowing if these necessary measures have been implemented, and that’s going to become a significant risk should a case develop there,” she said.“I don’t think it’s acceptable for the relevant government branch to just say … we expect them to do what they need to do, because it’s an unprecedented risk to the health of the residents.”awhite-crummey@postmedia.com