'No Lessons Learned’ As Deadly COVID-19 Outbreaks Hit Manitoba Nursing Homes

For months before his father died after contracting COVID-19 at his Winnipeg care home, Larry Baillie worried about that possibility.

His friend’s mother was one of the first residents to die at Orchard Villa in Ontario, the province’s hardest-hit home, where at least 71 residents died. His friend warned Baillie: What happened in Orchard Villa will happen in Manitoba. It’s going to get bad.

And it did.

Baillie’s father, Glen, died in hospital in November — after Baillie said multiple workers at Maples Personal Care Home discouraged him from sending Glen there sooner. His father is one of more than 40 residents who have died from COVID-19 at the home — and one of the more than 140 who have tested positive for the virus.

“The real shame here is that no lessons were learned,” Baillie told HuffPost Canada.

That’s a view shared by Michelle Porter, director of the University of Manitoba’s Centre on Aging. She said community transmission in Manitoba wasn’t a problem for so long — likely in part because the province’s March break hadn’t happened before the lockdown, so travellers didn’t bring the virus back from other countries — the province seemed to take its luck for granted.

“On a number of fronts, we didn’t act quickly,” Porter said, adding it seems there was little or no planning for how to handle major outbreaks at personal care homes.

The province shut down its COVID-19 command structure, which helped health regions and the government coordinate their pandemic response, in June and didn’t start it again until November, the Winnipeg Free Press reported. In Winnipeg, masks weren’t mandatory in indoor spaces until the end of September.

The province’s two hardest-hit facilities are Maples Personal Care Home and Parkview Place. Both are owned by Revera Inc., a for-profit company wholly owned by the federal Public Sector Pension Investment Board that has faced growing calls during the pandemic to be taken public. Four other Revera homes in Winnipeg have dealt with smaller outbreaks this fall, including one with four resident deaths.

The company faces several lawsuits for its pandemic response in Ontario, including a proposed class action alleging it was “systemically negligent” in its care of residents.

“Revera continues to do everything we can to keep our residents and employees safe as we work to prevent the spread of COVID-19 at our long term care homes and retirement residences,” spokesperson Larry Roberts said in a statement to HuffPost. He previously said Revera would respond to the lawsuit through the courts.

Families who lost loved ones at both Winnipeg homes allege there were problems with communication, short staffing, and a lack of planning for when the pandemic hit personal care homes. And experts say without immediate action the devastation in Manitoba’s care homes will worsen.

By late November, the death toll at Maples Personal Care Home and Parkview Place totalled 74 — about 25 per cent of Manitoba’s total COVID-19 deaths by that date. Manitoba’s Health Minister Cameron Friesen has called for an independent investigation of both homes, and a government spokesperson confirmed Dr. Lynn Stevenson, the former associate deputy minister in the British Columbia Ministry of Health who also co-led the review of a COVID-19 outbreak at a facility in Halifax, NS, will lead an examination of Maples.

“These outbreaks in personal care homes are tragic, and everything is being done to determine how they occurred, and how they can be prevented,” the spokesperson said in a statement to HuffPost.

They said the province spent months planning for how to prevent COVID-19 outbreaks in personal care homes, pointing to early visitor restrictions, implementing single-site staff requirements and constructing shelters for safe visits at all care homes. The spokesperson said they “believe that those efforts saved lives.”

Now that Manitoba is experiencing outbreaks in long-term care facilities, the spokesperson said regional health authorities are being more hands-on with their monitoring of personal care home operators, in addition to adding staff on site to oversee management at some homes and other measures. Manitoba has also been in contact with public health officials from other provinces and territories, according to the spokesperson.

‘To this day, I am devastated’

Glen Baillie’s “contagious” smile lit up rooms. His voice was like a foghorn, his son fondly remembers. He worked for the Toronto Police Service for 37 years, was active with Scouts Canada and Rotary, and once opened a ski rental and repair shop in Banff.

“My dad lived life large,” Baillie said.

Glen loved the song “Delta Dawn” by Helen Reddy. It made him think of his wife, whom he met while working as a conductor for CP.

It’s the song Baillie sang for his dad as he lay in the hospital, before Glen went to meet his wife in the “mansion in the sky,” as Reddy, who died in September of this year, sings.

“Hopefully they can go to a Helen Reddy concert,” Baillie said of his late parents.

Glen, 88, had been living at Maples Personal Care Home in Winnipeg for more than two and a half years.

He was tested for COVID-19 on Oct. 24 and Baillie assumed the result was negative because he didn’t receive any calls about it — but when he phoned to check days later, a nurse told him his father had actually tested positive. He was told his dad was asymptomatic but knew he was experiencing chills. Baillie expected a contact tracing call, since he had been with his father the day before his test, but it never came. Baillie also said he was never contacted when his father was moved from his room, away from his TV and phone.

Roberts said Revera can’t comment on the specifics of a resident’s care because of privacy legislation, but offers its “most sincere condolences” to the families whose stories HuffPost asked for comment on.

The next week, a nurse said Glen had “major symptoms.” Baillie said to send him to hospital, where there would be more staff and monitoring equipment. His dad’s doctor from Maples called him back to suggest Baillie “let him die” comfortably at the nursing home.

A paramedic also called Baillie that night to talk him out of sending his dad to hospital, he said.

The next day, a nurse called Baillie to say his dad should be in the hospital. Baillie said to send him by ambulance when his oxygen saturation fell below 94, the lowest end of the normal blood oxygen range.

That’s what ended up happening.

Baillie was able to spend three days with his dad at the hospital, telling him stories and singing Delta Dawn. He died on Nov. 9.

“To this day, I am devastated. Because if he had got help earlier, like the COVID cocktail of steroids, I may not have lost my dad,” he said.

“I want to shout from the biggest mountains that this should never happen. It should have been stopped. There were no lessons learned.”

Calls for increased staff

Manitoba hasn’t moved quickly enough to proactively address staff shortages despite months of warnings, experts and advocates say.

One Manitoba union that represents staff in a number of Revera homes in the province sent a letter to the Ministry of Health in June, calling for action to increase staff in care homes, among other issues.

“While Manitoba has to-date weathered the pandemic better than most jurisdictions, we know the real vulnerabilities that exist in our long-term care facilities,” the president of Canadian Public Union of Employees (CUPE) Manitoba and other union leaders wrote.

Their recommendations include increasing staff levels, improving working conditions and education for staff, increasing unannounced inspections and making public the “few private, for-profit” facilities in the province.

Manitoba’s assistant deputy minister of health wrote back a month later, thanking the union for “sharing this valuable information.”

Manitoba Health, Seniors and Active Living was reviewing the experiences of other jurisdictions “in an effort to learn from them and mitigate these impacts in Manitoba,” Teresa Mrozek wrote, adding health authorities implemented daily screenings of personal care home staff and reduced visitations in care homes, among other measures.

Despite those steps, the vulnerabilities the union warned about have been exposed as outbreak numbers in personal care homes climb.

A significant number of unionized staff at Maples and Parkview Place have contracted COVID-19, CUPE Manitoba’s health-care coordinator Shannon McAteer told HuffPost.

Employees are emotionally and physically drained, working overtime, worried about getting sick themselves or spreading the virus to their families and watching the residents they care for die, she said.

That’s on top of what McAteer said was a “staffing crisis pre-COVID.”

‘We are going to see this spiral way out of control’

CUPE filed grievances and successfully got staff more access to N95 masks, but that still isn’t consistent in Revera homes, including Maples and Parkview Place, McAteer said.

Revera spokesperson Roberts said all of the company’s homes have access to “sufficient and appropriate” PPE, including N95 masks.

Manitoba is fast-tracking a college program for health-care aides, hiring uncertified aides who will get free training in exchange for working in a care home for three months and reassigning staff from home care — who typically provide at-home services to seniors — to personal care homes. It also implemented a one-time pay top-up for workers who make $5,000 per month before taxes.

The Canadian Red Cross has put 20 support aides and an occupational health and safety advisor at Maples, according to the Winnipeg Regional Health Authority (WRHA). But McAteer noted calling in the charitable organization is not a sustainable solution to the staffing crisis. Reassigning staff from home care also means there’s a gap somewhere else in the system, she said.

“There’s only so many bodies, like so many employees, that they can move around,” she said. “So they still need to do more.”

Brianne Goertzen, provincial director of the Manitoba Health Coalition, agreed further action needs to be taken. When front-line workers at Maples and Parkview Place started to speak out months ago about a lack of personal protective equipment (PPE) and staff shortages, she said Revera and the province didn’t communicate about what action they would take, leading to a “deplorable” and “inhumane” situation she fears will worsen without action.

“If you think it’s bad now, just wait. It’s already devastating, and I’m honestly trying to find a word to fully encapsulate how unbelievably heartbreaking [it could be],” she said through tears.

“If nothing is done, we are going to see this spiral way out of control.”

Roberts said the company has added several new general staff members at both Maples and Parkview Place, in addition to nurses from an agency and security guards who help keep residents in their rooms. The general staff members help with meals, provide companionship and do cleaning, he said, adding Revera continues to recruit for a range of positions in Winnipeg.

Revera is grateful for the Red Cross’s support at Maples, Roberts said. At Parkview Place, he said staffing has “returned to stable levels” as staff return to work from self-isolating.

In preparation for the second wave, Revera created a formal pandemic plan in July that included creating an external advisory committee of industry experts to develop best practices and a new recruitment model to address staffing, Roberts said.

But despite Revera’s plan, the second wave still hit hard. Roberts attributes this to “the fact that outbreaks in homes are occurring in areas with the highest levels of community spread” because staff and residents are more easily exposed in their community or in hospital.

‘Nightmare’ night at Maples Personal Care Home

Eddie Calisto-Tavares wakes up in the middle of the night hearing the pleas for help from residents at Maples Personal Care Home.

After her dad, Manuel, tested positive at the end of October, she became a caregiver to get into the home and provide direct care to him. She moved into a nearby hotel and was trained on how to properly use PPE, wearing the same full-body protection as staff.

She is still haunted by what she saw on a Friday night in early November, when there was only one nurse on the main floor to look after almost 100 residents. The nurse — who Calisto-Tavares said she’d “trust with her life” — called 911 because there was no one to help, Calisto-Tavares said.

To try to help that night, Calisto-Tavares attempted to calm residents down from outside their rooms, assuring them help was coming. It was, as someone who said they were an anonymous paramedic described the night later in a viral Reddit post, a “nightmare,” she said.

Two residents who were receiving end-of-life care died that night in the time between when paramedics were called and when they arrived, an official confirmed at a press conference the next day. Paramedics ultimately assessed 10 other residents, three of whom were taken to hospital, said Gina Trinidad, the WRHA’s chief operating officer of long-term care. In just 48 hours at the home, there were eight resident deaths, one of which was not COVID-19 related, she said.

After that night, the WRHA deployed a rapid response team of EMS workers to Maples to provide 24-hour assessment and treatment, Trinidad said. It also appointed a leader from a Winnipeg rehabilitation and long-term care centre to oversee the home’s administration.

Revera gave incorrect information about staffing

At that Saturday press conference, Jason Chester, Revera’s vice-president, long-term care operations for Western Canada, said the home was “at its full complement” on the evening shift.

But officials later confirmed the home was not fully staffed that night.

Revera has since apologized for the false information. It confirmed from 7:30 p.m. on that night, there were seven health-care aides working out of the 19 scheduled for the evening shift because some were self-isolating and others called in sick.

Following that incident, Manitoba’s health minister called for the creation of a task force specific to long-term care homes.

“Some may ask, ‘Why would you call for that just now?’” Friesen said. “I want to assure Manitobans we have had that capacity at health incident command structure.… This represents an escalation and it’s an escalation that we are prepared to make at this time.”

Winnipeg Police Service is “aware of concerns” about Maples and investigators have begun a preliminary assessment, Const. Jay Murray told HuffPost.

Another detail from that weekend at the home stands out for Calisto-Tavares. On Sunday night, she heard cries from residents’ rooms, and a woman was repeating, “I’m on fire, I’m on fire.” She guessed the resident had a fever or was experiencing delirium, which a new study suggests can be a sign of COVID-19 in older adults.

That night, one of the security guards at the home approached Calisto-Tavares in the hallway, mistaking her for a nurse. Overwhelmed with grief and emotions, he said he needed a break. Calisto-Tavares told the security guard he needed to take a moment to calm down and then go back to work — because there was no one else around.

Manuel Calisto turned 88 on Nov. 1 — two days after his daughter’s birthday. As they have done every year, they celebrated together. He died on Nov. 11.

Calisto immigrated from Portugal in 1972 with his wife and their six children. He was an entrepreneur who believed in the possibilities of life and always smiled when he heard a family member say they were “going to work,” his daughter said. He loved big celebrations and wine.

“This generation that we are letting down, we’re disrespecting, and they’re dying with less dignity than they deserved,” Calisto-Tavares said.

“We have to continue to push and we have to change the model, the Reveras and others, that they have to put people first, above it all. Yes, it’s OK for people to make money, but not when it comes to the compromise in the quality and the well-being of our elderly.”

Make Revera public, NDP urges

Revera, the second-largest operator of long-term care in Canada, is a wholly owned subsidiary of PSP Investments, a federal agency that manages pensions for federal employees, including the RCMP and Canadian Armed Forces.

Early in the pandemic, Revera’s long-term care homes saw high death tolls in Ontario. In both waves of the pandemic in that province, data analysis by the Toronto Star indicated residents in for-profit long-term care homes had worse outcomes than those in nonprofit or municipal homes.

That also appears to be the case so far in Manitoba, CUPE’s McAteer said.

“When health care is for profit, standards are not the same, the oversight isn’t the same. It becomes all about the profit,” she said.

Provincial and federal NDP members have joined calls to take Revera public.

Mintu Sandhu, an NDP MLA who represents The Maples riding in Winnipeg, told HuffPost he went to Maples Personal Care Home the day after the “nightmare” night when paramedics stayed for hours. As he stood outside the home, he watched upset family members ask staff leaving the building questions about their loved ones, desperate for information.

Not only did Manitoba not learn from the experiences of provinces like Ontario and Quebec, but it also didn’t take significant action after Parkview Place first saw an outbreak, he said.

“The biggest thing coming out of this is that we had seven months to learn.”

The Manitoba NDP tabled a motion in November for the province to immediately take over management of Revera’s care homes. It was voted down by the ruling Conservatives.

That, Sandhu said, demonstrates the party is prioritizing money over care.

Federal NDP leader Jagmeet Singh, who has been vocal about wanting to take Revera public, said the conditions are “heartbreaking” when asked by HuffPost about the two Revera homes in Winnipeg.

The federal government has previously said PSP Investments is independent and operates at an arm’s length from the government. But to say the government can’t do anything is “nonsense,” a CUPE pensions researcher said at a town hall in September.

“They said before that everything was on the table,” Singh said. “So everything being on the table means, let’s make this public right away.”

But Roberts said Revera does not profit from the delivery of care.

In Manitoba, the WRHA provides full funding for the provision of care — such as for nursing, personal care, support services and food — in long-term care homes, and this money is closely accounted for and must be reconciled at the end of the year, he said. For Revera, the majority of funding goes toward paying staff wages. In addition, Revera invests in health-care programs beyond the funding it is given by the government, Roberts said.

The cost of services is shared by the government and resident, with the majority of the costs being paid by the WRHA. The resident pays the remaining portion based on their income, Roberts said.

“It is only from these ‘rent’ payments that private sector operators can make a modest return on their investment,” he said, adding there needs to be more focus on issues these facilities face.

“The focus on ownership models, instead of the common challenges facing long-term care operators, is becoming a distraction from discussions about the real reform needed in the sector,” he said.

The “prioritization gap” between acute care like hospitals, and chronic care like long-term care, needs to be closed, he added. There needs to be investments in long-term care infrastructure, such as a program to redevelop older homes to meet the “increasingly acute” needs of residents, as well as short- and long-term staffing strategies, he said.

‘Something seriously wrong’ with health-care system

Denis Mathieu was a welder of 41 years. He’d always ask his daughter Yvette if she wanted to accompany him to the dump or hardware store. He was “forever building,” she recalled, always sawing or hammering. In his later years, he would turn up his music loud and play along on the fiddle. What he played didn’t exactly resemble music, she laughed, but he was having fun.

In June, Denis, 74, fell and was taken to hospital, where he fell again and broke his hip. He wasn’t responding to physiotherapy to strengthen his legs, so nurses and doctors pushed for him to move into a care home. Mathieu and her mom wanted to bring Denis home and get home care instead “and they just made it seem like it was an impossible task,” she said.

In the day’s delay before Denis left the hospital for Parkview Place — the only option given to the family despite it being further from their home than they wanted — the hospital sent a $120 bill for his overnight stay. Unable to afford both the Parkview rent and to stay in the home the family had lived in for 41 years, Mathieu’s mom had to start packing to move.

In the first week of October, Denis was sent to hospital for respiratory issues. There, he was diagnosed with pneumonia and got a COVID-19 test before he was sent back to Parkview. Mathieu and her mom believed he must have been getting better, since he was returned to the home so quickly.

But by Oct. 13, he was back at the hospital — his health was deteriorating and his COVID-19 test had come back positive. Less than two days later, he was sent back to Parkview. There, a social worker called to ask if the family was OK with the home offering “comfort care,” Mathieu said, meaning if he didn’t want to eat, drink or take his medicine, he wouldn’t be forced to.

“And so my mom’s response … was, ‘So you’re just waiting for him to die?’” Mathieu recounted. “And they were just so nonchalant and saying, ‘Yep, that’s pretty much what we’re waiting for, is just for him to pass away.’”

Mathieu worried her dad being sent back and forth twice between the home and hospital, both while his test results were unclear and after he tested positive, could have posed a risk for others at either facility.

“There’s something seriously wrong with our health-care system here,” she said.

A WRHA spokesperson said they could not comment on Mathieu’s concerns because of Manitoba’s Personal Health Information Act.

‘I would have fought harder’

As the residents at Parkview Place continued to contract the virus, the WRHA conducted an unannounced review of the home in mid-October, finding it needed immediate help with staffing.

“Parkview’s largest risk is their staffing and has immediate needs to maintain and sustain resident care,” the review, provided to HuffPost, reads. “Staff are burned out, exhausted, are being mandated and Revera has exhausted recruitment strategies.”

The WRHA identified several other concerns at Parkview Place, including limited housekeeping staff, PPE zone signage missing in half of units and staff not following proper procedures to take PPE on and off. The areas the team observed were clean, but the home was still managing a cockroach issue, according to the review.

Roberts said Revera works closely with the WRHA to address any issues that come up and appreciates the health authority’s support for the company’s Winnipeg care homes.

Mathieu and her mom visited Denis on Parkview’s floor for COVID-19 positive residents on Oct. 15 for a palliative visit. She recalled the sound of resident’s call bells going off while the pair spent time with Denis, dressed in full PPE.

The next morning, Mathieu called the home to ask about her dad’s condition. She said the nurse read his chart to her, saying his stats were declining, but told her she hadn’t yet been to his room.

That was at 9 a.m., Mathieu said. Around 40 minutes later, she got a call saying he had died.

“So, in my eyes, he had passed before I called at nine, and they had no idea how long he had been deceased already,” she said.

Mathieu has been reading concerns about the facility’s cleanliness and what she called “horror stories” from other families during the pandemic. She wishes she had researched more about Parkview Place before her dad was sent there.

“I would have fought harder for my dad to be home and get home care,” she said. “And between my mom and I, we would’ve helped my dad. And I think he’d still be alive.”