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Long-term Care System

Inquiry--Debate Continued

December 1, 2020


Hon. Donald Neil Plett (Leader of the Opposition)

Honourable senators, I rise today to speak to Senator Seidman’s inquiry calling the attention of the Senate to weaknesses within Canada’s long-term care system, which have been exposed by the COVID-19 pandemic. As you recall, before our one-week break, I did speak for a few minutes to this very important inquiry, and I want to continue.

I want to thank Senator Seidman for initiating this inquiry, and I want to also sincerely thank all senators who have participated in this very important discussion.

During the first wave of the pandemic, Canadians did not know what to expect. They were being given startling projections about possible scenarios, which included an alarming number of infections and deaths. Most of these did not materialize, but one number which uniformly troubled Canadians was when we learned in June that residents of long-term care facilities accounted for 81% of all COVID deaths. This horrific number has only improved marginally since then.

On November 24, the National Institute on Aging reported that long-term care and retirement homes in Canada now account for 75% of COVID deaths. The grim reality is that if you are a resident of a long-term care home in Canada, you are 226 times more likely to die of COVID-19 than anyone else. This is an alarming number because it demonstrates the scale of the threat against our loved ones who are in their senior years.

It has been painful to hear many stories of parents and grandparents whose departure was hastened by the virus, and in some cases, left unchecked by those charged with their care.

Our family faced our own scare a few weeks ago when my 92‑year-old mother, who is in long-term care in Manitoba, tested positive for COVID-19. No matter how much you prepare yourself, when that moment comes, your stomach goes into a knot.

I want to take a few minutes to relive the dates that led up to the call that we received. I am my mother’s legal caregiver. My wife and my sister are her practical caregivers, but legally I am the one.

I got the call from the care home telling me that they had tested the residents on the second floor of the care home that my mother is in, Rest Haven nursing home in Steinbach. Eleven of those residents had tested positive, my mother one of them. My mother is a remarkably strong woman, but she is in very failing health. She is in a wheelchair and she has crippling arthritis. She cannot really walk well, but she insists on trying when they don’t come and make her bed early enough in the morning for her liking. Then she is found trying to get out of her wheelchair and make it herself because she’s an impatient woman. I remember when I was growing up, when we had dinner at the house and wanted to have a second serving, we had to hang on to our plate because when the last bit of it came off the plate, my mother was cleaning up and washing the dishes. She is still that way today; she’s impatient.

Nevertheless, she has crippling arthritis. I used to call her a walking pharmacy, and now she is a rolling one with all the drugs she takes to keep her going.

Clearly, when we got the call we naturally assumed this was the death toll, if you will, and that there would not be much chance. The call we got from the home was on Friday, and our doctor called me on Saturday. He happens to be my doctor as well as my mother’s doctor, and he took time out Saturday at 8:30 in the evening to call me and explain the chances of my mother pulling through this. He suggested that we needed to talk about end-of-life decisions, and so of course we started that. He asked what questions I had and what my biggest concerns were. I said that we understand that COVID is definitely a respiratory issue, and so my biggest concern was would my mother choke to death. My second concern was would she, as so many seniors have had to do, die alone?

He assured me that my mother would probably slip into a coma and, with drugs, they could make sure she did not choke and would probably pass away very peacefully, but nevertheless, would probably pass away within the next little bit. He then called me a day later and said that he believed that one of the family members would probably be able to be at her side when she would pass away. Nevertheless, this was a conversation where, really, it was pretty much a done deal. My mother was going to pass away. I, of course, then had a conference call with my siblings, and we discussed how this would end.

As I said, 11 patients on that floor tested positive, the youngest one being 80 years old and the oldest 98 or 99 — I’m not sure of the age. The manager of the personal care home called me daily, and I’m sharing the whole thing because this is very relevant to the rest of my speech. She called me every morning to give me an update on how my mother was feeling. I should mention as well that we struggled with how we were going to tell Mom. I had asked them not to until we had determined how we were going to tell my mother, so we made arrangements that one the managers of the home would go into my mom’s apartment and would tell her that she had tested positive, and while they were in there, they would make a phone call to me so that I could talk to my mother.

They did that, and when they got me on the phone, my mother was in the background and I could hear her wailing and weeping and gnashing her teeth, and this was a horrible thing. My mother wanted to live. It is not that my mother was not ready to die, but my mother wanted to live, and she has the feeling that, “I’m going to spend eternity in heaven, but eternity is a long time, so let me have a few more years here because I don’t need to go to heaven that quickly because I will be there forever.”

They are adding 160 beds to her care home. It’s brand new. They have shown her a plan and which room will be hers in that new care home; she will be able to move. That’s what she is looking forward to: “I will be able to be in a brand new room for however long I will have.” She did not want to die. I then talked to her and convinced her that, in fact, she didn’t have symptoms. She had been diagnosed positive, but she didn’t have any symptoms, so I believed that she might be able to fight through this. I didn’t believe that at all, but nevertheless I managed to convince her. I settled her down, and indeed, she went through the next number of days, with Lorraine Friesen, the manager of the facility, calling me regularly, telling me, “Your mother is in fine shape; she still isn’t showing any symptoms.” Of course, this went on for about seven or eight days straight.

I talked to the doctor. I said, “Are you sure that she tested positive?” Absolutely.

Since then, 8 more residents tested positive, for a total of 19 — again, the youngest being 80 and the oldest being right around 99. Out of those 19 residents, 4 have passed away. A 97-year-old just two doors down from my mother also made it through. They all had symptoms. My mother, I think, was the only one that didn’t have symptoms.

The 80-year-old passed away; they’d had a couple of strokes. One 99-year-old passed away. The manager said this individual would have passed away if he would have gotten the flu. So these people had very serious issues aside from their age.

But out of the 19 cases, there have been 4 deaths and 15 that didn’t pass away. I’m not sure if they have all gotten what they called a “green light,” but my mother has. My mother has gotten the green light. We’re tremendously thankful for that.

Now, of course, she’s afraid. She called me the other day and said, “They want to take me out of my room again to give me a bath,” and “Do you think it’s safe for me to go into that disease-infected hallway and have a bath?” I said, “Mother, you’ve made it through this. You’re going to make it through everything. You go ahead.” And they have done that.

These are difficult times. You all know that I have been known to not be as cautious as many of you would even like me to be, and as many of you are.

I told my wife, when we got that call, I’m going to have to go back to Ottawa, hat in hand and looking at my feet, saying, “Well now, we are one of the statistics.”

Then when mother got the green light, I said to Betty, “Now I’m going to have to be very careful that I don’t go to Ottawa, being a little too flippant and too arrogant, and say this really isn’t that big of an issue. If my mother can beat this, then surely we can all beat this.”

But we can’t all beat this. Thousands and thousands of families have been in the same situation since March. It is incredibly difficult and incredibly challenging.

Our family was blessed that my mother recovered without exhibiting any symptoms, not even a scratchy throat. As I said, her doctor recently gave her the all clear and she is doing fine. For this, we are very thankful. But at the same time, I am deeply aware that many, many families did not have the joy of hearing their doctor deliver to them that same message. Many sons, daughters, spouses and grandchildren received the most terrible news of all that their loved one had passed away due to the impact of the virus.

In many cases, they were on their own, without a loved one there. These are lonely, lonely people.

This has not been an easy time for anyone, but perhaps most of all for those who are residents of long-term care homes and their families. I know we were all moved when we listened to Senator Pate share her heart-wrenching story about her late mother. Such a lack of respect for the dignity of life is tragic, and the deficiencies that enable our most vulnerable to be treated in this manner need to be addressed.

We have all heard stories of long-term care residents who caught COVID because they did not receive the proper care, because the proper safety measures were not in place or because someone was careless.

We all know about the report of the Canadian Armed Forces on the condition of five long-term care homes in Ontario. The conditions were appalling, and the lack of proper treatment received by some seniors is unacceptable. I am deeply supportive of every effort to address these inadequacies.

But, colleagues, today I want to spend some time drawing our attention to the fact that there is another side to this sad story. While there have been too many horror stories of care homes where the staff were irresponsible in how they handled this virus, there are other stories that must be told and other statistics that underscore our victories, our successes and the phenomenal work that so many health care providers and personal care workers have been providing to our seniors.

My mother’s home care is one of those, where the manager calls me on a regular basis, where my doctor takes the time on a Saturday night at 8:30 to call me and discuss the entire situation.

The uncomfortable truth is that our elderly population who live in care homes are a high-risk population for this deadly virus.

When it comes to this virus, the odds are against you if you are elderly. They move against you even more if you have an underlying condition that already compromises your health, and the odds are really stacked against you if you are also a resident of a long-term care home.

Dr. Nathan Stall, a geriatrician at Toronto’s Mount Sinai Hospital, put it this way in an interview with CTV news:

You’re taking the frailest adults, frailest individuals who are in society — they live in congregate settings and the settings they live in are often outdated and crowded with many homes having three- or four-person rooms — and then you’re introducing a highly-transmissible virus that is highly lethal . . . a perfect storm for a disaster.

But it doesn’t end there. Statistics Canada recently reported:

There is now clear evidence that people with pre-existing chronic conditions or compromised immune systems are at higher risk of dying of COVID-19, especially among those over the age of 80.

These conditions include dementia, Alzheimer’s, pneumonia, hypertensive diseases, heart disease, respiratory failure, renal failure, diabetes, chronic lower respiratory diseases, nervous system disorders and cancer.

The Statistics Canada report noted that:

Many of these conditions are significantly more prevalent among Canadians aged 65 or older, who accounted for 94% of all COVID-involved deaths in the first wave.

Colleagues, it is imperative that we do everything in our power to protect our elderly and those who are residents in long-term care homes, because COVID-19 represents a very real danger to them. However, I urge you to not take these statistics and generalize what is happening by casting a shadow over all long-term care homes and the caregivers who have worked themselves to exhaustion trying to protect our elderly.

Without question, there have been many failures in the system. We need to identify those and address them in order to safeguard the health and dignity of our senior citizens. However, we also need to realize that while the alarming COVID death count in long-term care homes illustrates the vulnerability of this cohort, the impact of COVID on long-term care homes has varied significantly.

An article published in the Canadian Medical Association Journal on November 23 noted:

People living in long-term care (LTC) homes in Canada have been far more likely to die of coronavirus disease 2019 (COVID-19) than the rest of the population. However, the effect of COVID-19 on residents in LTC has varied across provinces and territories.

Colleagues, you wouldn’t know from the media coverage that there are many good news stories when it comes to COVID and long-term care in Canada. Let me illustrate this by using my home province of Manitoba.

Manitoba has been in the news lately because of its rising cases of COVID-19. We have been left with the impression that the situation in care homes across the province is uniformly disastrous.

When our friend Senator Bovey spoke on this inquiry, she lumped Manitoba in with the terrible track record of Ontario and Quebec when she said:

The situation is deepening in Manitoba, becoming darker every day. We are failing to provide for our seniors in long-term care homes and they are dying because of it. . . .

She noted that, “By November 17, 36 care homes . . . had experienced outbreaks . . . .”

She said that, “Steinbach is another concerning centre,” and asked, “Did Manitoba have no option but to follow the sad steps of negligence seen in the homes in Ontario and Quebec?”

Listening to this, colleagues, you might fear for your life to go to our province, especially Manitoba’s Southern Health region, which is where I am from.

But let’s take a step back and consider the facts. While 75% of all COVID-19 deaths in Canada have been residents of long-term care homes, the number in Manitoba is much lower, at 44%. This number is still unacceptably high, but it is important to note that it is not only well below the Canadian average, it also falls below the global average. The International Long-term care Policy Network reported in October:

Despite the difficulties arising from differences in definitions, in almost all countries where there have been deaths linked to COVID-19, a substantial proportion of those deaths were among care home residents. Based on the data gathered for this report, the current average of the share of all COVID-19 deaths that were care home residents is 46%. . . .

Those are the numbers. The global average of COVID-19 deaths in long-term care homes is 46%. The Canadian average is 75%. The Manitoba average is lower than both of them, at 44%.

In the Manitoba Southern Health region, which Steinbach is part of, the death rate is even lower. Deaths in long-term care homes due to COVID-19 are not 75% of the total, nor are they 44% of the total. They are 17% — less than one quarter of the national average.

Colleagues, a single death is one too many. But we need to acknowledge that those who are working in our long-term care homes are playing defence, fighting a formidable enemy with the odds stacked heavily against them. Despite this, many long-term care residences in southern Manitoba are mounting an incredible effort and crushing the odds.

As I said earlier, if you live in a long-term care residence, your chances of dying from COVID-19 are 226 times higher than everyone else. In southern Manitoba, however, the chance of a long-term care resident dying from COVID is only 30 times higher. That’s still a lot, but it is 88% lower than the national average.

Furthermore, after eight months of a global pandemic in which 378,139 Canadians have been infected with the virus, and 12,130 people have died, almost three quarters of long-term care homes in southern Manitoba have not had a single case of COVID-19 to date, and 85% have not had a single death.

When you consider the incredible vulnerability of the long-term care cohort to this virus, those figures are astounding. They tell us that most long-term care residences in southern Manitoba are winning the battle against COVID-19.

I think that Dr. Roussin, our public health officer, should ask southern Manitoba how to deal with this virus instead of telling them how to deal with this.

I want to read from a document citing personal care home outbreaks in Manitoba to illustrate some of the numbers. Out of 64 personal care homes in Manitoba, there have been a total of 1,108 cases and 153 deaths. Of those 153 deaths, 49 were in one personal care home — one third of them.

So the outlook in Manitoba isn’t as bad as we have been told. Colleagues, I am in no way minimizing the very real impact that COVID is having in Manitoba and across our country. But I do want to put it into perspective for you so you realize that Manitoba, and especially southern Manitoba, is doing a much better job of protecting their long-term care residents than is sometimes being portrayed.

In fact, at last count, 20 long-term care residences in Manitoba had reported staff infections and yet continued to maintain zero infections among the seniors who live in those residences. When you consider how easily and stealthily this virus moves, those numbers are evidence of a vigorous and vigilant effort to both detect the virus and prevent it from reaching our most vulnerable citizens. I think it is time to not only thank our health care providers and personal care workers but to acknowledge that in many, many cases their efforts have been beyond commendable — they have been heroic.

However, colleagues, there are some things that trouble me about how we are handling this pandemic — namely, the inconsistencies in our efforts and the tendency to allow policy to be dictated by emotion rather than science in our efforts to prevent the spread of COVID.

Let me speak to a few inconsistencies, again because Steinbach has been on the map.

Last weekend, a church just south of Steinbach wanted to have a service. They had been in the news for having a service in their church building the week before, and they decided they would do it right this time. They put up a large screen in their yard and decided they would have a drive-in service. People would stay in their cars.

The RCMP came along and allowed five cars onto the yard, and then blocked it. This is a large yard, and about 100 cars wanted to get on. People were all going to stay in their vehicles and watch the service on a large screen. They were blocked from going onto the yard, to sit in their cars and watch a church service.

I wasn’t there, but I did happen to drive around the city of Winnipeg that day. I drove by Costco, Walmart, Home Depot and a few other shopping centres. I saw hundreds of cars on their yards. They were not limited as to how many cars they had on the yard. They were limited in terms of how many people could go into the store, but not in terms of how many cars there were or even how far apart the cars had to park.

So that is okay, but going to a church service isn’t.

There are many in this chamber who know how I feel about drug issues, marijuana being one of them. Yet, the marijuana store — and I walk by it when I go for a walk on a Sunday afternoon — is open. People can go and buy their recreational marijuana — and their medicinal marijuana, for sure.

The liquor store is open. I do frequent that. On Saturday, when I walked into the liquor store, there were 35 to 40 people in the liquor store. That is allowed, but church services aren’t.

My wife went out and bought me a pair of winter boots while I was on Zoom calls. She went to Sport Chek to buy me a pair of winter boots so we could go on our walks. That was fine; she could buy them, and she got them on the Black Friday discount.

While she was doing that, she decided to stop at Shoppers Drug Mart and buy a birthday card for one of our granddaughters. That was not allowed. She could not buy a birthday card.

However, there were toys out for pets, dogs and cats, and she was allowed, if she had wanted to — we don’t have a pet — to buy a toy for a pet. That somehow was an essential service. But to buy a toy, or even a birthday card, for our grandchildren wasn’t right.

We have a school division that the public health officer has shut down again because it’s southern Manitoba. The Hanover School Division has been shut down. It’s a large school division whose catchment includes many towns, Steinbach being the largest. The towns of Niverville and Blumenort and the village of Landmark are all 15 to 20 miles away from Steinbach, but they are part of the Hanover School Division, so they all had to be closed down. The Seine River School Division, under the control of the same public health officer, was open. The towns of La Broquerie and Ste. Anne border the city of Steinbach. They are in the Seine River School Division. They are four miles away and they could be open. But Landmark, 20 miles away, couldn’t because Hanover had had a breakout. No consistency.

We’ve talked about visitations to long-term care facilities, and we’ve shared that. We all know the stories; we aren’t allowed to go in and visit our parents. They have a rule at the facility my mother is in, and we certainly respect that. They have been trying to be very accommodating, but, again, my wife and my sister are the two people designated to visit my mother. Only they can go and visit her, but during this time of the COVID outbreak, even they aren’t allowed to visit.

I’m wondering, why would we not allow someone who is willing — and my wife was — to go there and be tested? This isn’t a speech where I want to rail on the government, but if we had rapid testing, where people could get tested for COVID, put on the gowns that health care workers have to put on, put on the masks — do everything they have to — these people could then be allowed to visit their loved ones. Loneliness is the worst thing for these people. Loneliness is worse for them than death.

Colleagues, when this pandemic started at the beginning of 2020, we heard from our provincial and federal leaders. They said, “We are all in this together.”

In the province of Manitoba, we have a “snitch” line. If you see your neighbour doing something wrong, we have a quick service. We can call a number and say, “My neighbour is not wearing a mask when he or she is walking down the hall,” or, “I know that they had one of their grandchildren visiting. Can you send the squad over?” We also have a special squad hired specifically to deal with COVID, to drive around the province, knock on someone’s door and see if there are more than five people in that household. If there are, it is a $1,200 ticket.

The RCMP doesn’t want to do this, so we’ve formed a squad of some kind, and we now have a snitch line so we can snitch on our neighbours and enforcement officers will hunt down the offenders. How, colleagues, is that being in this together? I fail to see that.

There was a post on Facebook that captured the idiocy of this quite accurately. Here’s what it said:

Friendly reminder! So, the government is encouraging you to report your neighbours if they don’t follow the new rules. Before following this advice, you should really consider the fact the government won’t be there to help you jump start your car or lend you tools or a cup of sugar if you needed it. They won’t be an extra set of eyes to watch over your property if you are away. They won’t keep an eye on your kids if they are playing in the street and someone strange is hanging around. We need each other, it’s how we get by and live in peace.

I could not agree more. Encouraging neighbours to turn on neighbours is not how we get through COVID. Instead, we will weather this storm by encouraging one another, standing by each other and pulling together.

In closing, I want to acknowledge all of those who have lost a loved one due to COVID-19. You may have lost them directly because of COVID as the virus attacked their body, or you may have lost them because they were suffering from another illness and were unable to access the health care they needed due to the increased strain that the virus has placed on our health care system. Whatever the reason, our hearts and prayers go out to you.

I also want to take a moment to once again thank all of our health care workers and long-term care staff members who have put their own health at risk as they served in their places of employment. Your service is exemplary of the Canadian spirit which built this great country and never lets hardship or difficulty prevent us from taking care of those around us.

There is no question that these are challenging times, and the winter ahead could be a long one. But when things are at their darkest, even a little light is a lot of light. It’s at times like these that a small act of kindness can make a big difference. A word of encouragement can lighten the load for someone.

I pray that along the road we find ourselves travelling together, we will continue to bring out the best in all of us. I pray that, as we endure the winter ahead and move into spring, we all find fresh hope and new strength for tomorrow.

Hon. Éric Forest [ - ]

Would the senator take a question?

Absolutely.

Senator Forest [ - ]

I will not ask the senator what sort of boots his wife bought him.

I would like to better understand the spirit of your intervention. Do you believe that we must standardize all the rules? From what I gather from your intervention, these rules might vary, even within a province.

Senator, let me say that I do believe in provincial autonomy. We have to accept some provincial autonomy. Cases are different from one province to another, and I certainly want to recognize that.

I want to respect the Province of Manitoba and the leadership there, but let me say that I believe all decisions should be based on science. From the inconsistencies that I see in many of the decisions that are made, they are not based on science.

When an entire school division is closed, or we put in rules for an entire health region that, in fact, has done very well, and we do that based on science when, in fact, in that school division we allow schools that are much closer than other schools to be open, that’s not based on science. When my wife isn’t allowed to buy a birthday card, but she can buy a gift for her dog, that’s not based on science.

Decisions need to be based on science, and then I want to follow them. As a matter of fact, I do follow them. I faithfully put my mask on when I walk into the hallway of my condominium building because it’s the rule and the law.

We have a notice of motion in front of us today that will deal, maybe later this week or next, with masks in the Senate. I do not support that. If that were the rule, I would deal with it. Even though I don’t agree with it, I would follow the rules. I try to follow the rules. I believe I need to follow the rules, but I also believe that I can be outspoken when I believe that they don’t make sense and are not scientific.

Senator Forest [ - ]

So we need to base our decisions on science?

That is correct. That is how I feel, yes.

Senator Forest [ - ]

Thank you.

The Hon. the Acting Speaker [ - ]

Honourable senators, it is now six o’clock, and pursuant to rule 3-3(1) and the order adopted on October 27, 2020, I am obliged to leave the chair until seven o’clock unless there is leave that the sitting continue.

If you wish the sitting to be suspended please say “suspend.”

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