General says military discipline helped restore stability to Quebec care homes during first wave

Brig.-Gen. Timothy Arsenault testified at a coroner's inquiry on Tuesday that when his soldiers first arrived to help out in Montreal's long-term care homes in May 2020, they found some residences "completely overwhelmed" and "chaotic."

Arsenault led a group of 1,500 Canadian Armed Forces soldiers in a support mission at 47 long-term care residences in Montreal during the first wave of the pandemic.

The province called in the military to help as deaths continued to rise.

Arsenault testified that it was clear when his troops arrived that there was a serious lack of nurses and orderlies. 

He said the staffing shortage meant that managers were often directly caring for patients, and as a result, there was a general lack of planning and co-ordination.

Arsenault testified that often his soldiers found no clearly marked hot or cold zones to keep infected patients isolated, and that there was a general lack of discipline in correct use of personal protective equipment (PPE).

"This wasn't necessarily negligence or ignorance, but a reflection of the crisis underway. It was understandable given the context," Arsenault told the inquiry.

He added that the staffing shortages also meant that health-care workers were only able to provide a minimum of essential care, and that little things to make patients more comfortable were left behind.

Military discipline to the rescue

Arsenault testified that his soldiers were able to help stabilize things quickly by adopting infection-control protocols and correct use of PPE, and thus provide a good example for health-care workers.

Arsenault said soldiers created a centralized supply depot to distribute PPE in Montreal, and helped managers come up with better systems to schedule and deploy staff.

He said he believes military assistance helped reduce the number of cases at residences, and gave health-care workers a bit of breathing room to restore stability.

"I'm proud of the positivity and adaptability of my soldiers. It was an honour to serve Quebecers in this way," Arsenault said.

Coroner Géhane Kamel thanked Arsenault for his service and asked him to pass along the message to all the soldiers who helped out.

"Your intervention was a breath of fresh air and a source of hope for all Quebecers," Kamel said.

The inquiry also heard Tuesday from the head of a facility that was able to keep COVID-19 at bay.

Sandra Lavoie is the director of the Montreal Chinese Hospital, a long-term care residence that caters to clients of Asian heritage. Most of the staff speak both Chinese dialects and French.

Lavoie testified that because her staff and residents had connections to Asia, they were aware of COVID-19 earlier than most people in Quebec.

She said that staff members began voluntarily wearing masks in February 2020, weeks before there was any government directive instructing them to do so.

She said talk of the pandemic worried staff, so in early February she invited public health officials to discuss infection-control measures.

Lavoie also said cultural ties to the community and the residence meant that there was less reliance on workers from placement agencies, reducing the movement between care homes.

"Between March 12 and May 1, 2020, we had zero cases," she said when asked how many COVID-19 cases there were during the first wave.

Kamel called the Chinese Hospital an "extraordinary success story."

Expert testifies system was fragile well before pandemic

Also testifying Tuesday was Francine Ducharme, a retired professor of nursing from the Université de Montreal specializing in quality of care for elderly patients. 

Ducharme wrote a report for the government about what led to the crisis.

She testified that the residences have been a blind spot of successive governments for decades, and that the pandemic exposed and exacerbated problems within the already fragile system. She outlined several of those problems, including:

• Decreasing staff/patient ratios.
• Insufficient staff  trained in infection control.
• Low stock of PPE.
• Chronic staff shortages and forced overtime, leading to staff burnout.
• Over-reliance on workers from placement agencies, disrupting continuity of care and routine.
• Lack of communication between hospitals, long-term residences and home-care services
• Bureaucratic "megastructures" leading to managers who don't have close contact with patients making decisions.

Ducharme said she believed a complete overhaul of the system was required to address these problems. She said more local decision making and increased oversight of private residences were required, as well as more staff.

She said patients at care homes should have access to other health professionals such as psychologists and occupational therapists to improve their quality of life, and that the system needs more experts in geriatrics as the population ages.

Kamel's inquiry is looking into the tragedy that unfolded in long-term care homes across the province during the first wave of COVID-19, when thousands of residents died.

The first phase of the inquiry focused on six different long-term care homes selected by Kamel to be examined more closely.

This phase of the inquiry is focusing on expert witnesses who may have recommendations about how to prevent such a tragedy from ever happening again.

Nurses, doctors, geriatricians and health-care administrators are being called to testify.