Early missteps made outbreak at Parkside care home worse, Extendicare workers say

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Decisions made early in the COVID-19 outbreak at Regina's Parkside care home only worsened the virus's spread, two Extendicare employees say.  

"It was a war zone," says one male employee who has worked inside the private home and who agreed to speak to CBC News on the condition of confidentiality.

"We were losing people every day," he said. "It was unimaginable, the conditions inside. They were so short staffed."

Nineteen infected residents at the home had died as of Tuesday, three and a half weeks after the outbreak was declared. In that time, the number of COVID-19 cases at the facility exploded.

When the outbreak began, 200 people lived at the facility. By Nov. 29, 50 of those residents and 25 staff members tested positive. One resident had died.

By last Thursday — shortly after the Saskatchewan Health Authority announced it was taking over day-to-day operations at the home — 160 residents and 86 workers had contracted the virus. 

The number of active cases among residents at the home has since decreased, according to the daily updates Extendicare sends families. 

But employees are questioning the rationale behind some of the early efforts to contain the virus.

The male Extendicare worker — who said he wants to keep his job so he can continue to help — said COVID-positive residents and their belongings were moved to new rooms in the building's north wing, which was set aside as the place to cohort infected people. Meanwhile, COVID-negative patients on the north wing were moved to the south and main wings. 

"Why didn't they isolate [infected] people in their rooms?" the worker said. "It just seemed like a comedy of errors in the beginning."

During a Dec. 2 virtual town hall with the families of Parkside residents, Extendicare officials said the more than 100 recent moves were necessary "to be able to contain the spread of the outbreak."

Over the next week, the total number of infected residents to date nearly doubled, from 84 on Dec. 3 to 160 on Dec. 10. 

"The entire care home was infected and it was because they were moving people," the male employee said.

4-person rooms make for 'difficult choice': expert

Cory Neudorf, a professor of community health and epidemiology at the University of Saskatchewan, said that when dealing with an outbreak in a long-term care home, it's important for positive residents to stay in their rooms, if possible. 

But at places like Parkside — where, according to a 2019 inspection report, there were 34 rooms that housed four residents — that can be a hard decision to make, he added.

"You tend to get only one individual coming down with that illness first and so you're left with a difficult choice around leaving that person where they're at because they may have already infected others in that room, [or] if they haven't been infected yet, you're actually having people who are susceptible and vulnerable right next to that infectious person."

One option, Neudorf said, is to remove positive residents and place them in unoccupied rooms. The other residents in the original room would remain there, but be quarantined in case they were infected.

But another Extendicare employee who has also worked at Parkside during the outbreak and spoke to CBC News on the condition of confidentiality said other negative residents were moved into rooms that had once housed positive residents, "thinking that that whole room was going to be negative." 

"Then one of those people that were with a positive turn positive," she said. "There's definitely a chain reaction."

Making matters worse was that during room changes, "there wasn't additional housekeeping staff on to make sure that the rooms were completely scrubbed down," according to the male employee.

"Beds were wiped down, bed rails were wiped down," he said. "But those curtains, which are notorious for harboring bacteria and viruses, wouldn't have been cleaned."

We would know that someone was dying and we would find them dead on rounds at four in the morning.- Parkside Extendicare worker

Extendicare has acknowledged staffing Parkside was a challenge, with so many employees testing positive and needing to self-isolate. 

The male worker said the shortages resulted in unmasked, unsupervised and infected Parkside residents with dementia wandering inside other people's rooms and beds.

Some Parkside residents died alone because there was no one to sit with them, he added. 

"We would know that someone was dying and we would find them dead on rounds at four in the morning," he said. 

Virus 'just going to have to burn itself out': employee

Last week, the Saskatchewan Health Authority (SHA) put out a wide call for help at Parkside. Regina firefighters also came in. By Thursday, the SHA said the home had "much more of a stable situation in terms of supporting staffing."

The way Parkside workers had been assigned inside the building has also come under scrutiny. 

The female employee said she and other employees worked all over the building, in both positive and negative areas. 

"I wasn't just stuck to one side," she said.

That's a terrible idea from a virus containment standpoint, she said. 

"If a care aide is in with a COVID-positive [resident], the cough or sneeze droplets are now on [their] clothes because even though we have PPE, our skin and clothes are not 100 per cent covered," she said. "When that worker is transferred to a wing with negatives, the virus that is stuck on the care aid can accidentally, unintentionally be transferred to the negative one."

Residents' family members have asked Extendicare officials at virtual town halls about how staff were being deployed.

"Most of our staff have been cohorted to the different wings except when we need to shift them due to staffing shortages," senior administrator Jason Carson said on Nov. 25. "It does make it difficult at times to have everybody cohorted on the same wings on the same shifts at all times. We are trying hard but we're not 100 per cent on that." 

One week later, after residents had been shuffled between wings, the response was similar.

"We are, for the most part, trying to keep everybody who has worked with a positive resident working on north [wing]," Carson said. "Because of the amount of staff that has been put off due to positive results or self isolating … we are still managing the wings and moving people to where we have to make the care safe for everybody."

The male worker said the notion that staff were being properly cohorted in different wings is "completely false."

"At this point it's too late to really do anything about it. I think this infection is just going to have to burn itself out," he said. 

'Heightened' PPE use at Parkside

The male worker said a report about the outbreak is needed, because "people are going to demand to know how this happened."

On Tuesday, a Saskatchewan Health Authority spokesperson, also speaking on behalf of Extendicare, said there are many factors that might have contributed to Parkside's "exceptionally high" rate of transmission, including "PPE practices, ventilation and building infrastructure as an example. As a response, we heightened our measure for N95 [mask] usage."

It was not clear exactly when the change in mask usage began. 

Tracy Zambory, the president of the Saskatchewan Union of Nurses, said staff were being refused a proper supply of PPE as recently as a few days ago.

"They were told to wear the same personal protective equipment from the start of the shift to the end of the shift," Zambory said. 

It was a complete disaster. [Staff] are doing the best they can. They required leadership and they didn't have any.-Tracy Zambory, Saskatchewan Union of Nurses

The union, and residents' families, have asked about the HVAC system at Parkside. The 2019 inspection found that "the facility is old and in need of replacement due to pending infrastructure and large system (HVAC) failures."

Extendicare officials said the company had no concerns with the ventilation system, that it was regularly maintained and that filters were changed monthly. 

Call for public inquiry

The nurses' union is calling for a public inquiry into the outbreak — one that will produce new rules applying to private homes too.

"It was a complete disaster," Zambory said of Extendicare's handling of the outbreak. "[Staff] are doing the best they can. They required leadership and they didn't have any."

The Ministry of Health did not indicate whether it would support or commit to an inquiry.

"Our focus is on the safety and well-being of residents at all long-term care and personal care homes," the ministry said in an emailed statement Wednesday. 

The ministry said the health authority has also helped Extendicare by moving more residents out of the home.

Extendicare confirmed to families earlier this week that 12 COVID-negative or recovered residents are being transferred to Broadview Union Hospital, located about 150 kilometres east of Regina. 

"Our focus at this time is solely with our residents, families and staff, until COVID-19 is no longer a threat," Extendicare spokesperson Laura Gallant said. "However, we welcome the renewed urgency and focus on the systemic issues facing long-term care and our hope is that this pandemic prompts the long-needed change our residents deserve."

Outbreaks 'a tremendous tragedy': top doc

The health authority spokesperson said Tuesday that care homes reported monthly to the SHA on their pandemic readiness, and on PPE and human resources needs.

The health authority provided Parkside with rapid test kits on Dec. 10, the spokesperson added.

Extendicare had called on the province to help provide for regular and mandatory testing of staff a week after the outbreak was declared. Staff are "encouraged" to take part in the rapid testing, according to an update Extendicare provided to families on Tuesday. 

Parkside is a private home that is monitored and licensed by the province. The health authority will oversee the facility until at least Jan. 15.

Neudorf, a former medical health officer in Saskatoon, said the SHA's current enhanced role at Parkside is not common. 

Saskatchewan NDP Leader Ryan Meili has called on the government to do more. He wants health officials to inspect every long-term care home that has been hit with a COVID-19 outbreak and make those results public.

As of Tuesday, the list of outbreak homes included 34 facilities, with Parkside far exceeding all other locations (including other Extendicare homes in Saskatoon and Moose Jaw) in number of infected residents. 

Meili also called for care homes to limit rooms to two residents.

Premier Scott Moe had hoped to relax restrictions in time to allow visits inside care homes at Christmas.

On Monday, Moe said the ban on visits (except for people seeing dying patients) would remain in place in the face of still-high daily case numbers province wide. 

Dr. Saqib Shahab, Saskatchewan's chief medical health officer, called the outbreaks in long-term care homes "a tremendous tragedy."

"It is devastating for the families. It is devastating for the care staff who in many cases are family and themselves are facing illness as well," he said.

"These are all factors that require us to be especially vigilant over the holiday season."

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