Damning report points to numerous problems in deadly Parkside COVID outbreak

Last winter, residents at Parkside Extendicare in Regina endured the deadliest COVID-19 outbreak a Saskatchewan care home has seen, where only four residents didn’t catch the virus, and 39 died.

A report from Saskatchewan’s Ombudsman looks into the details, day-by-day, of what happened before and during the outbreak. It found numerous problems from start to finish and is critical of all three parties involved – Extendicare, the Saskatchewan Health Authority (SHA), and the Ministry of Health.

“… This should not come as a surprise …”

Even before the outbreak started, there was one big problem at Parkside – it was still housing four people in a room. At the time of the outbreak, the long-term care home had 34 four-bed rooms.

“As early as March 2020, (health) authority and Extendicare officials were aware that Parkside would be in serious trouble if it were to have a major COVID-19 outbreak because so many of its
residents were crowded into 4-bed rooms,” read the report summary.

The report said, unequivocally, that ‘yes,’ conditions at Parkside impacted the transmission of COVID.

“But this should not come as a surprise. The Ministry, the (health) authority, and Extendicare have been aware of Parkside’s overcrowded rooms, crowded office area and break rooms, narrow hallways, and lack of adequate storage for over a decade,” said the summary.

“… One mask per shift …”

The ombudsman found errors on things from masking, to distancing, and even working while sick.

On Nov. 11, the first staff member showed symptoms but continued to work with residents for eight days. The employee said they were masked while working with residents but not when they were just around other staff.

That pattern continued with several staff members.

Extendicare said its policy was for staff to get their temperature taken, do a COVID screening and sign a form before starting their shift, and that staff with symptoms weren’t allowed to go inside.

But some staff said they weren’t screened, that there was just a sign on the door telling workers to do a self-assessment.

When the Ombudsman’s office asked for copies of the screening forms leading up to the outbreak, the company said those forms had been destroyed.

An on-site assessment done by the health authority on Dec. 2 found some staff reported being “harassed” if they stayed home sick.

The health authority recommended disposing of used masks frequently, meaning workers would be using about four a day, but that didn’t happen at Parkside. Instead, the report said staff were given one mask per shift with a paper bag to store it in during breaks.

The SHA made it clear to the home that workers needed to use four masks a day but didn’t try to actually enforce the policy because, with Extendicare being an independent operator, it didn’t believe it could.

There were also problems with masking residents. On Nov. 6 an order came down for residents to be masked unless they were in their private rooms. But the report said that neither Extendicare nor the health authority officials responsible for long-term care were aware of this change until late December.

“By the time the Authority and Extendicare realized Parkside had not been complying with the masking order, the Authority had already taken over Parkside, almost all of Parkside’s residents had contracted COVID-19, and many had already died,” explained the report summary.

 “… That was a mistake …”

The home was required to have a detailed pandemic plan, but it appears Parkside’s wasn’t good enough.

“Extendicare did not effectively ensure Parkside successfully implemented a facility-specific pandemic plan … or that it complied with the Ministry’s public health orders regarding physical distancing,” said the report summary.

The ombudsman said that, as late as October, the home hadn’t fully implemented key things, like a staff contingency plan, or infection prevention and control practices.

When the first several residents tested positive, the home left them in the main wing, which the report said was a mistake.

“Staff working with residents on other wings had to frequently travel through the main wing to get supplies, so Parkside could not keep staff working on the non-COVID-19 wings out of the COVID-19 wing,” said the report summary.

Eventually, the entire north wing of the home was converted to isolate COVID-positive residents, but the report said safety policies weren’t always followed when residents were moved. Some were moved several times.

In early December, 25 residents were moved from Parkside to an empty unit at Pioneer Village to help make more room. Twenty-four of those residents would eventually test positive for COVID, along with four Pioneer Village employees.

“Staffing crisis”

After positive cases started showing up, staffing became an issue as many workers had to isolate.

The health authority had entered into an agreement with unions to create a bigger labour pool, but because of where Extendicare falls under the SHA, it didn’t have access to it – something neither the Extendicare management nor some in the health authority knew.

That meant the home was left scrambling for workers, eventually getting help from continuing care assistant students from Saskatchewan Polytechnic.

“Had Extendicare planned for and arranged to have access to a temporary emergency replacement staffing team  … it would not have struggled as much as it did,” read the report summary.

On Dec. 8, Parkside entered into a co-management agreement for the health authority to come in and help. At that time there were 238 positive cases between residents and staff.

The outbreak was declared over Jan. 21 though the co-management agreement was extended into February.

“No recommendations … could ever adequately address the tragedy”

The ombudsman made recommendations for Extendicare and the health authority, but none for the Ministry of Health.

That’s because the ministry didn’t provide any direct oversight or support to Parkside during the pandemic or outbreak – despite having a critical role – the ombudsman said,

“The Ministry has a great deal of control over how and how well the system functions. We strongly encourage the Ministry to ensure that something like the Parkside outbreak does not happen again – to make meaningful and lasting systemic and structural improvements to Saskatchewan’s long-term care system,” read the report summary.

Four recommendations were made to the Extendicare company including finally conducting the required critical incident review, develop processes and put resources on-site to make sure staff comply with policies and procedures.

The ombudsman also recommended that Extendicare send a formal, written apology to the families of everyone who died in the outbreak and all the residents who had to live through it.

“There are no recommendations an Ombudsman can make that could ever adequately address the tragedy that happened at Parkside or provide the basis for a public policy debate over how long-term care should be structured or funded. We do believe, however, that apologizing to its residents and their families is the least Extendicare could do,” read the report summary.

When it comes to the Saskatchewan Health Authority, the report said it gave Parkside reasonable support, but there were places where oversight was lacking. There were four recommendations made for the SHA, including that it end four-bed resident rooms, create an annual review of care homes and report on whether they’re following standards and practices, and that it ensures standards and practices are consistently applied.

The Ombudsman also recommended the authority update its standard agreement to require that service providers comply with care-related policies, standards and practices

“When we asked, the Authority rejected the idea that it was or should be responsible for evaluating Extendicare’s (or any operator’s) policies and procedures to ensure they comply or are compatible with the Authority’s policies, procedures, standards and practices,” read the report. “It said that the Authority does not have the resources to conduct such reviews, and, from a liability perspective, each operator needs to do its own due diligence to ensure it is meeting the threshold for compliance.”

The Parkside outbreak remains the worst Saskatchewan has seen in a care home, with 194 residents and 132 staff contracting the virus. Forty-two residents who tested positive died, but three died from something other than COVID-19, putting the death toll from the outbreak at 39.