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B.C.'s COVID response in long-term care lacked coordination, centralized oversight: report

Lack of centralized oversight a major hurdle for the province, according to the report
The October 2020 report by Ernst & Young pointed to the lack of centralized oversight as a major hurdle facing the province, highlighting a number of areas that B.C. should improve on in terms of governance, policy and operations in long-term care.

A report on B.C.’s response to the deadly COVID pandemic in the long-term care sector showed the province had a number of “operational challenges” that hampered officials in fighting the spread of the virus.

The Ernst & Young report completed at the behest of the B.C. Ministry of Health and containing the interview results from more than 40 stakeholders (including health authorities, the BC Centre of Disease Control, seniors’ associations, care homes and front-line workers unions) found that while policy and guidelines were quickly formed, carrying out these measures ran into logistical realities that hurt the effort to limit the pandemic in long-term care homes.

“There was general acceptance that there were gaps in Infection Prevention and Control [IPC] and emergency preparedness, including inconsistent application of clinical standards and use of PPE, as well as the availability of PPE supplies,” the report found. “Health authorities also varied in their interpretation and implementation of operational orders and policies, which led to differences in practice in areas such as the process for decanting and/or isolating residents that tested positive.”

Outbreaks at long-term care homes played a key role in the spread of COVID-19 in B.C. starting at a North Vancouver facility in March, and to-date has accounted for the majority of the 1,128 COVID-related deaths in the province, health officials said.

In the report, Ernst & Young pointed to the lack of centralized oversight as a major hurdle facing the province, highlighting a number of areas that B.C. should improve on in terms of governance, policy and operations in long-term care.

In particular, the agency created by the province to respond to COVID-19 in early 2020 which was meant to facilitate communication and coordination between different parties fighting the pandemic was sometimes making decisions “in silos” within the agency structure, the report said.

“The Health Emergency Coordination Centre [HECC] could have been better integrated into provincial decision-making and accountability frameworks, resulting in decisions being better coordinated, and addressing the decision-making powers and accountabilities of the HECC,” the report said.

“The decision-making powers of the HECC were not explicitly defined and the accountabilities and responsibilities were sometimes unclear, which lead to
confusion around who was authorized to make key decisions, including direction to [health authorities] to enter into commitments to use funds specifically around additional PPE.”

On Monday, the province said it has already released its fall/winter plan for COVID-19 management, adding that the Ministry of Health introduced streamlined pandemic response through a new agency (CRHEM) to replace the embattled HECC.

The province is also stepping up efforts to get a better idea of what’s happening on the ground in the front lines of B.C. long-term care homes with regards to COVID, officials said.

“Starting in late-November, [COVID-19 operational] leads began to meet daily with the Ministry... to enhance coordination, collaboration, and data-sharing to strengthen decision-making, communication with the LTC sector,” the province said in a statement. “The Ministry is using a weekly check-in with industry associations as a vehicle for increased communication, coordination, and policy discussions.”

That increased connection between top-level decision-makers and on-the-ground front line workers will be crucial, since the Ernst & Young report found that the lack of such a connection played a key role in hampering the effectiveness of B.C.’s COVID response at long-term care homes.

The report also noted that the “oversight, management, and support available to providers depended on whether a facility was health Authority owned and operated or operated by a private or not-for-profit provider.” 

“Policy challenges were communicated to contracted and private care providers through different means, and private operators reported feeling they were given less implementation support,” the report said. “The above was made more difficult by the Ministry and Health Authorities having limited visibility into operations, and challenges in collecting some human resource and financial data.”

According to the report, there were also complaints from stakeholders that there was some confusion over who had the primary authority when orders from the Ministry of Health and local authorities conflicted with one another and that conflicts arose because guidelines and directions “didn't always consider operational constraints.”

“The rationale for collecting personal health and other data was not well understood and contributed to a perception of the ministry's lack of trust in operator's ability to report outbreaks,” the report said. “Real time supply chain data was not readily available, leading to reduced oversight and inefficient management of supplies.”

Provincial officials noted all of those items have begun to be addressed, including a new data-reporting structure and a centralize supply chain coordination system for items such as PPEs.

“The Ministry had begun work on several new data reporting structures to assist with both short-term and long-term collection of health human resource and financial data to better inform policy directives,” the provincial statement said. “These actions align with issues identified in the report.”

The province added that B.C.’s COVID response as resulted in lower infection and mortality rates when compared to places like Ontario, Quebec and Alberta.

The October report did find some strengths in the province’s response, including “a united and consistent presence” by B.C. Health Minister Adrian Dix and Provincial Health Officer Bonnie Henry in the public which contributed to people following public health orders in larger numbers.

Ernst & Young also found that a significant part of the problems that arose came from the fact that government mobilized emergency response mechanism so quickly across sectors, and issues emerged when these mechanisms again contradicted with real-life challenges such as an existing strain in the long-term care labour force.

“Early implementation of workforce-related policies, including the single site order and wage levelling policy had a significant and positive impact on reducing the overall spread of infection,” the report said. “However, the strain placed on the long-term care system by COVID-19 highlighted pre-existing human health resource shortages. 

“Operational staff and front-line workers also felt the psychosocial burden of working across the sector responding to the emergency, expressing concerns about their personal safety and their ability to effectively care for residents.”

The full report can be read on the province's website