FREDERICTON — New Brunswick nursing homes that reported high COVID-19 rates lacked staff and infection-control measures, and did not learn lessons from the 2009 H1N1 influenza pandemic, says a report by the province's auditor general.
Care homes did not have up-to-date pandemic plans, and the Department of Social Development wasn't able to properly enforce health and safety regulations, Paul Martin concluded in the first volume of his performance audit tabled at the legislative assembly Thursday.
"We want to ensure we learn from this," Martin told reporters after he presented his report. "We have to take those lessons learned and update those plans, be prepared to test them, be ready should another (pandemic) occur."
Martin's audit found that New Brunswick's pandemic plans were not updated with recommendations from the provincial government's 2009 report on the H1N1 crisis. Recommendations included that government ensure nursing homes have sufficient staff and that they are inspected regularly.
The Department of Social Development was aware of systemic issues facing nursing homes well before COVID-19, Martin said, adding that the province did not provide care homes with additional funding to prepare for the possibility of a pandemic.
Of the 358 people in New Brunswick who lost their lives to the COVID-19 pandemic as of March 31, 2022, 90 were nursing home residents and one was a staff member.
Martin said the New Brunswick government needs to take his report seriously.
"Many of the matters in there were issues that existed before COVID-19 and were magnified because of the pandemic. I would hope they'll be able to work through some of these matters .... We need some of those bright, strong-minded people in New Brunswick to come to the table and help us fix these problems."
The auditor general reviewed inspection results for a sample of 30 nursing homes and noted the percentage of facilities that did not comply with "appropriate care staff ratios" rose to 87 per cent from 30 per cent between 2018 and 2022. The percentage of care homes that did not have a full-time registered nurse "all at times" rose to 40 per cent from 10 per cent over the same period.
As well, the province failed to properly enforce infection prevention and control rules at the care facilities, the report said.
The federal government recommends that provinces employ one infection and control inspector per 150 to 200 beds, but the report said the province had hired two specialists for the entire province.
"According to the (Department of Social Development), the specialists made efforts to work with each home in outbreak, but with the number of nursing homes experiencing outbreaks they were unable to visit every home in person."
Martin said that inspectors had few mechanisms to enforce the rules. They could modify a nursing home licence or revoke it, or place the care home into trusteeship. But he said the province was reluctant to revoke licences during the pandemic because of the potential harm to residents.
And modifying licences — the primary enforcement mechanism — has not proven effective, the report said. "Several nursing homes operate under a modified licence," it said.
"While nursing home inspection reports are available on the departmental website, the status of the home’s licence is not. This is important information for residents and their families to assist in their decision-making processes."
Martin also noted in his report that employees at the Department of Social Development reported that the risk of contamination was high because infection control rules weren't being followed and staff lacked training on how to use personal protective equipment.
Robert Gauvin, the Liberal Opposition critic for social development, said it was concerning that lessons from H1N1 were forgotten. He said he hoped the government implements the recommendations from Thursday's report, including increasing wages to recruit and retain more staff.
"We need to retain people who work in nursing homes," Gauvin said. "To me it will always come down to this. We are an aging population, a quarter of people are now or close to over 65 years old. So we will need more people to work in these fields."
Green Leader David Coon said the government can use the budget surplus it has accrued to address staffing issues and upgrade nursing homes.
"Ensure that the infrastructure itself is more effective at resisting the transmission of viruses," he said.
Coon said he was "quite upset" the auditor only looked at roughly half the long-term care sector in his report.
"He really missed the opportunity to produce a report that, in the end, needs to be of a quality and of comprehensiveness to enable us to ensure that we're better prepared for the variant that might come along that's COVID, that's going to be particularly problematic, or a new novel virus," he said.
"That's what concerns me because in the end this is all about being better prepared for what we may face in the future. And this report doesn't do that."
Martin says he will table volume two of his 2023 performance audit in December.
This report by The Canadian Press was first published Sept. 7, 2023.
Hina Alam, The Canadian Press