Cracks to Chasms: How and why tragedy hit Alberta's long-term care homes

This is part four of a four-part series. Part 4 examines trends in COVID-19 outbreaks in Edmonton care homes. Since January, more than 700 older adults and family members helped shape our coverage of Seniors and COVID-19 through Groundwork, an Edmonton Journal pilot project in engagement journalism.

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It’s the helplessness of the victims that gets to Heather McKeown.

One year ago Friday, her mother Wendy became the first of hundreds of long-term care residents to die when Alberta’s facility lockdowns, masks and quarantines failed to protect them from a new coronavirus sweeping the globe.

“That’s where the rage comes from, whether it’s warranted or not,” said Heather, still grieving, bewildered and quick to tears. “She didn’t go out and get it. My mom was not mobile. Somebody brought it to her, 100%, no question. It was brought to her and it killed her.

“Then, of course, it spread. … I’m at the anger stage and I’ve been stuck at that for a long time.”

It was a long year.

By the time the first and second waves finally receded the death toll from outbreaks in long-term and other continuing care facilities stood at 1,238 residents. Six health care staff also died. According to a Postmedia analysis, Alberta had 36 facilities that were on outbreak for longer than three months, and that’s despite Premier Jason Kenney’s May 2020 commitment to focus Alberta’s efforts on protecting the most vulnerable “in the strongest and most discreet ways possible.”

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Heather is not the only one who is angry.

The death toll and long periods of enforced isolation were a shock to those both inside and outside the facilities. But why it happened, and how the virus managed to so quickly overwhelm Alberta’s defences — those answers are only just becoming clear.



The first wave was marked by confusion as the continuing care system scrambled to keep up with a virus that looked, acted and spread in unexpected ways. In the second wave, defences were simply overwhelmed. A wildfire raged outside the walls with sparks falling in dozens of places at once. Alberta Health was caught under-prepared for the intensity of the blaze.

Today, families are left with a complex grief. Continuing care staff are traumatized and medical leaders wonder if the political will exists to ensure it never happens again.

When we launched Groundwork II: Seniors & COVID-19 — an Edmonton Journal pilot project in engagement journalism — we heard a call for accountability. Families and friends wanted to understand what really happened behind the locked doors.

Here’s the story as we know it so far.

Wave 1: A steep learning curve

In many ways, Wendy McKeown’s story was typical for wave one, both in the loneliness of her death and how quickly it happened.

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She was a former Edmonton Journal customer service representative and a huge Oilers fan, an usher at Rexall Place whose “super power” was evident in the way she connected with strangers, said her daughter Heather. Her whole section knew her.

Wendy McKeown
Wendy McKeown sent this photo of herself and her grandson to the Edmonton Journal in 2013 for its Show Us Your 99 project, part of Gretzky anniversary. Supplied

But she also suffered from depression and bipolar disorder. Possibly because of the treatments she received for that, she found herself with symptoms that looked like early-onset dementia. She was 73, living in long-term care at Shepherd’s Care Kensington when the pandemic hit.

At first, Heather said she was not concerned. Then a COVID-19 case was discovered on the independent living side of her mom’s facility. Still, Heather said, “we felt pretty confident. These are trained professionals; they’re wearing PPE.”

Even when Wendy got sick, the signs were confusing. Staff called on a Tuesday evening to say she was lethargic with a slight fever. But they called again Wednesday to say not to worry. There were still no test results, but she was eating breakfast. She seemed fine.

It wasn’t until Thursday at 4:30 a.m. that staff called to say they found her unresponsive. The positive COVID-19 test result came as she was en route to the hospital. Then a doctor from the Royal Alexandra Hospital called.

“He said: ‘We just got your mom. It’s dire. She cannot be saved. We expect her to pass probably within the hour. If you want to come and see her, you need to come now,’” she said.

But Heather has asthma. She said to the doctor: “‘I’m really scared. What do you think I should do?’ Then he started crying. He completely broke down. That’s when I knew how bad it was for them, on their side.”

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The doctor recommended both she and her brother stay away. Wendy hung on until 11 a.m., when she died with a nurse holding her hand. That was April 23.

‘People just didn’t know they were sick’

The biggest challenge in wave one for Alberta Health Services (AHS) was simply trying to track and understand the new virus, said Dr. Doug Faulder, Alberta Health Services medical director for continuing care in the Edmonton Zone.

The first positive case was identified in Alberta on March 5. The first person to die in a long-term care outbreak was March 24, when a woman in her 80s died at McKenzie Towne Continuing Care Centre in Calgary, a private facility run by Revera where the virus spread quickly.

By that time, China had already released the DNA sequence for the novel coronavirus and the symptoms were well-known, or so it seemed. But it surprised doctors and staff when it appeared in seniors. Faulder organized a webinar with Calgary physicians to find out what caught them off guard.

“They were finding long-term care residents with COVID were presenting with atypical things — all of the sudden they were sick, or inactive, or just didn’t eat their breakfast that morning, or they had a fall when they never had a fall before,” he said.

“They realized that all of these other things were how they were presenting with COVID.”

Asymptomatic spread magnified the impact. Alberta Health Services is used to handling outbreaks. It’s normal to do widespread testing in any outbreak to make sure all cases are caught. But with COVID-19, doctors would identify one case, then test those who lived or worked nearby and case numbers would just explode.

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“Either they were positive and it wasn’t even recognized, or they didn’t have any issue at all, or the issues they had were so subtle. Often they went on to more obvious illness within a couple days,” Faulder said. “We were seeing how quickly it could spread because people just didn’t know they were sick. It was coming into the facility with staff but not to blame them. They didn’t feel sick, they didn’t know they were sick and yet they were able to spread it.”

Doctors were also learning about how to treat older, frail patients, which usually meant just keeping them hydrated and sometimes offering oxygen. Both of those could be done in care homes. There was a push to update patient’s care plans to confirm with family if they wanted them transferred to hospital if they got sick.

In normal times, that’s one measure used to gauge a well-run home, said Faulder, because it demonstrates if staff are able to manage residents’ needs and support them to a good death in familiar surroundings. The median length of stay in long-term care homes just prior to COVID-19 was one year, since only the most complex cases are admitted for these scarce beds.

AHS statistics show transfers to hospital from long-term care dropped 20 per cent last year in Edmonton; 79 per cent of residents died in their care home.

By the numbers, 17 per cent of long-term care homes in Alberta had an outbreak during the first wave. Those outbreaks had an average of 17 resident cases, 12 cases among staff and five resident deaths. Thirty per cent of long-term care residents who tested positive for COVID-19 during that time died.

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The learning curve was steep in many areas. As deaths and infections climbed, it became obvious that face masks were critical to controlling spread. But most continuing care homes didn’t have more than three days supply. Alberta made masks mandatory for continuing care and supplied the masks in mid April.

The effect was dramatic. Revera is a private chain that operates 170 homes across Canada including nine in or around Edmonton. Nationally, 873 of their residents got the disease during the first wave, but 97 per cent of those were linked to outbreaks that started before staff wore masks.

The lack of tests also hampered that early response, especially where long-term care did not get priority access. Until late spring, when testing of staff and residents became widespread, most outbreaks were discovered first in residents even though staff were the ones inadvertently bringing the virus through the doors.

Summer 2020: A time of preparation

Alberta came through the first wave better than the larger Canadian provinces, to the point where it gave masks and ventilators away and Kenney boasted about the effectiveness of Alberta’s approach to balancing restrictions and the economy.

The long-term care sector studied the first wave outbreaks. Officials found ventilation in old buildings had been one issue but it’s not clear how much of that was fixed between outbreaks.

“In some sites that has been remediated; in some sites it has not yet been remediated,” said Dr. James Silvius, provincial medical director for seniors care, speaking to family members during a town hall this month. 

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When contacted later, AHS communications would not say how many or which buildings are still operating with problematic ventilation.

Staff education was also a challenge, with spread in some outbreaks tracked back to employees letting their guard down in the break room, said Dr. Chris Sikora, medical officer of health for the Edmonton Zone, in an interview.

Unlike in acute care settings, long-term and home care employees have little experience with masks, face shields and gowns. So Alberta Health Services ran a series of audits and an education campaign for staff, emphasizing the risk and proper donning/doffing techniques.

That unified support helped, according to facility operators. Unlike B.C. and Ontario, Alberta has one health authority. That meant orders were consistent, and there was an expectation that AHS medical staff would help in an outbreak.

But it wasn’t enough.

There’s a long-standing tendency for geriatric issues to get less attention than acute care; some call that ageism. There’s been report after report highlighting the under-funding and lack of support for long-term care, said Dr. Faulder.

“It was not a mystery what needs to be done. This is my personal view, but there’s a systemic bias,” he said. “The cracks that we knew were there were turned into chasms with the stress of COVID.”

Douglas Twigge was living in a long-term care home before he died during the second wave of the COVID-19 pandemic in Edmonton, Alberta. Photo supplied by Faye Macyk.
Douglas Twigge was living in a long-term care home before he died during the second wave of the COVID-19 pandemic in Edmonton, Alberta. Photo supplied by Faye Macyk.

Wave 2: Defences overwhelmed

Douglas Twigge, an 86-year-old retired farmer from Andrew, Alta., rode out the first wave at home, living in an Edmonton condo in the same building as his daughter Faye Macyk. But he fell in May, broke his arm and his dementia took a turn for the worse. He was in McConnell Place North when the second wave hit last fall.

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For Macyk, the chaos of those days makes the grief harder.

She barely saw her dad in the month before he died because one of her co-workers tested positive and Macyk had to self-isolate. So in early December, the call saying her dad was hallucinating and running a fever came out of the blue. Staff sent him to hospital thinking it was a urinary tract infection.

But it wasn’t that. Twigge was tested for COVID-19 on arrival and three days later, it came back positive. That night, he took a turn for the worse. He was put on oxygen. When he tried to pull the oxygen mask off because it was painful, staff restrained him.

“I said, ‘You know what, just let him go. How are you restraining a dying man?’” Macyk said. “That’s what happened and it didn’t take long. It’s just an awful, awful thing.”

The next day, in grief and anger, she called McConnell Place to ask how Twigge had contracted COVID-19. Staff didn’t even know he tested positive. No one from the hospital had called to tell them. Macyk was dumbfounded.

“My dad had it. He caught it there. So in four days, whoever gave it to him, where did they go? In four days, they could have infected how many more people? I was just beside myself how no one phoned McConnell Place.”

Faye Macyk’s father Douglas Twigge died alone after contracting COVID-19 in a long-term care home in December. Taken on Monday, April 12, 2021 in Edmonton.
Faye Macyk’s father Douglas Twigge died alone after contracting COVID-19 in a long-term care home in December. Taken on Monday, April 12, 2021 in Edmonton. Photo by Greg Southam /Postmedia

In wave two, provincial contact tracing efforts fell apart.

Schools, businesses and individual citizens were forced to take on their own contact tracing when case numbers grew too fast, and in care facilities that meant situations like Macyk experienced. But also, it meant staff exposed from family, at a restaurant or a separate workplace in the community had no idea. They had no warning.

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Alberta’s experience is classic. Multiple research studies have found the biggest predictor of whether a care facility will have an outbreak or not is the amount of COVID-19 in the surrounding community.

In September, there were nine new outbreaks, roughly equivalent to the number at the height of wave one. By October, 27 more facilities declared a new outbreak. In November, 60 more clocked in, and that’s just counting outbreaks that lead to at least one death.

About half of the outbreaks were small, with one or two deaths. Many others had dozens of fatalities and lasted for months. Only when homes got access to vaccines and rapid test strips did they see the numbers come down. Between September and February, 1,162 residents of long-term care and other seniors-living homes had died, seven times as many as during the first wave.

Dr. Sikora, who is also a long-term care doctor, remembers AHS trying to recruit staff for more rapid response teams in October, as the virus was surging. An experienced AHS nurse normally leads each response team, working with facilities on outbreak to organize testing, identify risks and makes sure nothing gets overlooked. But as they tried to create more teams, the fire was spreading.

Soon these AHS teams were supporting multiple facilities on outbreak at once.

Likewise, with COVID-19 tests. The provincial lab was trying to ramp up capacity. But at times, it took up to five days to get results back, which meant cases could be missed.

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Dr. Chris Sikora Medical Officer of Health, Edmonton Zone.
Dr. Chris Sikora Medical Officer of Health, Edmonton Zone. Photo by Ian Kucerak /Postmedia

As more staff had to self-isolate, sites were running out of workers. By mid-November, 25 sites had been granted permission to let staff travel from site to site, even though that increased infection risk. According to the union, staff also ran out of vacation and sick pay, since many employers no longer allowed them to claim time off specifically from COVID exposure during the second wave.

That was part of the financial pressure to keep working, according to a survey of 2,053 health care workers by the Alberta Union of Provincial Employees last month.

Forty per cent lost income during the pandemic, with many falling behind on rent or mortgage payments. They had been promised extra hours when the single site rule came in, but 77 per cent of those subject to the restrictions told the union they had not been given the hours expected.

The situation also led to intense, localized staffing shortage, said union executive Susan Slade. “Some places, almost their whole staff was gone.”

The bad months: behind locked doors

Inside the facilities on outbreak, it was hectic, traumatic, exhausting.

“It looked like a critical care unit. So many people, it was mind-blowing,” said Kelley Deguerre, director of nursing at the privately-owned Benevolence Care Centre, which saw its first resident test positive in mid-December.

Within one week, they went from zero positives to more than a dozen and needed help. They called in a nursing agency to replace all the staff who had to self-isolate from exposure, then extra nurses to do assessments on new COVID-19-positive patients. They needed still more staff to put in place all the physicians’ orders, such as giving hypodermoclysis, one ounce of the isotonic solution an hour, given just under the skin, to keep frail residents hydrated.

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AHS staff helped, swabbing everyone repeatedly. The facility operator hired extra janitors to do round-the-clock cleaning, quadrupled their recreation therapy staff to reduce resident anxiety, and hired security to keep everyone in their rooms. Security also emptied garbage cans of single-use masks, gowns and gloves every 45 minutes to keep them from overflowing.

Benevolence had 34 cases among residents: 23 recovered, 11 died. The outbreak ended Feb. 14.

Other facilities saw outbreaks drag on. Extendicare Eaux Claires, a private facility built in 2011, was on outbreak for the longest period of time in the Edmonton area — roughly 26 weeks (6.5 months). That’s calculated by counting the number of weeks they were listed at Alberta.ca. It’s a long-term care facility with 204 beds in private rooms. They had three outbreaks with 84 cases and 10 deaths.

The non-profit Good Samaritan Southgate was second longest: three outbreaks for 25 weeks and a total 230 cases, 50 deaths. The facility has shared rooms in an old building, plus a significant number of dementia patients who tend to find it difficult to understand the need to isolate. All three of those are well-established risk factors for spread.

The facility has since changed the smallest rooms to single-occupancy and are hoping to eventually build a new facility, said executive director Katherine Chubbs. They also rehired kitchen staff as comfort care aides to boost resources at the bedside.

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Early research from Ontario suggested ownership structure was a risk factor for bad outbreaks, with private for-profit chain-operators being the worst. But when data from the second wave was added, ownership models didn’t seem to have made a significant difference. The major risk continued to be from large, old buildings with shared rooms and bathrooms.

It’s not yet clear what role staffing shortages played.

One local facility manager, who spoke on the condition of anonymity because he was not authorized to speak with the media, recalled sleeping nights at the office and calling off-duty paramedics, anyone who could help exhausted staff. They didn’t have security guards to keep COVID-19 positive dementia patients in their rooms. He even tried calling police, he said, but they didn’t respond.

Benevolence Care Centre recreation therapist Kateline Hladky helped create a memory wall of residents who died during a recent COVID-19 outbreak, which included personal items staff packed up in their rooms. Here Hladky holds a collector train that belonged to Brian Vollrath.
Benevolence Care Centre recreation therapist Kateline Hladky helped create a memory wall of residents who died during a recent COVID-19 outbreak, which included personal items staff packed up in their rooms. Here Hladky holds a collector train that belonged to Brian Vollrath. Photo by Ed Kaiser /Postmedia

Recovery: the science and the grief

It’s hard to know whether or not long-term care and other supportive living facilities are entirely out of the woods.

Residents have all been offered at least one dose of the Moderna COVID-19 vaccine, 90 per cent accepted and many staff are vaccinated, too. So far it’s been effective against the surging variants; it’s unclear whether that will continue but whether or not the virus has left the long-term care scene, a lot of damage remains.

A COVID-19 outbreak in a long-term care home is a classic case of the type of stress that’s most harmful to the human brain. It’s unpredictable, prolonged and urgent. The human brain is resilient but few people can easily bounce back from that combination. It puts the nervous system in overdrive, which floods the body with stress hormones and interrupts sleep and mood regulation.

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“Your survival brain is putting out a lot of chemicals,” said Carole Marriott, whose job it is to keep as many of CapitalCare’s front-line workers as healthy as possible.

For many people, that’s what the next phase of recovering from COVID-19 needs to focus on: mental health. Facility operators are trying to pull back, grieve the many losses, remember and take care of their staff. They’re setting up memorial walls, talking about the trauma.

Marriott was at Lynnwood during the outbreak, the public facility where 62 residents died. They’re planting a tree in the atrium in honour of those those lost, and creating a memory wall on wheels to move between floors since staff and residents are still not allowed out of their smaller cohorts.

Each week, she was sent to the worst outbreaks, where she called staff into a huddle and gave bite-sized mental health tips. She led two-minute grounding exercises and offered breathing techniques — anything to help them cope and stay in the moment.

The grief people feel is complex. Part of it is linked to something researchers call “moral injury,” which is stress arising from inner conflict, such when staff were required to police families even when they saw the damage isolation was doing to residents. It was also the sheer number of people dying, and how they died.

“Normally, you’re not dealing with seven or eight deaths in one day. And they died alone. (Staff) were just devastated that these people had nobody there at the end of their lives,” said Rhea Coughlan, a health care aide and chair of Local 049 with AUPE.

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“I’d come home crying,” said Kateline Hladky, a recreation therapist at Benevolence. “One of the thank-you cards inside (the lobby) is from a family where I did three end-of-life Zoom calls in a day so they could all say good-bye to their loved one without coming in.”

“It wasn’t easy, that’s for sure. But the summer, the warm weather, being allowed to garden with our residents and having them come out of their rooms again,” she said. “It’s finally lifting.”

estolte@postmedia.com

twitter.com/estolte

— With files from Lauren Boothby


This article is part of Groundwork, an Edmonton Journal pilot project in engagement journalism that saw more than 700 seniors, caregivers and family members contribute through surveys and emails this winter to help shape our coverage. This was meant to ensure our reporting was focused on issues that matter most to our community, building trust and opening the work of journalism to new voices and insight.

Read more at edmontonjournal.com/groundwork and help us evaluate the project. Our final series on COVID-19 and continuing care runs Tuesday through Friday this week. As a final event, join us live for a Q&A at noon May 4.

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