‘Everyone knew this could happen:’ The deadly spread of COVID-19 through Canada’s seniors’ homes

Through the camera on the dresser in the Calgary nursing home, Nina Vaughan watches her father survive.

He'll turn 82 next week, but right now he's barely hanging on, at least emotionally, after spending weeks alone in his room. From the emptiness of his face, Nina can see he's turning inward, growing detached.

Lorne Vaughan has COVID-19. He lives in McKenzie Towne, where 21 fellow residents, including his sister-in-law, Doreen Gauvreau, have died of COVID-related conditions. Another 60 people, the same number that jam inside a TTC bus during rush hour, have tested positive for the virus.

Given the number of deaths at Toronto's Eatonville Care Centre, reporting 27 as of Tuesday, Bobcaygeon's Pinecrest with 29, or the 31 at Quebec's Ri(C)sidence Herron, odds are that a lot more will die in Vaughan's home, too.

Across Canada, seniors homes have become the epicentres for the COVID-19 pandemic. People who were teachers, soldiers, plumbers, professors are dying en masse. Many are fragile, living in a long-term-care or retirement home system that runs on low-paid, part-time staff who are forced to work in multiple homes to make a full-time salary. That is how a virus can spread.

"Everyone knew this could happen," said Doris Grinspun, president and CEO of the Registered Nurses' Association of Ontario. "It's like somebody sat in a room and said, 'This is a population we can live without.'"

Now that Nina can't visit her father, she keeps an eye on him through the camera linked to an app on her cellphone, installed with the home's permission when he moved in. There's a sign on the door informing staff his room is under surveillance.

Nina's father has Parkinson's disease, and she doesn't know if he understands why his wife no longer visits every day. Last month, when McKenzie Towne struggled with the loss of workers who were sent home to isolate, she watched him through the camera. Sick from the virus, sometimes he slept. Mostly, he sat alone, staring at the wall.

Forty-one workers from McKenzie Towne have tested positive for COVID. Revera Living, which owns McKenzie Towne, said it is now fully staffed after regional and national teams brought 37 new workers to the home. "We are singularly focused on doing everything we can to contain this outbreak," said a statement attributed to Dr. Rhonda Collins, Revera's chief medical officer. "Our hearts go out to the families of the residents who have passed away because of the pandemic."

Before the recruits arrived, Nina took her complaints to Alberta NDP Leader Rachel Notley, who detailed the Vaughan family's concerns in a virtual press conference. On April 7, Notley told the Alberta legislature that the outbreak left the home without "enough staff to help him move to a bathroom, so he's left to soil himself."

Nina doesn't blame the workers. A retired Calgary police superintendent, she could see they were kind to her father when they had time to come in and feed him. Now, she worries about his mental health as much as the coronavirus, watching him decline after weeks alone.

"He sits in his room all day and stares at his TV. There were days when I had to phone and say, 'For the love of God can somebody please turn the TV on so he has something to stare at?'"

As homes are overwhelmed with infections and deaths, health-care and seniors' advocates are calling for sweeping change.

York University professor Pat Armstrong wants long-term care to move from provincial control to the Canada Health Act, the federal legislation for public health care.

With national care priorities defined in legislation, Armstrong said federal money for nursing homes could require proof of improvement in a system that has long been underfunded and staffed by part-time workers.

"I think (governments) have got to realize that long-term care needs to be an integral part of the health-care system," said Armstrong, known for her research into long-term care.

"They need to be doing the same thing (in nursing homes) as they are doing in hospitals. That means we need a new piece of national legislation, a national long-term-care act," Armstrong said.

In Canada, each province has had a unique response to desperate families and staff.

Late last week, British Columbia moved to limit the spread of infections by mandating that staff who hold multiple part-time jobs work in only one location. The province provided funding to augment lost wages.

Notley, the Alberta NDP leader, asked the government April 2 to implement similar one-site rules. Last week, Alberta confirmed the employment change, saying it is "considering financial supports" for affected workers. Until Ontario announced its one-site rule Tuesday, the province had offered little more than a recommendation that employees work at one location. Some homes, struggling for staff, were still accepting workers juggling multiple jobs.

With the push for one location resolved in some provinces, advocates are still pressing for better reporting of COVID-related deaths. Right now, it's hit-and-miss.

Quality data is key to prevention, said Dr. Samir Sinha, director of geriatrics for Sinai Health System in Toronto. His staff have been trying to cobble together details of outbreaks and deaths in Ontario's 630 long-term-care and 775 retirement homes.

"It's important so we can have an accurate picture on how the situation is unfolding," Sinha said.

"If we don't understand these things or have the level of knowledge we need, we are likely to repeat mistakes when we have the next pandemic and make assumptions on data that was not correct."

Early in the pandemic, some homes stopped testing after three residents tested positive for COVID, said Laura Tamblyn Watts, CEO of CanAge, a national seniors advocacy group. The rest were considered presumptive cases, and it is not clear if all those deaths have been included in official counts, Tamblyn Watts said. A government spokesperson said there is no formal requirement for homes to report residents with presumptive COVID to the Ministry of Long-Term Care.

"The degree of the statistical shell game going on right now, in terms of infections and deaths, is unprecedented," Tamblyn Watts said.

Bad data is one problem. Just as offensive, said Grinspun of the nurses association, are government leaders who refer to the COVID-related deaths of older people as if they are numbers on a spreadsheet.

"In B.C., (provincial health officer) Dr. Bonnie Henry says 'we lost' these people. It is such a human approach. In Ontario, they call them 'cases,'" Grinspun said.

Calgary's Lorne Vaughan is not a number. He served in the Canadian military for 36 years, retiring as a captain. His daughter, Nina, called him a perennial joker, bringing life to every party, a man who loved the game of curling and was particularly proud of the time his team shot a perfect end. There's a picture of Vaughan and his teammates, with all eight rocks, on the wall of his nursing home room.

After his Parkinson's progressed, Vaughan moved into McKenzie Towne, along with his wife's twin sister, Doreen, a master quilter, and her husband, Syl, one of the home's first residents to test positive for COVID. Vaughan's wife, Dorothy, moved into the adjacent retirement home and popped in five or more times a day to see her family. Her home is now on lockdown, too.

Dorothy and Doreen were close. "I actually had to tell my mom that her twin sister died over FaceTime," Nina said. "I just sat with her on FaceTime. She cried for hours."

Nina helps her mother FaceTime her dad, but he no longer speaks to them. She doesn't know if he's angry because no one is visiting. He used to say "I love you," at the end of her regular visits. Now, he says nothing.

"I told my mom, even if he lives through this, I don't think we are going to get the same dad back."

It's the fear of the unknown that keeps Julian Morelli on the telephone, for hours each day, with families from his mother-in-law's nursing home in Ottawa. One staffer has tested positive for COVID.

Morelli said the home is doing its best, but Ontario's current directives do not call for universal testing in long-term care.

"That doesn't make sense to a lot of people," he said. "The stress of not knowing is what creates so much fear. But we are not babies. We are adults."

In Prince Edward Island, Dr. Martha Carmichael is planning, and waiting.

So far, P.E.I. has not seen COVID in its seniors homes and has been "incredibly lucky" with 23 of its 25 COVID-positive community cases now recovered, said Carmichael, a geriatrician.

The island's medical workers are working with nursing homes and retirement homes, preparing for the eventuality that the virus will arrive. Federal guidelines help, she said. All staff will wear surgical masks and test at the earliest signs of a cough, sore throat or unusual behaviour, which is sometimes how residents who can't express themselves will display symptoms, Carmichael said.

"We have the luxury of time, of being able to learn from other provinces."

Maison Herron, Montreal

Maison Herron is a private high-end seniors' residence in Dorval, southwest of downtown Montreal, where residents pay several thousand dollars a month to stay.

Relatives of residents and staff say there have been issues with the facility for some time. But things reached a boiling point in late March.

That's when, according to witnesses and staff, some residents were left to lie in their urine and feces, and not given water or food for days.

Union representatives and provincial health officials reported that conditions slipped so badly last month that some staff walked off the job, in part due to the lack of protective equipment to prevent the spread of COVID-19. After the walkout, the province placed the centre under trusteeship.

That was all before last week's revelations that 31 people had died at the facility in the last month. It was confirmed Tuesday that five of the victims had COVID-19.

The Quebec coroner has launched an investigation into the deaths and Montreal police launched a criminal investigation, seizing personnel records and surveillance tapes from inside the facility.

The premier of Quebec has even gone so far as to describe conditions in the centre as "deplorable" as well as "unacceptable" and akin to "gross negligence."

According to a news report, residence co-owner Samantha Chowieri, in an April 9 email, accused Lynne McVey - CEO of the local West Island regional health board - of causing COVID-19 to spread among staff and residents by not calling for a quarantine of infectious residents.

Lafliche, Shawinigan, Que.

CHSLD Lafliche, a long-term-care home in Shawinigan, Que., is one of Canada's hardest hit by COVID-19, with 27 deaths as of April 14. More than 90 residents have been infected.

The disease has also ravaged workers in the centre, with more than 60 testing positive and now in isolation. The shortfall of staff has forced local health officials to call in backup workers.

About 50 workers were promised around the Easter holidays - 43 initially, according to the regional health agency (CIUSS Mauricie Centre-du-Qui(C)bec), with more coming.

But frustrated workers were complaining Tuesday that no fill-ins had arrived, and many departments and floors did not have enough workers to operate properly over the past weekend.

"It is very worrying to see that there are still, according to our members in the field, many people who are overworked," Pascal Bastarache, president of the Union of Paratechnical Personnel, Auxiliary Services and Trades Mauricie Centre-du-Qui(C)bec, told reporters this week.

Premier Franiois Legault said one significant challenge has been finding qualified staff to bring in to fill the required roles at the facility.

Companies in Shawinigan donated car- and truckloads of equipment for the staff, including N95 masks, disinfecting solutions and protective visors, which arrived April 13.

Notre-Dame-de-la-Merci, Montreal

Notre-Dame-de-la-Merci is one of Quebec's six or seven hot spots for the coronavirus, with 72 COVID-19 cases.

The 400-bed public facility in Montreal which, as of last week, had 13 deaths since early March, provides housing and long-term care for seniors and people with memory impairment.

According to local reports, some staff in the centre stopped coming to work late last month, fearing the virus. That situation later calmed down with the provision of protective equipment, according to health officials.

But union representatives disputed that, saying seniors' facilities such as Notre-Dame-de-la-Merci were already short-staffed and COVID-19 has just made a bad situation worse.

Staff from a local hospital, Hipital du Sacri(C)-Coeur de Montreal, have reportedly stepped in to help fill the void.

La Piniire, Laval, Que.

La Piniire, in Laval, Que., is a seniors residence that at last count had just over 30 COVID-19 cases and 14 deaths.

The 68-bed facility saw the number of cases balloon from the seven positive cases it had March 28 to this week's 31.

The coronavirus cases mushroomed despite the facility putting measures in place to protect its staff and residents.

Beyond the seniors home, the local health authority, CISSS de Laval, rented an entire hotel around the end of March and refurbished it as a 100-bed overflow unit to create space at a Laval hospital, Cite-de-la-Santi(C) Hospital, for people suspected of having the coronavirus.

The hotel was able to take 133 people with palliative care needs, as well as those with mental health issues, allowing more space at the hospital for COVID-19 cases.

This week, Quebec's premier announced restrictions on visiting seniors' homes will be loosened. Starting Thursday, primary caregivers already in place will be permitted to visit and care for residents in these homes.

Seven Oaks Long Term Care Home, Toronto

By March 20, Toronto was working to contain an outbreak at the Seven Oaks Long-Term Care Home - days later, the city-operated centre was reporting its first deaths there linked to COVID-19.

Since then, there have been 22 deaths at this Scarborough facility, where both residents and staff have fallen ill. As of April 13, there were 82 confirmed cases among 249 residents, and 14 cases among a staff of 200.

A few weeks ago, as the outbreak intensified, Seven Oaks introduced several measures to try to stop the virus's spread. They included cancelling group activities, twice-a-day screening for symptoms of residents and staff, enhanced cleaning and ensuring staff used personal protective equipment.

"One of the first measures that was instituted to prevent COVID-19 outbreaks - and in many ways the most difficult - was stopping family and friends from visiting," said Dr. Elizabeth Rea, Toronto Public Health's associate medical officer of health. That, she said, "was a critical step" in minimizing residents' exposure to the virus.

"Overall we are starting to see a positive effect of the stringent outbreak measures that have been put in place throughout Seven Oaks, and the rate of new COVID-19 infections is starting to slow."

Pinecrest Nursing Home, Bobcaygeon, Ont.

Pinecrest Nursing Home in Bobcaygeon was among the first long-term care facilities in Ontario to garner tragic headlines as it grappled with multiple deaths related to COVID-19, an anguishing scene now occurring in numerous centres across the province.

The 65-bed facility has so far experienced 29 deaths due to the novel coronavirus. Positive cases were first reported there March 20 and the virus quickly spread. Within days, Pinecrest had the largest COVID-19 outbreak in the province.

According to reports, the virus spread easily amongst the frail and elderly, their vulnerability heightened because three to four were kept to a room, their beds separated by curtains. Even before the virus struck, staffing levels were skeletal and, when it did hit, staff members also fell ill, leading to a frenzied hunt by administrators to try to find additional workers.

On Tuesday, Mary Carr, the home's administrator, told the Star that Pinecrest has welcomed "a few staff members back" and thanked the team "for their diligence in providing safe and compassionate care to our residents." She also said staff have access to necessary personal protective equipment (PPE) "at all times while working in the home."

"We currently have a surplus of PPE and are working to share much needed supplies with other homes in the province," she said.

Markhaven Home for Seniors, Toronto

The number of residents at the Markhaven Home for Seniors who have died as a result of the novel coronavirus rose to 11 on Tuesday.

The 96-bed long-term-care facility in Markham has an additional 10 residents in the home who have been confirmed to be COVID-positive, said executive director Mike Bakewell.

"Markhaven's sole focus at this time is the well-being of our residents, staff and the community," he told the Star.

As the tragedy has unfolded at this home, Markham Mayor Frank Scarpitti has been sharing his condolences on Twitter.

"Another sad day in the City of Markham. A 79-year-old man has passed away at Markhaven Home for Seniors, marking the 10th #COVID19 related death at the home. Our thoughts are with his family, friends and loved ones," he tweeted Monday.

On Good Friday, Scarpitti issued a statement, in part calling for emergency support to help Markhaven. He noted: "There is a critical need for nurses and personal support workers."

Lundy Manor, Niagara Falls, Ont.

Two Niagara New Democrat MPPs are calling for an investigation into a Niagara Falls retirement home where a dozen deaths have been reported since a COVID-19 outbreak was declared at the end of March.

After 12 residents of Lundy Manor had died as of Monday, with 22 residents and five staff members confirmed to have COVID-19, both Niagara Centre MPP Jeff Burch and Niagara Falls MPP Wayne Gates called on the province to investigate the facility's response to the crisis.

"It's unfortunate that a lot of our long-term-care facilities were not ready and prepared, both in terms of transparency with the families of residents and with practices in the home," Burch said. "We want to make sure we understand exactly what has happened, not just at Lundy Manor, but in other places. And not just because the families deserve to know, but for the future so we can be better prepared to handle these issues."

Tim Foster, vice-president of strategy and business development for Lundy Manor's owner, Oxford Living, said the company is working closely with Niagara Region Public Health and the Retirement Homes Regulatory Authority.

"We are doing everything in our power to protect the health and safety of our residents," Foster said in an email.

Heritage Green Seniors Complex, Hamilton, Ont.

Heritage Green Nursing Home in Hamilton has come under fire from residents' families, tenants of its seniors complex and the union representing its workers over an alleged lack of communication amid a COVID-19 outbreak.

For a while, it seemed no one knew what was going on in the home.

SEIU Healthcare, the union representing 187 workers at the home, raised the alarm in late March after staff were initially told not to wear personal protective equipment (PPE), including masks, unless they were dealing directly with a COVID patient. The union also said they couldn't reach the home's administrators. Days later, provincial directives changed and the union said the home was now providing PPE.

Residents' families, meanwhile, spoke out after they learned from media - instead of the home - that 27 residents and staff were presumed to have the virus. The home disputed this number, released by public health. The next day, a provincial directive changed again, requiring all residents and staff showing symptoms to be tested.

At least two residents of the adjacent Heritage Green Seniors Complex also raised concerns about a lack of communication. They were told nothing about the nursing home outbreak next door, they said.

Eatonville Care Centre, Etobicoke

Jane Bayly, whose parents live at Eatonville Care Centre in Etobicoke, was stunned Easter Sunday when the facility reported its 14th death.

On Monday, the grim tally shot up to 25 - in part because the deaths of nine residents who had previously succumbed to unknown causes were attributed to COVID-19. On Tuesday, the death toll climbed to 27.

The virus's spread at this 247-bed facility has baffled Bayly, whose parents - Peter and Margaret Green, aged 90 and 89, respectively - tested positive but show no symptoms. For the past month, the couple has been quarantined in their room, as have all residents.

Bayly suspects a lack of testing capability has made it challenging for staff to know the magnitude of the outbreak. She credits the staff, some of whom are off sick, with "being incredible. I have never seen that kind of love, consideration and kindness."

In a media statement April 14, Evelyn MacDonald, the centre's executive director, said due to expanded COVID-19 testing criteria they have tested more residents and are awaiting the results for 70 of them. The centre has 53 confirmed cases.

"Some of the measures currently in place within our home include self-isolation of all residents, meal delivery via a tray service, and close monitoring of all residents and staff for COVID-19 symptoms twice a day," MacDonald said. "Our cleaning and sanitizing protocols have been ramped up across the home, and we have recruited additional care and cleaning staff."

Anson Place Care Centre, Hagersville, Ontario

A COVID-19 outbreak at Anson Place Care Centre in Hagersville, Ont., accounts for 19 of the 20 confirmed COVID-related deaths in Haldimand and Norfolk counties.

As of April 14, nearly three-quarters of the 101 residents of the long-term care centre and retirement home - 73 people in total - had tested positive, as have 31 staff members who are now off work and in quarantine.

The first resident died in hospital on March 26, before there were any confirmed COVID-19 cases in Haldimand-Norfolk. Since then, residents have been treated at the home.

The source of the outbreak at Anson Place, south of Brantford, is unclear. All residents and staff have been tested, including those without symptoms. Residents are confined to their rooms, including for meals, and staff are in self-isolation when not at work.

The local health unit expects to see more deaths at Anson Place, as residents who were infected two weeks ago begin to show symptoms. But the unit's chief medical officer of health is encouraged that preventative measures put in place at the home seem to be slowing the spread of the disease.

Almonte Country Haven, Ottawa

The death toll at Almonte Country Haven climbed Tuesday as the Ottawa-area home reported two more residents had died of complications related to COVID-19, bringing the total to 18.

Carolyn Della Foresta, administrator at the 82-bed facility, said all community members "are grieving these losses."

In an effort to stop the spread of the virus, Della Foresta said staff are "monitoring this situation closely," and working with local and provincial health authorities "to ensure we are proactive in following all protocols and directives."

"Our number one priority has always been the health and safety of our residents and our front-line staff," she said in a statement.

Over the weekend, Della Foresta said the centre was welcoming back staff members who had fallen ill - but only after testing negative twice, or being symptom-free at least 24 hours and waiting at least 14 days since first experiencing symptoms. She also noted all staff are screened upon entering and exiting the home, and wear personal protective equipment at all times when providing care to residents.

On Tuesday, she thanked the broader community, noting they have "gone above and beyond to share their thoughts and prayers with all of us here " It truly means the world to us."

Lynn Valley Care Centre, North Vancouver, B.C.

Lynn Valley Care Centre is nestled in the suburb of North Vancouver, about a 15-minute trip across the Burrard Inlet from downtown Vancouver. It is also the site of Canada's first COVID-19 death.

The 250-bed long-term-care facility was the first in Canada to detect a coronavirus outbreak among its residents. The blazing speed with which the virus took lives there was a warning sign of what was to come for seniors homes across the country.

The first announcement came on a Friday - a care worker at the home had tested positive for the virus. The next day, provincial health officer Dr. Bonnie Henry confirmed people's worst fears - two residents had contracted the virus. They began experiencing symptoms a couple days earlier and were tested right away, she said.

By Sunday, one of the residents died. He was a man in his 80s.

Henry said the facility was following its outbreak protocol, which restricted visitors and implemented "infection control precautions" on all staff interactions. But the care home has continued to struggle to contain the COVID-19 outbreak. As of April 14, 20 residents have died and more than two dozen workers have tested positive for the virus.

Across the province, as of April 13, 254 care-home residents have tested positive for coronavirus.

McKenzie Towne, Calgary, Alberta

Almost half of Alberta's COVID-related deaths have been at one long-term-care centre, a low-slung building of pale-yellow siding and brick called McKenzie Towne, located in a master-planned residential neighbourhood in southeast Calgary.

The first death came March 23. The woman in her 80s was the first Calgarian to succumb to the virus. At the time, two other residents had tested positive and 11 had symptoms, Dr. Deena Hinshaw, Alberta's chief medical officer, said.

Since then, the number of confirmed cases at the facility, which features a personalized care approach and "engaging" recreation programs on its website, has risen sharply. Twenty-one residents have died, and family members continue to speak publicly about the need for more support for front-line staff.

Among the people who have died is Doreen Gauvreau, whose husband of 61 years and brother-in-law also live at the facility and have contracted the virus. The mother of five, retired retail worker and Elvis Presley fan died April 6.

In response to the deaths, the province set a ban on visitors to long-term care centres and group homes. Days later, they introduced new rules that care workers must wear masks at all times and work at only one location.

Atlantic Canada

Of the four Atlantic provinces, Nova Scotia is the only one reporting a significant number of coronavirus cases in nursing homes, and its government has stepped in with new measures to combat virus spread.

Northwood Halifax Campus Long Term Care Facility reported in a Monday release that 16 residents and 10 staff members had tested positive for COVID-19.

According to the release, all cases displayed "mild to moderate" symptoms.

Nova Scotia reported its third coronavirus death Monday, a man in his 80s, one of two residents who tested positive at the Admiral Long Term Care Centre in Dartmouth.

On the same day, the Nova Scotia government unveiled strict new public health guidelines for nursing home workers.

Under the new guidelines, front-line workers in all public and private long-term-care homes, residential-care facilities and home-care agencies will be required to wear face masks. The province plans to begin distributing masks Tuesday.

"We're now seeing increased community spread and we know from other jurisdictions that this means an increase in cases in long-term care facilities," Dr. Robert Strang, the province's chief medical officer of health, said.

"It's almost impossible for people working in long-term care facilities to practise physical distancing given they are helping people who need hands-on care. Wearing a surgical mask is another measure we can use to prevent further spread of infection and protect health-care workers and those most at risk of becoming severely ill."

Newfoundland reported only one case in a long-term-care home, while both New Brunswick and P.E.I. reported none.

With reporting by Isabel Teotonio, Donovan Vincent, Wanyee Li, Alex Boyd, Steve McKinley, Katrina Clarke, Allan Benner, and J.P. Antonacci, whose reporting is funded by the Canadian government through its Local Journalism Intiative.

Moira Welsh is an investigative reporter based in Toronto. She can be reached at mwelsh@thestar.ca.