As COVID-19 infections and deaths soared at Tendercare Living Centre in December, the families of sick seniors and a doctor who volunteered to combat the outbreak came to a troubling realization: no one seemed accountable.
The company paid to manage the Scarborough nursing home, Extendicare Canada, did not answer questions about its shortage of doctors and alleged shortages of oxygen and medication, stating that the company’s contracts with homes “vary” and it “does not comment on progress or outcomes in homes it does not own.” The firm redirected the Star to an employee of the nursing home owners.
One of Tendercare’s owners, tracked down by the Star at his High Park house, said Extendicare runs the day-to-day operations, and that he was in daily contact with Extendicare until North York General took over managing the facility on Christmas day.
Alex Chan, whose 100-year-old grandmother, Leu Mai Jun, lived in the home until she died of COVID on Dec. 23, says an apparent absence of leadership and accountability during that month was especially frustrating at a time when homes should have been more prepared after the lessons of the first wave.
“This is something that could have been prevented and should have been prevented — my grandmother didn’t have to pass away alone,” Chan said.
“I feel like right now without accountability you won’t know who could have done what in the beginning or where did it fall short.”
Chan’s grandmother was one of 73 residents who have died from COVID-19 at the 254-bed nursing home.
John Doherty, the co-owner from High Park and also president of Tendercare Nursing Homes, said: “At no time during the outbreak was there no leadership.”
“Despite every effort, this outbreak has been devastating on our residents, their families and our team…We are a community grieving the loss of dear loved ones and community elders,” Doherty wrote on Jan. 4, adding that the home worked hard since the pandemic’s first wave to prepare yet was still overrun.
Meanwhile, Extendicare told the Star on Friday that at all times the company and the home’s owners have been aligned in their strategy to fight COVID. Extendicare staff worked swiftly and without delay to combat the virus and company managers were onsite to ensure no lapse in leadership, the company said.
“The idea that there was any lack of action, engagement or responsibility in addressing this outbreak is not accurate,” an Extendicare Canada spokesperson said. “This pandemic is a tragedy. Our hearts are with every family at Tendercare who has lost a loved one to this virus. Our focus has been and will continue to be on supporting the home, and the people who live and work there.”
Until December, Doherty said, Tendercare’s infection prevention and control protocols were successful in managing staff outbreaks and keeping residents safe.
The home has also been working with Scarborough Health Network on infection control practices for months, he said.
“Unfortunately, this most recent outbreak overwhelmed our defenses and swept through the home. We are devastated by these developments, as our team worked hard to prevent this situation from happening,” he said.
The lack of accountability is an age-old practice in long-term care, said Laura Tamblyn Watts, CEO of CanAge, a national seniors’ advocacy group.
“What we have seen here is a continuation of what we’ve seen for decades, which is finger pointing at someone else,” Tamblyn Watts said.
She said the problem extends to the government’s oversight of nursing homes.
“While there is a ministry devoted to long-term care, it is not forthcoming with critical information and the provinces and the federal governments are each pointing at each other. It is very hard to understand who is accountable when trying to get information that is timely, relevant and transparent.
“The seniors pay the price,” she said. “The seniors are the ones who are harmed.”
In the two weeks since North York General signed a voluntary management contract to oversee Tendercare operations in an effort to get control of COVID, the number of active cases has dropped to 23. Doherty said with the new management agreement, he is in regular contact with hospital officials about the home’s situation.
On Dec. 22, when Extendicare Canada told the Star it could not speak about alleged shortages of oxygen and medication, Tendercare said there were 109 residents with active COVID infections in the home.
At that time, deaths in Tendercare were surging. A government inspector had just visited and days later would release a report that said the staff infection control practices and the availability of PPE were “inconsistent.”
As a result, the critical incident report said, “the disease spread rapidly throughout the home and there were a number of resident deaths and also a number of residents who have tested positive for the outbreak resulting in actual risk to the residents.”
Extendicare sent out a call for doctors. Physicians on chat groups sent help messages, and a Toronto family physician agreed to go inside. Dr. Kate Greenaway spent Dec. 20 and 21 working in Tendercare, trying to find oxygen for struggling residents or dexamethasone to ease inflamed lungs. Greenaway said she saw no sign of functioning leadership within the home and said she heard from other physicians that Extendicare had made it clear to them that it was not the owner.
“My sense is that there was an absence of leadership being shown in the environment in that there clearly hadn’t been a process around pandemic planning, for example, there would have been oxygen in the centre if that had been pre-planned,” she said.
“Who do you complain to? Who do you take this up to if no one is saying we are the leadership that runs this? Where do you even take your concerns?”
In the days leading to his grandmother’s death, Chan said his family got conflicting information from the home about what was going on. He said they asked if a family caregiver could enter the home to make sure she was eating, but received no response.
Tendercare’s Doherty said “preparatory work…had been going on for months with infection control training for every care provider at Tendercare.” Staff and residents were tested for COVID, as prescribed by Toronto Public Health. The home also connected with “leading scientists conducting a pilot project to monitor wastewater for COVID-19 as a potential early indicator of an outbreak.”
There are two other owners named on the corporate records — one with an address in Guelph, another with an address in Sault Ste. Marie. They did not return messages left by the Star.
Advocates have repeatedly urged the province to push for faster vaccinations of residents, staff and essential caregivers; and to ensure homes were ready with intense infection control training, personal protective equipment and medical supplies. Yet the Star has on several occasions heard doctors say they used Uber to send oxygen tanks from a hospital to a nursing home.
Extendicare’s website says it bought Tendercare (Michigan) Inc. in 2007. Doherty told the Star he was involved in the Michigan operation until that year.
In 2014, the U.S. Justice Department announced that the American Extendicare Health Services Inc. was to pay a $ 38-million settlement after an investigation into its management of the Michigan Tendercare homes. The Justice Department investigation covered the years 2007 to 2013, AP said.
Doherty was not an owner during this time.
The Department of Justice in the U.S. said Extendicare agreed to pay to “resolve allegations that Extendicare billed Medicare and Medicaid for materially substandard nursing services that were so deficient they were effectively worthless and billed Medicare for medically unreasonable and unnecessary rehabilitation therapy services.”
An Extendicare Canada spokesperson said Extendicare Health Services in the U.S. was a “completely separate legal and operational entity from Extendicare (Canada) Inc., (and) was sold in 2015.”