Vaccine Rollout Brings Hope to Maimonides

Dec. 17, 2020

By JANICE ARNOLD

MONTREAL—Every December, Beverly Spanier has organized a Hanukkah party for her friends. That celebration, held in a favourite restaurant or hotel, continued even after she moved into Maimonides Geriatric Centre five years ago.

Planning the party was a project the retired high school teacher worked on for weeks in advance. A paraplegic, she got to the site via the city’s adapted transit service.

That, of course, did not happen this year. Spanier, 75, has not left Maimonides since the pandemic began in March except for three hospital visits. In fact, she has been confined to her room for the past nine months, save for some time in its garden during the summer.

Beverly Spanier
Beverly Spanier

For the first months of the pandemic, all visitors, including paid caregivers on whom Spanier relied, were barred from Maimonides, and remain restricted.

For Spanier, Hanukkah has been limited to looking at the menorah in a municipal park from her fifth-floor window.

When Maimonides was selected as the first site in Montreal for the Pfizer/BioNTech vaccine rollout, she didn’t hesitate to consent. On the afternoon of Dec. 14, Spanier was among the first of the first in Canada – and indeed the world – to be inoculated.

Maimonides, a long-term care institution in Cote Saint-Luc, and a Quebec City nursing home, Centre d’Hébergement St. Antoine, received the first vaccine shipments to Quebec. The highly anticipated cargo landed at Mirabel Airport north of Montreal on the evening of Dec. 13.

Maimonides took delivery of two boxes of 972 doses each, and 150 residents and staff received their first shot on Dec. 14. Almost 95 percent of Maimonides’s approximately 350 residents have agreed to be inoculated, as have, at time of writing, 40 percent of its roughly 500 employees, according to CIUSSS West-Central Montreal, the regional health authority that administers Maimonides.

Surplus doses from this initial batch will be made available to workers at other health care facilities in the local network.

The day after the first of her two shots, Spanier said she felt fine, with only a little redness at the injection site on her arm. Although she has much faith in medicine – her late brother was a doctor – Spanier was nervous about any adverse reaction and wondered if Maimonides had sufficient medical support on standby should a problem arise.

(CIUSSS officials reassured the public that it does have a trained team in place and precautions, such as a “crash cart,” to treat anaphylactic shock.)

“It is miraculous how the scientists and pharmaceutical industry have been able to produce an effective vaccine in such a short time, but you do worry,” Spanier said. “We are still, in a sense, in the midst of an experiment.”

On balance, she realizes that her risk of catching COVID is far greater than any associated with the vaccine. The consequences for Spanier, who has respiratory issues, could be fatal.

She also has a sense of responsibility toward society. “I think that we all have to do what we can to overcome this terrible disease and allow the world to return to normal.”

The psychological toll of the pandemic has been brutal, she said.

Maimonides has been hard hit by the coronavirus, twice. In the first wave, a third of residents were infected and 39 died, according to government information. It took the assistance of the Canadian Armed Forces and, after that, the Canadian Red Cross to help overwhelmed staff get the outbreak under control.

In early October, Maimonides was proud to announce there were no more active cases. But within weeks, the numbers went from zero to over 50 and, after trying to care for the sick in an isolated ward, transferred many to hospital.

On Dec. 16, Maimonides site coordinator Jennifer Clarke made public that, in the second wave, a total of 88 residents have had COVID and 19 have died. There are currently nine active cases, she reported.

Spanier compares her life to being on a “battleground,” with its fear, disruption and grief.

“We are a community here. I knew some of the people who died, or know someone who knew them,” she said. Her hope today is tinged with solemnity because she can’t forget the havoc the virus wreaked.

Much hoopla surrounded the rollout at Maimonides, with Quebec Health Minister Christian Dubé and federal Health Minister Patty Hajdu on hand for a ceremony held outside the building just before the first shot was administered to resident Gloria Lallouz, 78.

The politicians hailed it as a historic occasion. Hajdu, who did not hide her tears, said, “I see this as the first step toward the light.”

Spanier is more cautious. The first battle to be won is ending the pandemic, but the definition of victory in the long term, she believes, is changing society’s disregard for the institutionalized frail elderly.

“If any good has come out of this, it is that light has been shed on what is happening in chronic care places. We can’t just dump people, and the resources have to back that up. One orderly for 35 patients at night is not feasible anymore.”

Breaking News: Maimonides Sends COVID Patients to Hospital to Curb Outbreak

Dec. 1, 2020

By JANICE ARNOLD

MONTREAL – A rapidly worsening COVID outbreak at Maimonides Geriatric Centre has been brought under temporary control by transferring infected residents to hospital, but family members say more needs to be done to prevent a recurrence.

On Nov. 29, 20 residents were taken by ambulance from the Cote Saint-Luc long-term care facility’s “hot zone.” Two acutely ill residents were brought to the Jewish General Hospital and the rest to Hotel Dieu Hospital, which has a unit dedicated to less severely ill patients from nursing and seniors’ homes.

Maimonides’s hot zone for active cases, located on its uppermost seventh floor, is closed for now.

The move was made after some relatives held a demonstration outside Maimonides on Nov. 26, fearing the facility had lost control of the viral spread. They claimed infection prevention measures were inadequate, that a shortage of nursing and support staff was resulting in repeated movement between cold, warm and hot zones, and that infected residents were not getting the medical treatment they needed.

They appealed to Premier Francois Legault to take immediate action.

Active cases went from zero to over 50 in a couple of weeks, the most at any long-term care home in the province at that point, although not the highest per capita rate. Eight residents had previously been sent to hospital. Ten residents have died, while others recovered.

In addition, more than 20 staff members and about a dozen registered caregivers – either family members or workers privately hired – have tested positive and had to quarantine at home.

Maimonides was hard hit by COVID in the first wave, when one-third of residents had the virus and 39 succumbed to it, according to Quebec government statistics. Members of the Canadian Armed Forces and later the Canadian Red Cross were brought in.

During this second wave, administrators had insisted the situation was in hand, that stringent infection prevention measures were in place, and that staffing overall met government requirements, until relatives raised their voices ever louder that this was not what they observed. They received support from Cote Saint-Luc Mayor Mitchell Brownstein and local Member of the National Assembly, David Birnbaum.

In a Nov. 29 public message under the heading “Mission accomplished!” Barbra Gold, an official of CIUSSS West-Central Montreal, the regional health authority that manages Maimonides, confirmed that the residents’ transfer to hospital had been completed that day.

“We hope that this temporary closing of our hot zone will break the cycle of infection in our facility,” she stated.

Gold said that 10 other residents with active COVID who had been in the hot zone remain at Maimonides, explaining, “our medical team determined they could be safely returned to their rooms (in other areas).”

Caregivers are not allowed to visit the residents at Hotel Dieu, she said, but an effort is being made to set up FaceTime calls. They were accompanied to Hotel Dieu by the nurses and orderlies who had tended to them at Maimonides. The CIUSSS has arranged for kosher food to be available there.

Gold added that a virtual town hall with families is being planned to address concerns.

The day before, Gold communicated that an evaluation of Maimonides’s COVID isolation unit by public health authorities, infectious disease specialists and the institution’s health care professionals had been conducted. A “contributing factor” to the virus’s rapid spread, they believe, was “a high density of very contagious individuals in a relatively small area that has not been built to accommodate them.” That seventh-floor wing was sealed off with plastic sheeting.

Another CIUSSS official, associate chief executive officer Francine Dupuis, told the media that the ventilation system may have been another factor. She also said the origin of the outbreak was traced to a caregiver, who was asymptomatic and later tested positive.

The Family Advocacy Committee, which staged the demonstration, is now calling for mandatory weekly testing of all employees and visitors to Maimonides. Its chair, Joyce Shanks, whose 92-year-old father is a resident, deplored that testing is now voluntary and only required when a positive case occurs in a unit.

The committee would also like to see the return of the Red Cross or of the health department’s “swat team,” which shores up staff when an outbreak reaches a critical level.

The CIUSSS says that, as of Dec. 7, all registered caregivers at Maimonides and other CHSLD under its jurisdiction, which includes the Jewish Eldercare Centre, must be tested every two weeks, either on-site or at any testing centre in the province. Written proof of a negative result must be shown or they will be barred. Maimonides has an on-site clinic three days a week, and Eldercare twice a week.

Since the second wave began, the 320-bed Eldercare has had total of 17 cases among its residents of which 10 are now active, attending physician Dr. Mark Karanofsky reported. Two residents have died. Two positive staff are currently isolating at home. Karanofsky himself came down with COVID in late October and has recovered.

Montreal Geriatric Centres Battling COVID Outbreak

Nov. 18, 2020

By JANICE ARNOLD

MONTREAL—Less than a month after declaring it was COVID-free, Maimonides Geriatric Centre is trying to contain a serious outbreak among residents, as well as staff and outside caregivers.

On Nov. 17, the long-term care institution reported that 26 residents have tested positive for the coronavirus, and that three have died since the start of the second wave.

In addition, 16 staff have been infected, as well as six registered caregivers. The latter are either family members or private personal support workers permitted to regularly visit a resident, under strict conditions. Maimonides says five other caregivers earlier tested positive, but have recovered.

All infected staff remain at home.

Maimonides, a 380-bed facility in Cote Saint-Luc, was hard hit by COVID in the spring and summer. According to government statistics, a third of the residents contracted the illness and 39 died during that period.

The virus appears to be spreading rapidly. On Nov. 13, Maimonides reported that 16 residents and 11 staff had tested positive, and no deaths were announced.

The positive residents, all from the second and third floors, have been moved to a sealed-off ward occupying half of the uppermost seventh floor.

All residents who were cared for by the 16 infected staff members, who worked on the second, third, fourth and sixth floors, have been placed in isolation elsewhere while they await their test results. Also isolated are those residents who were tended by the 11 infected caregivers, who were present in various units.

Five wings on the second to sixth floors are now designated “warm zones” for precautionary isolation where only essential medical appointments are permitted and all other services and activities considered non-essential are on hold.

“We are currently looking at different strategies for minimizing the introduction by caregivers of the virus into our facility,” states the public message, signed by Maimonides co-chiefs Dr. Jack Gaiptman and Dr. Kris MacMahon, and site coordinator Jennifer Clarke. On-site testing for caregivers is now available three days a week.

The first case of a resident contracting COVID in the second wave was reported on Nov. 4, and was traced to a staff member who had tested positive. On Oct. 31, Maimonides reported that three staff members had been found positive, and other staff with whom they had been in contact were being tested.

That was just 12 days after the CIUSSS West-Central Montreal informed families that there were no longer any COVID cases among residents at Maimonides and the Jewish Eldercare Centre.

This regional health authority, which administers the institutions, said that the “hot zones” at both facilities would therefore be made available for outside COVID-positive patients who are medically stable but require more care than is available where they live, such as seniors’ residences, or who are not strong enough to go home after hospitalization.

These patients would be from the geographical territory this CIUSSS oversees.

To date, no such patients have been admitted.

Eldercare, a 380-bed institution in the Cote-des-Neiges district, is also dealing with a new COVID outbreak. It was hit even harder in the first wave than Maimonides, suffering a rash of cases and deaths from the beginning of the pandemic in March.

On Oct. 31, families of Eldercare residents were advised that one resident and two employees on the fourth floor of its Hope pavilion had tested positive by attending physician Dr. Mark Karanofsky.

Days later, that had grown to four residents and seven staff on the same floor.

All infected residents are confined to the hot zone and attended by staff working only with them, said Karanofsky. The presence of “COVID agents” was increased to ensure sanitary practices were being followed by staff and registered caregivers.

On Nov. 2, Karanofsky reported that he had tested positive after showing symptoms of a cough and headache. 

He said the last time he was in the Eldercare building was Oct. 27 and that he had always worn a mask and face shield when he was with a resident.

In his latest communication on Nov. 17, Karanofsky said there were eight active cases among residents and two among staff, all from the Hope pavilion’s fourth floor. Having isolated for two weeks, he said he had been cleared to return to work.

Over the past few weeks throughout Quebec, there has been a spike in COVID cases in long-term care centres. Maimonides and Eldercare are now on the government’s watch list, ranked in the yellow zone below the more serious orange and red zones.

Among private seniors’ residences which provide intermediate care, the government has placed the kosher Le Waldorf in Cote Saint-Luc in the yellow category after nine residents, or five per cent of the total, came down with the illness. Two deaths are recorded.

Families Protest Possible Admission of COVID Patients to Nursing Homes

Oct. 28, 2020

By JANICE ARNOLD

MONTREAL— Families of residents of the long-term care institutions Maimonides Geriatric Centre and Jewish Eldercare Centre, which were hard-hit by COVID this spring and summer, are pleading with health officials to halt a plan to admit outside patients with the virus to recuperate in those facilities.

Jewish Edlercare

“My initial reaction was, ‘What are they thinking?’” Helen Adam, president of the users’ committee at Maimonides, told the CJR. At the outbreak’s worst, one-third of Maimonides’s 380 residents were infected and 39 would die, in addition to the staff members who tested positive. It took reinforcement by members of the Canadian Armed Forces and then the Red Cross to get the situation under control.

Eldercare had an even more difficult time from the outset of the pandemic in March, and lost more residents.

On Oct. 19, CIUSSS West-Central Montreal, the government health agency that administers Maimonides and Eldercare, informed families that there were no longer any COVID cases among residents and that the “hot zones” at both sites would, if necessary, accommodate certain people with the virus who live in the geographic territory served by the CIUSSS.

The email, signed by Barbra Gold, director of the CIUSSS’s Support Program for the Autonomy of Seniors, states that these beds would be for “COVID-positive patients who are medically stable (do not require hospitalization) but require a greater level of care than what is being offered at their current locations, such as private seniors’ residences, intermediate resources or those recovered in hospital who are not strong enough to go home.”

To date, no such transfers have been made and Gold noted that “every effort” is being made to keep such patients where they are. She added, “We are confident that this approach will not compromise the health and well-being of our residents and is in the best interest of the community we serve.”

Adam said families are flabbergasted that after waging such a lengthy battle to contain the virus – which included stopping visits for months and moving residents to different rooms and makeshift spaces to separate the infected from those who were not – the two institutions are now being opened to ill people from the community.

At Maimonides, the hot zone is located in part of the uppermost seventh floor. Adam said she is fearful that staff will inevitably move to other areas of the building despite the best intentions.

“I think Quebec has gone out of its mind. They try one thing one week and another the next. Now it looks like they are setting us up as an adjunct to the hospitals. People are so scared and confused,” said Adam.

Asked by the CJR to respond, the CIUSSS emailed a statement that those with COVID will be moved “only as a last resort” and with extra precautions.

“If and when any COVID-positive individuals arrive at the facility, they will not come into contact with uninfected residents. They will be put into designated hot zones that are separated by permanent walls from the other residents and the other units,” it said.

“They and the staff who care for them will also use designated elevators that will be unavailable to other residents and personnel. As well, they will receive care from dedicated members of the staff—in other words, the COVID-positive person or their health care provider should not have any contact with the other residents, caregivers or health care teams at Maimonides or Jewish Eldercare.”

West-Central Montreal adds that, “like every CIUSSS throughout the province, we are required to provide residents in our area with emergency spaces in a non-traditional site, such as a long-term care centre.”

This is not reassuring to Maimonides resident Beverly Spanier. The retired high school teacher is afraid of another COVID outbreak and has little confidence in the institution’s ability to deal with it.

“This is supposed to be our home, not a hospital,” she said, still traumatized by the upheaval that took place earlier this year. “We’ve already been through hell. I don’t want to live in a war zone again.”

In a letter to Premier Francois Legault, the users’ committee says a “highly vulnerable population” is being put at risk and suggests an alternative. “There are many virtually empty hotels, who would probably welcome the work. Why not use them?

“We appeal to you M. Legault to rethink this directive.”

The committee has also reached out to the Conseil pour la protection des malades, a group defending the rights of users of the health care system.

Adam’s mother, who lived for six years at Maimonides, died in May, but not of COVID. Adam thinks many residents’ passing, including her mother’s, was due to the loneliness and stress caused by the pandemic restrictions. She did not see her mother in person from mid-March until just before her death when she was allowed to visit on compassionate grounds.

She does not want that to happen again to any other residents or their relatives.

By the official count, more than 6,100 people in Quebec have died of COVID, the great majority of them residents of nursing homes or seniors’ facilities.