In the face of public criticism and calls to repeal its vaccine mandate for staff, Au Château’s administration shared two reports with its Board of Directors on May 17, one recommending they continue to require all staff to be vaccinated and the other showing very favourable results from a satisfaction survey of residents and their families. After deliberation, the majority of the board wanted to keep the vaccine mandate for employees of the long-term care facility, though it was not unanimous.
Director Jacques Dupuis provided a 9-page report outlining his reasoning to support a continued vaccine requirement. He noted that vaccination has been shown to reduce transmission, and while “variants of COVID have found ways around the vaccine… there remains a significant degree of protection against catching the original disease and all its variants compared to being unvaccinated.” Consequently, “As vaccinated persons are less likely to catch the disease, they are less likely to be sources of its transmission to the vulnerable population we serve,” he wrote.
Dupuis did acknowledge that as of March 31, the province removed many COVID-19 restrictions and left individual long-term care (LTC) homes to decide for themselves whether to require staff vaccination. However, he stressed that “the majority of Long-Term Care homes maintains a mandatory vaccination policy”, as do the local hospital and major teaching hospitals in Ontario, as well as the District of Nipissing Social Services Administration Board for paramedics and Home and Community Care of Ontario Health “as they deal with a vulnerable and compromised population.”
Dupuis opined that removing the mandate could be a slippery slope. “We believe that some staff may resist taking future boosters and other shots, including flu shots. This would create a culture that conflicts with the health and safety of our staff and of our frail elderly. It would create an environment whereby the Home would have significantly more outbreaks and likely more resident deaths.”
The director sought direction from the Nipissing Parry Sound District Health Unit. He highlighted the response from Dr. Chirico, Medical Officer of Health: “Residents of congregate living settings for seniors are still at high risk of severe illness from COVID-19, especially if they are not up to date with vaccination. (…) We remain firmly of the opinion that COVID-19 vaccines are pivotal and continue to be invaluable in combating COVID-19, and we continue to encourage staff to remain up to date with vaccinations,” Dr. Chirico was quoted in the report.
Dupuis stressed that the policy does not violate workers’ rights, as determined in precedent-setting arbitration, and that in fact the two unions representing Au Château workers, CUPE and ONA, do not oppose the policy. He added that, among the more than 100 employees of the Home, only 7 refused to vaccinate and were suspended without pay, though they can return anytime if they comply with the requirement. According to the director, this has not had an impact on staffing levels based on an analysis of net new hires from January 1, 2021 to May 5, 2023. While there has been a shortage of health care workers since well before the pandemic, Dupuis noted that this is a national problem but that current PSW programs are seeing strong enrolment. “Vaccination status is not a deterrent to recruitment among students who know that hospitals and LTC Homes require their new staff to be vaccinated. All these students choose to vaccinate or they pursue other careers,” he wrote.
Perhaps the most compelling argument was made not by Dupuis but by the home’s Family Council, which represents residents and their families. That council wrote to Dupuis indicating that at a March 1 meeting, they voted unanimously to ask the board not to change the vaccination requirement for staff. Dupuis stressed that under the new Fixing Long Term Care Act, Family Councils were given added powers and homes were advised to heed their recommendations. “This is their home and they should be the ones to decide,” he concluded.
Board reacts to report
Board member Jerome Courchesne thanked Dupuis for the detailed report and said that given the “limited guidance from the Ministry… I would vote to keep it as is for now” with the possibility of revisiting the policy in future.
Member Ronald Demers noted that he was part of the former board which had unanimously adopted the policy and stated, “I still stand by that vote.”
Vice chair Catherine Neddow referred to a document she had previously sent members highlighting concerns about staffing levels if LTC homes lose unvaccinated workers. She said that 45% of Personal Support Workers (PSW) are Black or Indigenous, and these groups are among the least vaccinated in her estimation. She wanted to know where these workers were, if they had been dismissed or were still working. “The board has a mystery,” she stated. Dupuis responded that 82% of the Black population over age 12 had been vaccinated. Neddow retorted that those statistics were from February 2022 and that they represented only the first dose of vaccine that the workers had been “coerced into receiving,” and she was convinced many had not followed up with further doses. She cited no data to back that up, and then walked back the assertion that workers had been “coerced.” Dupuis addressed her concern by saying “there has not been a mass exodus of staff, whether Black, Indigenous or otherwise.”
Neddow also regretted that the Ministry of Health and Long Term Care did not have a standardized policy, leading to “a huge variation in policy in facilities across Ontario.” She noted that some homes have lifted their vaccination mandate and said they had not experienced outbreaks as a result.
Fern Pellerin was concerned about the workers put on leave. “Many PSWs contacted me (…) and I get the feeling that we should move on and revisit the policy and that non-vaccinated go back to work, especially with the shortage” of staff, he expressed.
His colleague Jamie Restoule said he was sympathetic, but that the vaccine mandate “is not the reason we are short staffed, it’s been a problem for many years.” He felt the extra precaution taken at Au Château was appropriate as it “is a lot different than other organizations; we’re caring for seniors. (…) We should be as careful as we can with the residents.”
Board chair Daniel Gagné came back to the Family Council request, which had the most weight in his view. “They unanimously requested that we keep the vaccine policy intact at the moment,” he noted, adding that this could be revisited later. Dupuis indicated that a vote was not required as the majority’s will was clear and there was no motion. He assured that any new information or developments that would justify a review would be brought to the board in timely fashion.
Residents, families indicate high rate of satisfaction
In a second report, Dupuis presented results of 2022 surveys rating the satisfaction of residents and families. The voluntary surveys were taken by 34 residents and 30 family members.
Residents were asked to grade various aspects of the home with one of four ratings: poor, good, very good and excellent. Among the items rated were staff efforts to meet their needs, safety, confidentiality of their health information, respect for their privacy, bathing, activities, canteen and meal services, cleanliness, laundry services and so on. Only 1% of ratings were “poor”, 14% were “good”, 45% were “very good” and 40% were “excellent.” Dupuis told his board that the lowest marks, while still largely good to excellent, concerned meals, and he assured that they had already taken measures to improve this service by creating a resident food committee to offer recommendations.
Residents were also asked to grade medical care, nursing care, and other primary services, from poor to excellent. Again, only 1% of ratings were “poor”, all concerning food, while 20% were “good”, 42% “very good”, and 37% “excellent”.