Ontario Patient Ombudsman Long-Term Care Report Cites NIA Recommendations on Visitor Policy

The report details complaints received by the Patient Ombudsman related to COVID-19. The most frequent issues heard by the Patient Ombudsman and highlighted in the report were: 1) visitation, 2) infection, prevention and control, 3) communication, 4) quality of care, 5) staffing, 6) discharges and transfers, 7) testing, 8) access to treatment, 9) personal protective equipment, and 10) delays in care. The reports from the National Institute on Ageing and from the Canadian Foundation for Healthcare Improvement in particular (and those from other health system advocates) recommend a different approach to visitors going forward. In particular, the reports recommended that there is a need for distinction to be drawn between family or essential caregivers and general visitors.

Pandemic Experience in the Long-Term Care Sector How Does Canada Compare With Other Countries?

The NIA provided the Canadian Institute for Health Information (CIHI) with data from our LTC COVID-19 Tracker, a publicly accessible map that records cases of COVID-19 in nursing and retirement homes across Canada daily. Canada’s long-term care (LTC) sector has been especially hard hit by the COVID-19 pandemic. More than 840 outbreaks have been reported in LTC facilities and retirement homes, accounting for more than 80% of all COVID-19 deaths in the country (as of 9 p.m. ET on 05/25/2020). CIHI consolidated the NIA's findings as part of a national report comparing Canada to other countries in the Organization for Economic Co-operation and Development (OECD). 

REIMAGINING CARE FOR OLDER ADULTS Next Steps in COVID-19 Response in Long-Term Care and Retirement Homes

About 8 in 10 COVID-19-related deaths in Canada are in long-term care (LTC), double the OECD average. By July 7, 2020, the National Institute of Ageing reported more than 18,000 cases and 6,851 deaths among residents of long-term care (LTC) and retirement homes (RH) in Canada, as well as almost 10,000 staff cases and 16 deaths; however the majority of deaths have been in LTC. Reports in the press, by the Canadian Armed Forces and elsewhere have highlighted the pandemic’s devastating effects in some homes. This report focuses on steps we can take now to ensure that settings that care for older adults are better prepared for future waves of the pandemic, potentially coinciding with seasonal influenza.

Impact of COVID-19 on residents of Canada’s long-term care homes - ongoing challenges and policy responses

According to the 2016 Census, 425,755 Canadians live in long-term care or retirement homes as well as assisted living facilities. As of May 7, 2020, at least 9,746 (2.3%) of these residents have been infected with COVID-19, and 2,395 have died as a result. Much like populations in nursing homes in other countries, residents in Canada’s long-term care homes are frail and at the highest risk of experiencing severe symptoms and death from COVID-19. Recent studies of long-term care home residents in Ontario — Canada’s most populous province with 14.5 million residents — illustrate the high burden of chronic disease and frailty in this population. Because residents in long-term care homes are more susceptible to serious infection once exposed to COVID-19, homes where infection has been introduced have suffered dire consequences. Recent reports of tragic resident deaths from rapid outbreaks in long-term care homes across several Canadian provinces — such as Pinecrest Nursing Home in Bobcaygeon, Ontario; Lynn Valley Care Centre in North Vancouver, British Columbia; McKenzie Towne Continuing Care Centre in Calgary, Alberta; Résidence Herron in Montreal, Québec; and, most recently, Northwood long-term care home in Halifax, Nova Scotia — further illustrate the need to protect the vulnerabilities of this population from COVID-19 exposure. 

MorTality associated with COVID-19 outbreaks in care homes: early international evidence

There is growing international evidence that people living in care homes are particularly vulnerable to severe COVID-19 infections and that they are experiencing high rates of mortality as a result. There are also numerous examples from those countries of care homes becoming unlivable due to staff shortages caused by COVID-19 infection and self-isolation measures. This document, which will be updated and improved as new information and data become available, summarizes information from three types of sources: epidemiological studies, official estimates and news reports.

This document is available through the website ltccovid.org, which was set up in March 2020 as a rapidly shared collection of resources for community and institution-based long-term care responses to COVID-19.

Safe visiting at care homes during COVID-19: A review of international guidelines and emerging practices during the COVID-19 pandemic 

In developed countries, about 2-7% of older people live in care homes. A typical care home resident is in their eighth decade of life, often lives with dementia and/ or multiple chronic diseases and requires significant help with their activities of daily living (Gordon, Franklin et al. 2014, Department of Economic and Social Affairs - Population Division 2017, Canadian Institute for Health Information 2018). 

This document seeks to produce evidence-based recommendations to inform care homes and government policies on visiting in care homes during this and future pandemics. It includes a narrative review of international policy and practices relating to visitors to care homes during the COVID-19 pandemic and the impact of restrictions on residents, caregivers and staff, as well as illustrative case studies. At time of writing, ten months into the COVID-19 pandemic, many countries are experiencing increases in infections termed ‘second waves’ and ‘third waves’, care homes continue to have COVID-19 outbreaks and visitor bans have been re-instated in some regions. Care home residents and staff are being prioritised for COVID-19 vaccination, however, reducing risk of COVID-19 infection for residents will continue to be an important public health issue. 

International “living” report: Long-Term Care and COVID-19 vaccination, prioritization and data

This report aims to provide an overview of progress in the delivery of COVID-19 vaccinations to people who use and provide long-term care.. The report shows data on COVID-19 vaccinations for populations that either use and provide long-term care or are likely to do so. As of 26th January, these data are only available for a few countries, as most countries do not yet share disaggregated vaccination figures according to the characteristics of people who are vaccinated. In contrast, many countries provide data disaggregated by geographical area.

Bringing Long-Term Care Home: A Proposal to Create a Virtual Long-Term Care @ Home Program to Support a More Cost-Effective and Sustainable Way to Provide Long-Term Care Across Ontario

The provision of long-term care is at crossroads in Ontario. The current COVID-19 pandemic has brought to light not only some of the system’s pre-existing systemic vulnerabilities, but has also exacerbated its capability to serve more people in need of long-term care services. This paper proposes that the Government of Ontario’s Ministries of Health and Long-Term Care collaborate to enable the creation of a Virtual Long-Term Care @ Home Program.

Finding the Right Balance: An Evidence-Informed Guidance Document to Support the Re-Opening of Canadian Long-Term Care Homes to Family Caregivers and Visitors during the COVID-19 Pandemic

Long-term care (LTC) or nursing homes have experienced the worst of the coronavirus disease 2019 (COVID-19) pandemic in Canada, with residents of these homes accounting for approximately 80% of Canadian COVID-19 deaths. In reviewing the literature, consulting with national and international experts, and hearing from both residents, and their family caregivers and visitors through various forums, we have identified six core principles and planning assumptions as foundational and fundamental to any current and future guidelines. These recommendations focus on family caregivers and general visitors rather than essential support workers and LTC home staff, and are made with the acknowledgement that the approach to visiting may need to be dynamic based on the community prevalence of COVID-19.

The NIA’s Recommended ‘Iron Ring’ for Protecting Older Canadians in Long-Term Care and Congregate Living Settings

Older Canadians are more likely to die from COVID-19. Their advanced ages, higher likelihood of living with multiple chronic conditions, including dementia, and weaker immune systems all contribute to their greater risk of death. 

The term ‘Iron Ring' recently became popularized in Ontario to indicate the collective actions that the province would take to protect residents of long-term care and retirement homes. Through the leadership of Dr. Samir Sinha, the NIA’s Director of Health Policy Research, the NIA has been keeping abreast of rapidly emerging international evidence on how best to prevent and manage the introduction and spread of COVID-19 amongst both residents and care providers in these settings. This has positioned the NIA to quickly provide governments, long-term care providers, and the public the evidence-based recommendations that can be quickly and effectively implemented to better inform policies and strategies to address COVID-19. The NIA’s overall “Iron Ring” guidance will be continually updated as the evidence-base around COVID-19 evolves to further inform expert interpretations. We will also continually provide updates on how Canada’s provincial, territorial and federal governments remain aligned with the NIA’s recommended best practices.

Enabling the Future Provision of Long-Term Care

This inaugural paper in the NIA’s 2019 policy series on the future of long-term care explores the current landscape of the full range of long-term care services across Canada to determine how Canadians can be best supported to age with greater quality of life, better health outcomes, and dignity through appropriate models of care and support and best practices.

The Future Cost of Long-Term Care in Canada

This second paper in the NIA’s 2019 policy series on the future of long-term care by Dr. Bonnie-Jeanne MacDonald, Dr. Michael Wolfson, and Dr. John Hirdes, builds on Statistics Canada’s population microsimulation model to project the future costs of long-term care in Canada to both the public purse as well as the care support provided to Canadian seniors by their families.

Government of Canada

Infection Prevention and Control for COVID-19: Interim Guidance for Long Term Care Homes

Alberta

Guidelines for COVID-19 Outbreak Prevention, Control and Management in Congregate Living Sites

British Columbia 

Infection Prevention and Control for Novel Coronavirus (COVID-19): Interim guidance for Long-term Care and Assisted Living Facilities

Manitoba

Provincial COVID-19 resources for health-care providers and staff

Nova Scotia 

COVID-19 Management in Long-term Care Facilities - Directive Under the Authority of the Chief Medical Officer of Health 

Newfoundland and Labrador 

Resources

New Brunswick

COVID-19 Guidance for Long-Term Care Facilities (LTCF)

Ontario 

Outbreak Guidance for Long-Term Care Homes (LTCH)

Prince Edward Island 

Guidelines for the Management and Control of COVID-19 in Long-Term Care Facilities

Saskatchewan

Guidance for Healthcare Facilities 

United States Center for Disease Control and Prevention  (CDC)

Nursing Homes and Long-Term Care Facilities

World Health Organization (WHO)

Infection prevention and control guidance for long-term care facilities in the context of COVID-19