Analyzing COVID-19 outbreaks and resident deaths in for-profit long-term care homes
Long-term care (LTC) homes have been the epicentre of the COVID-19 pandemic in Canada, with residents of these homes accounting for around 80 per cent of the country’s deaths. Previous research shows that for-profit LTC homes deliver inferior care compared to non-profit homes, raising the question of whether for-profit homes have had worse COVID-19 outcomes.
Dr. Paula Rochon
A new study from Dr. Nathan Stall, a geriatrician and research fellow at Women’s College Research Institute (WCRI), and Dr. Paula Rochon, vice-president of research at Women’s College Hospital (WCH) and senior scientist at WCRI, found that the for-profit status of LTC homes was associated with larger COVID-19 outbreaks and higher numbers of resident COVID-19 deaths.
The study, published in CMAJ, looked at all LTC homes and their residents in Ontario from March 29 to May 20, 2020. For-profit status of LTC homes was associated with an approximately two-fold increase in the extent of a COVID-19 outbreak and a 178 per cent increase in the number of resident deaths compared with non-profit homes. Of the 10 homes with the highest death rates, seven were for-profit-homes with older design standards and chain ownership.
Dr. Nathan Stall
"Our findings suggest that for-profit status is an important risk factor for transmission of COVID-19 after an outbreak has been established in a LTC home," notes Dr. Stall. “These associations were mediated in large part by the higher proportion of outdated design standards and chain ownership in for-profit homes.”
For-profit homes were usually smaller, housed fewer residents, and had older design standards (meeting or falling below those established in 1972) with multiple-occupancy rooms and chain ownership. Newer design standards provide for larger and more private room accommodations, as well as less crowded and self-contained common spaces promoting both infection control and quality of life for residents.
"Beyond promoting quality of life, newer design standards including private rooms, smaller clusters of residents and access to outdoor space all promote infection prevention and control by limiting infection within resident bedrooms and among areas of a facility," adds Dr. Rochon. “While staffing plays a critical role, in homes where these design elements are already in place, residents generally have had better outcomes during COVID-19.”
The authors also note that recent public attention on LTC homes presents an opportunity to examine all the root causes of the present crisis and think creatively about how to provide LTC residents with the best medical care and quality of life. By considering how the physical design of LTC homes impacts the care of its residents, this evidence will help support capital projects to retrofit or rebuild older LTC homes.