The impact of COVID-19 measures on long-term care home residents

Report examines long-term care deaths A new report from CIHI found Canada had the worst record for COVID-19 care home deaths among other wealthy countries.

WINNIPEG — A new report from the Canadian Institute for Health Information (CIHI) is demonstrating the harmful, and sometimes fatal, consequences of the measures that were placed on long-term care homes in the first wave of the pandemic.

During the first wave, which lasted from March 1 to Aug. 31, care home residents across the country had to follow strict measures that included limited visitation and interaction with other people.

According to the CIHI report, throughout the first wave, long-term care residents had fewer physician visits and hospital transfers in Manitoba, Newfoundland and Labrador, Ontario, Alberta and British Columbia compared to years prior.

The report shows that the proportion of residents who received a doctor’s visit during the first wave declined by 16 per cent compared to the same period last year. Resident transfers to hospital for care decreased by 27 per cent.

CIHI noted that the largest drop in hospital transfers was for infections and medical conditions, such as chronic obstructive pulmonary disease or heart failure. The report notes that doctors and nurse practitioners are usually the ones who influence the decision to transfer someone to hospital.

CIHI also determined that compared to previous years, there were more long-term care resident deaths at the peak of the first wave (March 1 to June 30, 2020). It noted that this statistic was even true for care homes in provinces with fewer outbreaks and cases.

Manitoba, British Columbia, Alberta, Ontario, Newfoundland and Labrador all saw resident deaths – from all causes, not just COVID-19 – increase by 19 per cent. CIHI noted there were 2,273 more deaths than the average of the five years before the pandemic.

“As a result of the pandemic, we see excess deaths in those long-term care residences,” said Tracy Johnson, CIHI’s director of health system analysis and emerging issues. “We see more deaths from all causes in the first six months of the pandemic than expected for this fragile age group.”

MENTAL HEALTH

The protocols, however, didn’t just have an impact on residents’ physical health, but their mental health as well, because during the first wave of the pandemic residents had less contact with family, friends, and caregivers.

The report noted the proportion of residents who had no contact with loved ones tripled when compared to previous years. It added that residents who didn’t have any contact with family and friends were more likely to experience depression.

Johnson said in addition to the increase in depression observed, CIHI  saw an increase in prescriptions for antipsychotic medication.

THE SECOND WAVE

During the second wave of the pandemic, which began on Sept. 1, 2020, and is ongoing, there have been a larger number of deaths, outbreaks, and infections at long-term care and retirement homes.

Data collected by the National Institute on Aging, in partnership with CIHI, shows that the number of infections spiked among residents by 62 per cent compared to the first wave. However, CIHI noted, the pandemic varied between provinces and territories and between the two waves.

As of Feb. 15, deaths of residents at long-term care and retirement homes accounted for 69 per cent of overall COVID-19 deaths in Canada, which is significantly higher than the proportion in comparable countries, according to the report.

CIHI added that in the second wave the proportion of residents who died from a COVID-19 infection dropped from more than one in three in the first wave to one in five in the second.

Johnson said the pandemic shows that investment in long-term care is needed to help prevent tragic outcomes.

“Some of the recommendations say more staff, and making sure that they have appropriate training, and that people are cared for to a certain standard,” she said. “Those are all things that we can do.”