Ontario (Canada) – Resources to support community and institutional Long-Term Care responses to COVID-19

LTCcovid Country Profile – Printable Version

1.10. Workforce conditions: pay, employment conditions, qualification levels, shortages

Focussing on Ontario, a published article traces the antecedents of the COVID-19 crisis in long-term care and documents experiences of frontline staff and family members of residents during the pandemic. They argue that the marginalization of both residents and workers in Ontario’s long-term care system over two decades has eroded possibilities for recognition of their personhood. They also question broader societal attitudes toward aging, disability, and death that make possible the abandonment of the frail elderly (Badone, 2021).

References:

Badone, E. (2021). From Cruddiness to Catastrophe: COVID-19 and Long-term Care in Ontario. Medical Anthropology: Cross Cultural Studies in Health and Illness, 40(5), 389–403. https://doi.org/10.1080/01459740.2021.1927023

Update for: Ontario (Canada) Last updated: February 11th, 2022 Contributors: William Byrd |

1.12. Personalisation, user voice, choice and satisfaction

Focussing on Ontario, an article by Bardone (2021) traces the antecedents of the COVID-19 crisis in long-term care and documents experiences of frontline staff and family members of residents during the pandemic. They argue that the marginalization of both residents and workers in Ontario’s long-term care system over two decades has eroded possibilities for recognition of their personhood. They also question broader societal attitudes toward ageing, disability, and death that make possible the abandonment of frail older people.

References:

Update for: Ontario (Canada) Last updated: February 11th, 2022 Contributors: William Byrd |

2.05. Impacts of the pandemic on the health and wellbeing of people who use Long-Term Care

A survey of prescriptions for all nursing home residents in Ontario found evidence of increased prescriptions of psychotropic drugs to nursing homes residents between March and September 2020, compared to prescription pre-pandemic. The authors interpret this as likely to be associated with the social isolation experienced by residents due to infection prevention and control measures or decreased capacity for staff to respond to responsive behaviours.

Update for: Ontario (Canada) Last updated: November 6th, 2021

2.08. Impacts of the pandemic on people working in the Long-Term Care sector

A survey of care home staff in Ontario by Iaboni and colleagues (2022) found that staff experienced high level of moral distress about the impact of measures such as isolation on residents’ quality of life, and fear about the reaction of residents to the measures.

References:

Iaboni, A., Quirt, H., Engell, K. et al. (2022) Barriers and facilitators to person-centred infection prevention and control: results of a survey about the Dementia Isolation Toolkit. BMC Geriatr 22, 74. https://doi.org/10.1186/s12877-022-02759-4

Update for: Ontario (Canada) Last updated: February 6th, 2022 Contributors: Andrea Iaboni |

3.07. Infection Prevention and Control measures in the Long-Term Care sector: guidance, support and implementation

Restriction in staff mobility between nursing homes

From 22 April 2020, a public policy restricted staff from working at multiple homes. This policy was applied in Ontario later than in other provinces, such as British Columbia. The policy did not apply to temporary agency staff or other contracts staff; this ensured that nursing homes could have staff available to work in an emergency.

A study using GPS location data from mobile devices found that in the period prior to the restriction, 42.7% of nursing homes had a connection with at least one other nursing home. After the restrictions were 12.7% of nursing homes still had a connection with at least one other nursing home. In both periods, mobility between homes was higher in nursing homes in larger communities, with higher bed counts and those that were part of a large chain (Jones et al., 2021).

Workforce Training

Project ECHO (Extension for Community Healthcare Outcomes) Care of the Elderly Long-Term Care (COE-LTC): COVID-19, a virtual education programme

The capacity of long-term care (LTC) facilities in Canada was significantly affected by the pandemic. Project ECHO COE-LTC: COVID-19 is a case-based capacity-building online educational learning programme, developed for professionals working in LTC facilities. The program was developed in 2003, and attempts to bridge the gap between emerging best evidence its application: it was therefore a promising tool during the pandemic, which necessitated many changes in best practice and delivery of LTC. A study by Lingum et al. (2021) investigated whether the program was indeed effective at delivering just-in-time learning and best practices to support LTC residents and teams. The study found that participation in at least one weekly ECHO session led to increased confidence and comfort for workforce professionals working with residents who were either at risk, confirmed, or suspected of having the virus. Aside from this direct impact, study participants who attended sessions also reported an intention to share knowledge and change behaviour and resident care (Lingum et al., 2021).

References:

Jones, A., Watts, A. G., Khan, S. U., Forsyth, J., Brown, K. A., Costa, A. P., Bogoch, I. I., & Stall, N. M. (2021). Impact of a Public Policy Restricting Staff Mobility Between Nursing Homes in Ontario, Canada During the COVID-19 Pandemic. Journal of the American Medical Directors Association, 22(3), 494–497. https://doi.org/10.1016/J.JAMDA.2021.01.068

Lingum, N. R., Sokoloff, L. G., Meyer, R. M., Gingrich, S., Sodums, D. J., Santiago, A. T., Feldman, S., Guy, S., Moser, A., Shaikh, S., Grief, C. J., & Conn, D. K. (2021). Building Long-Term Care Staff Capacity During COVID-19 Through Just-in-Time Learning: Evaluation of a Modified ECHO Model. Journal of the American Medical Directors Association, 22(2), 238-244.e1. https://doi.org/10.1016/J.JAMDA.2020.10.039

Update for: Ontario (Canada) Last updated: March 3rd, 2022 Contributors: Daisy Pharoah |

3.07.02. Approach to isolation of people with confirmed or suspected Covid-19 infections in care homes

Evidence on barriers to implementing isolation

Iaboni et al (2022) surveyed staff working in care homes in Ontario, Canada, asking about their experiences with implementing infection control measures (IPC) in the first two waves, in the context of a preliminary evaluation of a toolkit to support compassionate and effective isolation for people with dementia (the Dementia Isolation Toolkit). Their study found that most homes were not able to implement IPC measures effectively, with residents leaving isolation to circulate in common areas and not following hand hygiene or masking requests. Staff found it difficult to mitigate the impact on resident well-being, with mental health impacts, physical decline, and safety issues all reported.

Staff identified many barriers to isolating residents effectively- in particular, staff distress about the impact of isolation on residents’ quality of life (61%), and their fear about the reaction of residents when enforcing these measures (59%) were reported as important barriers to the effectiveness of isolation. Moral distress around the implementation of these measures was high- one-third (33%) had large to extreme amounts of moral distress, 84% had an increase in moral distress since the start of the pandemic, and 40% reported a large impact of moral distress on their job satisfaction. Around one third of respondents had used tools from the Dementia Isolation Toolkit, and of those, about half found the toolkit helpful at reducing their level of distress.

References:

Iaboni, A., Quirt, H., Engell, K. et al. Barriers and facilitators to person-centred infection prevention and control: results of a survey about the Dementia Isolation Toolkit. BMC Geriatr 22, 74 (2022). https://doi.org/10.1186/s12877-022-02759-4

Update for: Ontario (Canada) Last updated: February 6th, 2022 Contributors: Andrea Iaboni |

4.05. Reforms to address Long-Term Care workforce recruitment, training, pay and conditions

To improve staffing levels, in November 2020, the Ontario government announced funding to increase the average daily direct care from a nurse or personal support worker per long-term care resident to four hours a day by 2025. The Act proposes to enshrine this commitment in legislation, and to increase care provided by allied health care professionals to an average of 36 minutes per resident per day by March 31, 2023. The proposed Act provides that higher (but not lower) targets of average care may be established by regulation (source: Fixing Long-Term Care Act, 2021;New Legislation To Reform Ontario’s Long-Term Care Sector).

Update for: Ontario (Canada) Last updated: December 10th, 2021

4.09. Reforms to improve care homes, including new standards and building regulations

The Fixing Long-Term Care Act, announced in 2021, would permit the Minister of Long-Term Care to develop a policy outlining how many beds are needed in the province and where these beds are most needed (source: Bill 37, Providing More Care, Protecting Seniors, and Building More Beds Act, 2021).

Update for: Ontario (Canada) Last updated: December 10th, 2021

4.12. Reforms to strengthen and guarantee the rights and voice of people who use and provide care

The Fixing Long-Term Care Act, 2021 proposes an expanded Residents’ Bill of Rights which includes a right to ongoing and safe support by caregivers and a right to be provided with care and services based on a palliative care philosophy (source: Bill 37, Providing More Care, Protecting Seniors, and Building More Beds Act, 2021).

Update for: Ontario (Canada) Last updated: December 10th, 2021