Canada – Page 2 – Resources to support community and institutional Long-Term Care responses to COVID-19

LTCcovid Country Profile – Printable Version

1.01. Population size and ageing context

As of 2019, the total population in BC is 5,071,336. There are 948,062 people over the age of 65 and 118,479 people over the age of 85 (source: https://bcstats.shinyapps.io/popApp/).

Update for: British Columbia (Canada) Last updated: February 11th, 2022

1.02. Long-Term Care system governance

Provinces in Canada have jurisdiction over the health care sector but are governed under the Canada Health Act, which establishes “criteria and conditions related to insured health services and extended health care services that the provinces and territories must fulfil to receive the full federal cash contribution under the Canada Health Transfer”. LTC facilities are not included under the Canada Health Act and are solely under the jurisdiction of the 5 regional health authorities (source: https://www.canada.ca/en/health-canada/services/health-care-system).

Update for: Canada Last updated: February 11th, 2022

1.02. Long-Term Care system governance

Five regional health authorities are accountable for all LTC including residential facilities and community care. However, public health authority owned facilities receive more support and oversight compared to privately owned facilities (source: https://news.gov.bc.ca/files/1.25.2021_LTC_COVID-19_Response_Review.pdf). BC has five regional health authorities and a Provincial Health Services Authority (PHSA), is responsible for managing the quality, coordination, accessibility and cost of certain province-wide health care programs. Each health authority has oversight over their own publicly owned LTC facilities. However, there is lack of coordination between health and social care. Healthcare is monitored more by the national government although jurisdiction is under the provincial government, whereas social care is almost exclusively provided and monitored by regional health authorities within the province (source: Health Authority: Overview).

Update for: British Columbia (Canada) Last updated: February 11th, 2022

1.03. Long-term care financing arrangements and coverage

In total, LTC services in British Columbia cost $2 billion CAD per year, with the majority, $1.3 billion CAD, spent in the contracted sector (source: https://www.seniorsadvocatebc.ca/app/uploads/sites/4/2020/02/ABillionReasonsToCare.pdf).

LTC services are available through publicly subsidized and privately funded services. Some publicly subsidized home and community care services are provided free of charge. For example, British Columbia has the highest recommended funded hours per resident day at 3.36 hours, higher than the Canadian average of 3.30. For other services, the cost is shared between the Ministry of Health and the person receiving services. The amount paid by individuals receiving care is called the client rate. Client rates are determined by BC’s health authorities and may be calculated based on income or set as a fixed rate, depending on the type of care received. For most LTC facilities, the person receiving care pays up to 80% of their income taxation and can also apply for a reduced rate due to financial hardship (source: https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/who-pays-for-care; https://rsc-src.ca/sites/default/files/LTC%20PB%20%2B%20ES_EN_0.pdf).

Unpaid carers (commonly referred to as family caregivers in Canada) are represented by the Family Caregivers of British Columbia (FCBC), a provincial non-profit. FCBC represents over 1 million people in British Columbia. Although there is no data yet on how many family caregivers are present in the province. FCBC provides access to information and education and acts as a voice for family caregivers when liaising with other stakeholders in the health and social sector (source: https://www.familycaregiversbc.ca/).

LTC residents and individuals receiving continuous care in the community are charged a portion of their after-tax income. Individuals may apply for a reduction in rates due to financial hardship. For the most part, anyone requiring care should be able to receive it (source: https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/who-pays-for-care).

Update for: British Columbia (Canada) Last updated: February 11th, 2022

1.04. Approach to care provision, including sector of ownership

Publicly subsidized services are provided by regional health authorities who deliver them through health authority owned or contracted private/not-for-profit facilities. For-profit, private facilities are often regarded as inferior to publicly owned/health authority owned facilities in terms of care, access to equipment, and government support.

In 2020, 33% of publicly funded LTC beds are operated directly by health authorities. The remaining 18,000 beds are delivered by for-profit companies (35%) and not-for-profit societies (32%) who have been contracted by one of the five regional health authorities in B.C.

A recent paper situates the contemporary crisis of COVID-19 deaths in seniors’ care facilities within the restructuring and privatisation of this sector. Through an ethnographic comparison in a for-profit and non-profit facility, they explore what they identify as brutal and soft modes of privatisation within publicly subsidised long-term seniors’ care in Vancouver, British Columbia, and their influence on the material and relational conditions of work and care. Workers in both places are explicit that they deliver only bare-bones care to seniors with increasingly complex care needs, and they document the distinct forms and extent to which these precarious workers give gifts of their time, labour, and other resources to compensate for the gaps in care that result from state withdrawal and the extraction of profits within the sector. They nonetheless locate more humane and hopeful processes in the non-profit facility, where a history of cooperative relations between workers, management, and families suggest the possibility of re-valuing the essential work of care (Molinary and Pratt, 2021; COVID-19_Response_Review.pdf; ABillionReasonsToCare.pdf).

References:

Molinari, N. and Pratt, G. (2021), Seniors’ Long-Term Care in Canada: A Continuum of Soft to Brutal Privatisation. Antipode. https://doi.org/10.1111/anti.12711

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

1.06. Care coordination

There is a lack of integration between health and social care both at a national and provincial level. Healthcare is broadly regulated by the Canada Health Act but provinces have jurisdiction over the operational aspects, funding, and services offered. Social care, including home and continuing care, are not covered under the Canada Health Act. Although the health and social care sectors are not governed under the same regulations, it is the same five regional health authorities providing both social and health care. The system is fragmented and power dynamics are difficult to understand (source: https://www.canada.ca/en/health-canada/services/health-care-system/reports-publications/health-care-system/canada.html).

Update for: British Columbia (Canada) Last updated: February 11th, 2022

1.07. Information and monitoring systems

Data availability presented a key challenge in managing pandemic, for example, lack of baseline data made it difficult to calculate excess staffing needs and costs during COVID-19 (source: https://news.gov.bc.ca/files/1.25.2021_LTC_COVID-19_Response_Review.pdf).

Update for: British Columbia (Canada) Last updated: February 11th, 2022

1.08. Care home infrastructure

There are longstanding problems in the LTC homes in Canada, which have been the subject of many reports, commissions and enquiries. A review carried out for the Royal Society of Canada Working Group on LTC found that, between 1998 and 2020, there were 80 reports making recommendations on the Long-Term Care system and LTC homes. The most common recommendations were for increased funding (66.7% of reports), standards/regulation/audits of LTC quality of care (58.3%), and regulation/reform/standardisation of education and training for staff (https://f1000research.com/articles/10-87).

Update for: Canada Last updated: January 31st, 2022

1.08. Care home infrastructure

89% of the rooms in LTC facilities are single-occupancy rooms, 7% are double-occupancy, and 4% are multi-bed rooms (3 or more beds). 76% of residents reside in single-occupancy rooms. In health authority owned facilities, 57% of residents reside in single-occupancy rooms compared to 85% in contracted facilities (source: QuickFacts2020-Summary.pdf).

Update for: British Columbia (Canada) Last updated: February 11th, 2022

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

Majority of LTC and AL health care workers in BC are represented by a union, the largest being The Hospital Employers Union (HEU) (source: https://news.gov.bc.ca/files/1.25.2021_LTC_COVID-19_Response_Review.pdf).

Normally, to become a health care assistant, one must complete six to eight months of post-secondary education at their own expense before applying for a position. Due to staffing shortages during COVID-19, BC has launched the subsidized Career Access Program, a sponsorship program where individuals will work as a health support worker while training to become a health care assistant. Applications for the program began in early 2021 (source: https://www2.gov.bc.ca/gov/content/economic-recovery/work-in-health-care; https://www.choose2care.ca/hcap/).

Update for: British Columbia (Canada) Last updated: February 11th, 2022

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 |

1.11. Role of unpaid carers and policies to support them

Unpaid carers in Canada are represented by the Family Caregivers of British Columbia (FCBC), a provincial non-profit. FCBC represents over 1 million people in British Columbia. Although there is no data yet on how many family caregivers are present in the province, FCBC provides access to information and education and acts as a voice for caregivers when liaising with the health and social sector (source: https://www.familycaregiversbc.ca/).

Update for: British Columbia (Canada) Last updated: March 3rd, 2022

1.12. Personalisation, user voice, choice and satisfaction

Individuals receiving LTC may choose between privately or public owned LTC facilities, day services, home support, assisted living, etc. which are all publicly subsidized (source: https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/care-options-and-cost). A survey by the Angus Reid Institute found that two-thirds of Canadians (66%) would like the government to take over – or nationalize – LTCFs in order to increase the health and safety outcomes for people requiring long-term care (source: http://angusreid.org/covid19-long-term-care/).

Update for: British Columbia (Canada) Last updated: February 11th, 2022

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 |

1.14. Pandemic preparedness of the Long-term care sector

A published practice paper presenting the chronology of events in Quebec leading to excess mortality in long-term care facilities (LTCFs) highlighted the lack of preparation in LTCFs and a critical shortage of staff. The massive transfer of older persons from hospitals to LTCFs, combined with human resources management, and a critical shortage of permanent staff before and during the crisis, generated unhealthy living conditions in LTCFs (Beaulieu et al. 2021).

References:

Beaulieu, M., Cadieux Genesse, J., & St-Martin, K. (2021). High death rate of older persons from COVID-19 in Quebec (Canada) long-term care facilities: chronology and analysis. Journal of Adult Protection, 23(2), 110–115. https://doi.org/10.1108/JAP-08-2020-0033

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

1.14. Pandemic preparedness of the Long-term care sector

Information on pre-pandemic prepared in the LTC sector is lacking. However, in terms of Canadian pandemic preparedness for the general population, there is evidence that some lessons were learnt from SARS, which affected Canada more than any other country outside of Asia. While responses differed across provinces, funding for infection control in hospitals increased and legislative changes were made to allow for better collaboration between federal and provincial actors (source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30670-X/fulltext?hss_channel=tw-27013292).

An independent review of the LTC response to COVID-19 was completed in October 2020 and released to the public in January 2021. The review provides a detailed analysis of the government’s and LTC sector’s preparedness. While quick policy decisions prevented further outbreaks in LTC facilities, the pandemic highlighted issues with staffing and Infection Prevention and Control (IPC) training (source: https://news.gov.bc.ca/files/1.25.2021_LTC_COVID-19_Response_Review.pdf).

Update for: British Columbia (Canada) Last updated: February 11th, 2022

2.01. Impact of the COVID-19 pandemic on the country (total population)

As of February 7, 2021, there have been 69,716 confirmed COVID-19 infections in British Columbia and 1,246 deaths attributed to COVID-19, corresponding to 25.45 COVID-19 attributed deaths per 100,000 population (Source: https://resources-covid19canada.hub.arcgis.com/app/cases-cases-per-100k-population-webapp).

The first presumptive positive case of COVID-19 in British Columbia was identified on January 28, 2020. The first case of community transmission was announced on March 5, 2020. On March 18, a provincial state of emergency was declared in British Columbia, and by the end of March, all schools, personal service establishments, and dine-in restaurant services were closed. Health officials considered British Columbia to be successful in flattening the curve by late April and on June 24, the province entered phase 3 of its restart plan, where most establishments were allowed to reopen and non-essential travel within the province resumed. A second wave of COVID-19 was declared in British Columbia on October 19 and in November, mandatory mask policies and new restrictions against social gatherings were introduced. In December, Pfizer and Moderna vaccines were approved for use in Canada. The first dose of COVID-19 vaccine in British Columbia was administered on December 15. As of January 29, 2021, 129.421 vaccine doses have been administered. Current restrictions on social gatherings, restaurant services, fitness centres, and travel have been extended indefinitely (Source: https://bc.ctvnews.ca/scroll-through-this-timeline-of-the-1st-year-of-covid-19-in-b-c-1.5284929).

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

2.02. Deaths attributed to COVID-19 among people using long-term care

The National Institute on Ageing Long-Term COVID-19 Tracker Open Data Working Group collects information on confirmed and presumptive positive, resident and staff cases and death in long-term care settings in Canada from multiple sources including public health units, government reports, media, information posted bu homes publicly and shared with their staff, residents and family. Given this, all cases reported cannot be guaranteed to be laboratory confirmed. This data is updated twice a week.

In Wave 1 (up to September, 2020) NIA data shows there were 7,310 deaths, across 1,171 LTC facilities with outbreaks, making up 74% of total deaths from COVID-19 in Canada for that wave. In Wave 2 (still ongoing at the publishing of this data on February 15, 2021) there were a further 7,016 deaths across, 1,389 LTC facilities with outbreaks. At this time resident deaths across both waves represented 67% of total deaths from COVID-19 in Canada.

As of April 25, 2022, there have been 16,780 COVID-attributed deaths in care home residents. As of the 2016 census Canada had 425,755 residents living across 6029 LTC facilities. Thus, the number of COVID-19 related deaths of LTC residents represents 3.94% of the estimated population in care homes.

Update for: Canada Last updated: May 3rd, 2022 Contributors: Disha Patel |

There is no data on long COVID in the LTC sector specifically, but British Columbia has opened three clinics that offer specialized care for “long haulers”. More than 1,400 people are estimated to still have COVID-19 symptoms three months following initial symptoms (Source: https://www.theglobeandmail.com/canada/british-columbia/article-bc-now-has-three-clinics-for-long-hauler-covid-19-patients-with/).

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

2.04. Impacts of the pandemic on access to care for people who use Long-Term Care

Elective surgeries were postponed during the first wave of COVID-19, but by January 6, 2021, 90% of postponed surgeries have been completed. Health authorities plan to add capacity for additional procedures throughout 2021 and 2022. There is no evidence of discontinuation of care in LTC facilities. However, there is a lack of data published about care in the community and by family providers (Source: https://www.theglobeandmail.com/canada/british-columbia/article-bc-has-completed-90-per-cent-of-elective-surgeries-delayed-because-of/).

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

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

A study carried out between July and October 2020 interviewed residents in care homes, as well as family members. The residents reported missing recreational activities, the loss of social interaction within the care home (for example meal times), lack of access to physiotherapy. Some residents described loss of weight. In terms of wellbeing, residents commonly described sadness, loneliness, fear and frustration. They also commented on the impact on others, particularly residents with dementia and expressed concern for them as they were not able to make phone calls or understand the reasons for changes in routines. Some residents expressed that they felt that the public health rules were affecting them more than the rest of the population and many were critical of the measures, particularly limits on visits. Residents also felt that more staff were needed and were concerned about the wellbeing of staff and their working conditions (Ickert et al., 2021).

References:

Ickert C., Stefaniuk R., Leask B.A. (2021) Experiences of long-term care and supportive living residents and families during the COVID-19 pandemic: “It’s a lot different for us than it is for the average Joe”. Geriatric Nursing 42(6): 1547-1555 https://doi.org/10.1016/j.gerinurse.2021.10.012

Update for: Alberta (Canada) Last updated: January 7th, 2022

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

A recent survey by Safe Care BC found that many LTC staff had increased psychological fears and anxiety and intention to leave as a result of COVID-19. They felt a psychosocial burden responding to pandemic and had concerns about their personal safety and ability to care for residents (Source: https://news.gov.bc.ca/files/1.25.2021_LTC_COVID-19_Response_Review.pdf).

A report by the office of the Seniors Advocate British Columbia highlights that the use of antipsychotics among LTC residents has increased by 7% during the COVID-19 pandemic and points towards interRAI assessments suggesting ‘unintended weight loss and worsening mood’ among residents.

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

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

A study in New Brunswick (Canada) used interRAI LTCF data to compare impacts on depression, delirium and behavioural problems in seven LTCFs. It found that, in the period studied (three months of lockdown at the beginning of the pandemic, up to June 2020, during which those homes did not experience outbreaks and had measures in place to mitigate the impacts of lockdown) the initial lockdown period had no negative impact on depression, delirium, or behavioural problems (McArthur et al, 2021).

References:

McArthur C., Saari M., Heckman G.A. et al. (2021) Evaluating the effect of COVID-19 pandemic lockdown on Long-Term Care residents mental health: a data-driven approach in New Brunswick, JAMDA; 22(1): 187–192. doi: 10.1016/j.jamda.2020.10.028

Update for: New Brunswick (Canada) Last updated: March 4th, 2022

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

2.07. Impacts of the pandemic on unpaid carers

Research found that unpaid carers were worried about the impact on their relatives with dementia and reported reduced or altered formal care support, as well as anxiety and feelings of burnout (Sources: https://journal.ilpnetwork.org/articles/10.31389/jltc.76/; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7952494/).

Update for: Canada Last updated: January 6th, 2022

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 |

2.09. Impact of the pandemic on workforce shortages in the Long-Term Care sector

There are media reports of a surge in COVID-19 cases driven by the spread of the Omicron variant resulting in staffing shortages across the country, and leading to shortages of a range of services, including home care. Providers reported that the recent staffing shortages throughout the workforce have left the already troubled sector in further crisis (see section 2.04 of this report for more details on access to care).

Update for: Canada Last updated: January 26th, 2022

3.01. Brief summary of the overall pandemic response (not specific to Long-Term Care)

The first presumptive positive case of COVID-19 in British Columbia was found on January 28, 2020. The first case of community transmission was announced on March 5. On March 18, a provincial state of emergency was declared in British Columbia and by the end of March, all schools, personal service establishments, and dine-in restaurant services were closed. Health officials considered British Columbia to be successful in flattening the curve by late April and on June 24, the province entered phase 3 of its restart plan where most establishments were allowed to reopen and non-essential travel within the province resumed. A second wave of COVID-19 was declared in British Columbia on October 19 and in November, mandatory mask policies and new restrictions against social gatherings were introduced. In December, Pfizer and Moderna vaccines were approved for use in Canada. The first dose of COVID-19 vaccine in British Columbia was administered on December 15. As of January 29, 2021, 129,421 vaccine doses have been administered. Current restrictions on social gatherings, restaurant services, fitness centres, and travel have been extended indefinitely (Source: https://bc.ctvnews.ca/scroll-through-this-timeline-of-the-1st-year-of-covid-19-in-b-c-1.5284929).

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

3.02. Governance of the Long-Term Care sector's pandemic response

Provincial Health Officer Dr Bonnie Henry and Minister of Health Adrian Dix had a “united and consistent presence in providing key messages to the public which may have led to greater adherence and compliance to public health recommendations. Each regional health authority mobilized an Emergency Operations Centre (EOC), which included the medical health officer (MHO). MHO has authority under the Public Health Act to manage the public health response and outbreak in their region. EOC was useful and effective in coordinating responses in health authority owned and operated (public) LTC facilities but not privately owned or affiliate facilities (Source: https://news.gov.bc.ca/files/1.25.2021_LTC_COVID-19_Response_Review.pdf).

There was a lack of coordination between health and social care. Healthcare is monitored more by the national government, although jurisdiction is under the provincial government. Social care is almost exclusively provided and monitored by regional health authorities within the provinces. While the same five health authorities oversee both health and social care, the creation of emergency committees and new medical health officer roles within these authorities created confusion regarding decision making power and authority.

Update for: British Columbia (Canada) Last updated: March 3rd, 2022

3.02. Governance of the Long-Term Care sector's pandemic response

A published paper critically reviews Canada’s response to the COVID-19 pandemic with a focus on the role of the federal government in this public health emergency, considering areas within its jurisdiction (international borders), areas where an increased federal role may be warranted (long-term care), as well as its technical role in terms of generating evidence and supporting public health surveillance, and its convening role to support collaboration across the country.

Source:

Allin, S., Fitzpatrick, T., Marchildon, G., & Quesnel-Valleé, A. (2021). The federal government and Canada’s COVID-19 Responses: From “we’re ready, we’re prepared” to “fires are burning.” Health Economics, Policy and Law. https://doi.org/10.1017/S1744133121000220

Update for: Canada Last updated: November 30th, 2021 Contributors: William Byrd |

3.02.01. National or equivalent Covid-19 Long-Term Care taskforce

There was no national taskforce because social care/LTC is governed provincially. British Columbia Ministry of Health set up a Health Emergency Command Centre (HECC) structure with the purpose of bringing people together and assisted with communication, but HECC decision making was not well integrated into provincial decision-making and accountability frameworks. The power of HECC was not clearly defined, which led to uncertainties around who should be making key decisions and how to use funds (Source: https://news.gov.bc.ca/files/1.25.2021_LTC_COVID-19_Response_Review.pdf).

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

3.02.02. Measures to improve coordination between Health and Social Care in response to the pandemic

While the same five health authorities in British Columbia oversee both health and social care, the creation of emergency committees and new medical health officer roles within these authorities created confusion regarding decision making power and authority (Source: https://news.gov.bc.ca/files/1.25.2021_LTC_COVID-19_Response_Review.pdf).

Update for: British Columbia (Canada) Last updated: November 2nd, 2021

3.03. Monitoring Covid-19 impacts in the Long-Term Care sector: data and information systems

Limitations in accessing basic LTC and assisted living sector data, including human resources and expense data, created challenges in implementing COVID-19 policy and operational support initiatives (Source: https://news.gov.bc.ca/files/1.25.2021_LTC_COVID-19_Response_Review.pdf). LTC operators reported “spending hundreds of extra hours to respond to requests for reporting and additional inspections over the course of the pandemic” and many providers found these requests to be overwhelming. But the government saw this information as essential to evaluate how LTC sector was doing throughout COVID-19 and what further assistance/support was needed.

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

3.04. Financial measures to support users and providers of Long-Term Care

At the beginning of the pandemic, LTC and assisted living providers reported spending an excessive amount on COVID-related expenditures and were unsure as to whether they would be reimbursed, because the Ministry of Health had not provided clear guidelines or timelines. Providers also reported lost revenue from an increased vacancy rate.

After the province announced additional funding to meet demands, LTC operators found funding distribution to be problematic. LTC operators were not sure how the funding was allocated and distributed. Additionally, privately-owned sites were not included in wage levelling and did not qualify for pandemic pay despite filling the same role. Managers and leaders were not included in pandemic pay, and in some instances, managers were paid less than the people working under them.

Despite supplemental funding totalling 1.3 full time equivalent per full-time staff person in order to cover additional staffing demands, operators found it difficult to fill the extra hours due to staffing shortages (Source: https://news.gov.bc.ca/files/1.25.2021_LTC_COVID-19_Response_Review.pdf).

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

3.05. Long-Term Care oversight and regulation functions during the pandemic

Health authority owned LTC facilities were found to have had better oversight, management, and support during the pandemic. Provincial health officer orders could be interpreted differently in each health authority, for example leading to different visitor guidelines/policies. The ministry established a clinical reference group as part of the Health Emergency Management British Columbia (HEMBC) to develop clinical policy responses to COVID-19. However, it is unclear how the HEMBC differs from the Provincial Health Services Authority (Source: https://news.gov.bc.ca/files/1.25.2021_LTC_COVID-19_Response_Review.pdf).

Update for: British Columbia (Canada) Last updated: March 3rd, 2022

3.06. Support for care sector staff and measures to ensure workforce availability

A single site order was introduced on March 25, 2020, meaning that workers in British Columbia’s LTC and assisted-living facilities were limited to working in a single facility. On March 26, 2020, LTC operators were asked to provide personal and employment information, including name, contact information, and Social Insurance Numbers for all staff to the ministry to support decisions about the allocation of staff among facilities. On April 10, 2020, all employees within the scope of the Single Site Order would receive a common hourly wage regardless of their facility and employer. On April 15, 2020, Regional Health Boards were ordered to establish a working group to make recommendations to their Medical Health Officer about the assignment of staff because staffing shortages became a bigger issue following the Single Site Order (Source: https://news.gov.bc.ca/files/1.25.2021_LTC_COVID-19_Response_Review.pdf).

Update for: British Columbia (Canada) Last updated: March 3rd, 2022

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

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:

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: Canada Last updated: March 3rd, 2022

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

At the beginning of the pandemic, LTC providers did not feel confident with IPC and emergency management practices and felt unaware of emergency support resources that could be used such as IPC specialists and staffing support. Providers did not receive regular training and education on IPC, emergency management, and how to use PPE. When guidance about PPE was given, they were inconsistent and unclear. There was also a lack of guidance for community care providers and for residents with advanced dementia or behaviour and aggression challenges, who generally do not understand or comply with social distancing requirements.

These concerns have since been addressed by the BC Centre for Disease Control releasing frequently updated IPC guidelines for LTC facilities and assisted living (https://news.gov.bc.ca/files/1.25.2021_LTC_COVID-19_Response_Review.pdf; http://www.bccdc.ca/Health-Professionals-Site/Documents/COVID19_HomeCommunityCareIPCGuidance.pdf; http://www.bccdc.ca/health-professionals/clinical-resources/covid-19-care/clinical-care/long-term-care-facilities-assisted-living).

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

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

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

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

3.07.01. Measures in relation to transfers to and from hospital, from community to care homes and between settings

Temporary suspension of interfacility transfers, except for cases of intolerable risk to the patient. Facilities were required to notify the receiving facility if an outbreak occurred within a 14-day period of the transfer. The outbreak protocol states that residents transferred to acute care for treatment of COVID-19 or its complications, can return to facility when medically stable. July 15, 2020 – Notification that interfacility transfers may resume if precautions are taken. Services must follow regional MHO directions (including restricting transfers between facilities with active COVID-19 outbreaks). Precautions (e.g., 14-day isolation) for interfacility transfers will be at the direction of the MHO based on assessed regional risk (https://news.gov.bc.ca/files/1.25.2021_LTC_COVID-19_Response_Review.pdf).

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

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

Guidance

If a positive case is found in a LTC facility, the operator must close the affected floor/unit/ward or facility/residence to new admissions, re-admissions, or transfers, unless medically necessary and/or approved by a Medical Health Officer. COVID positive residents are not transferred to an external quarantine facility and are only transferred to acute medical care for COVID if necessary (http://www.bccdc.ca/Health-Info-Site/Documents/COVID19_LongTermCareAssistedLiving.pdf).

Update for: British Columbia (Canada) Last updated: January 12th, 2022

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 |

3.07.03. Visiting and unpaid carer policies in care homes

In Ontario, Canada, social outdoor visits were generally encouraged. From September 2020, family carers providing essential caregiving activities could enter the homes. As cases increase again, some areas limited social visits but enable family carers to continue to see their relatives. Family carers entering homes must get regular COVID-19 (bi-weekly/weekly in areas with high transmission) to be allowed to enter.

In Quebec, the government stated in November 2020 that care homes could not make the provision of a negative test a requirement for visitors (https://ltccovid.org/wp-content/uploads/2021/01/Care-home-visiting-policies-international-report-19-January-2021-1.pdf).

Update for: Canada Last updated: September 8th, 2021

3.07.03. Visiting and unpaid carer policies in care homes

Visitor restrictions were put in place to only allow for essential visitors. March 19, 2020 – The definition of essential visitor was expanded and it was indicated that HAs would determine if a visit was essential. June 30, 2020 – Further amendment of the policy, stating that each facility must have a plan in place in accordance with BCCDC IPC (Infection Prevention and Control) guidance to indicate how social visits would be facilitated (https://news.gov.bc.ca/files/1.25.2021_LTC_COVID-19_Response_Review.pdf).

Visitor guidance for long-term care published March 30, 2021, stated that up to two adults and one child can visit a resident indoors without staff present, which may be increased when outdoors depending on current provincial guidelines (http://www.bccdc.ca/health-professionals/clinical-resources/covid-19-care/clinical-care/long-term-care-facilities-assisted-living). There are no restrictions on the frequency and duration of visits, with physical touching allowed as long as masks are worn. Residents may leave nursing homes for non-essential reasons and are not required to isolate upon return.

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

3.08. Access to testing and contact tracing for people who use and provide Long-Term Care

In care homes: Initially testing was only completed for symptomatic staff and patients, those experiencing “influenza-like illness (ILI) or respiratory symptoms, clients with fever without known cause, and clients experiencing other symptoms possibly due to COVID-19”. Contact tracing was completed by both public health authorities and the LTC facility itself. Residents who share rooms with the infected resident should be considered as exposed and should be monitored for symptoms at least twice a day for 14 days from last date of exposure (http://www.bccdc.ca/Health-Info-Site/Documents/COVID19_LongTermCareAssistedLiving.pdf). Staff wearing all appropriate PPE are not considered a close contact of a patient who tests positive (http://www.bccdc.ca/health-professionals/clinical-resources/covid-19-care/testing-and-case-management-for-healthcare-workers).

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

3.09. Access to Personal Protection Equipment (PPE) in the Long-Term Care sector

Health authority owned and operated facilities were supported in procuring PPE, managing staffing availability, and IPC education and training, whereas private and affiliate sites felt that they were left to manage independently unless an outbreak occurred. For example, one Health Authority provided PPE to private providers with 3 days notice, where others only provided supplies to health authority owned and operated facilities. Private LTC providers were left to source PPE through local community initiatives or unauthorized distributors, which often did not meet proper IPC requirements. Two policies were introduced regarding PPE: Emergency Prioritization in a Pandemic Equipment (PPE) Allocation Framework March 25, 2020 and Personal Protective Equipment (PPE) Supply, Assessment, Testing and Distribution Protocol May 1, 2020 (https://news.gov.bc.ca/files/1.25.2021_LTC_COVID-19_Response_Review.pdf).

Update for: British Columbia (Canada) Last updated: November 9th, 2021

3.10. Use of technology to compensate for difficulties accessing in-person care and support

A study among unpaid carers in Canada using remote services reported some advantages but also disadvantages and some reported technical barriers (Lorenz-Dant & Comas-Herrera, 2021). A report recommends the use of technology to ensure care in place for people in residential care settings (https://www.ic.gc.ca/eic/site/063.nsf/eng/h_98049.html).

References:

Lorenz-Dant, K and Comas-Herrera, A. 2021. The Impacts of COVID-19 on Unpaid Carers of Adults with Long-Term Care Needs and Measures to Address these Impacts: A Rapid Review of Evidence up to November 2020. Journal of Long-Term Care, (2021), pp. 124–153. DOI: https:// doi.org/10.31389/jltc.76

Update for: Canada Last updated: February 11th, 2022

3.10. Use of technology to compensate for difficulties accessing in-person care and support

Telemedicine and telehealth are covered under the Medical Services Plan. Individuals seeking care may also contact the non-emergency medical support phone line by dialing 811.

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

3.11. Vaccination policies for people using and providing Long-Term Care

COVID-19 vaccination policies are created by each of the thirteen provinces or territories. As a result, significant variation exists across the country. People who live in Long-Term Care Facilities (LTCFs), staff working there and, in some provinces, essential family caregivers (EFCs) were prioritised for vaccination. This resulted in a rapid reduction in COVID-19 infections and deaths in LTCFs during 2021. Vaccination take up among LTCF residents has been very high, but there has been some hesitancy among staff, which has led to several provinces introducing vaccination mandates for their LTC staff. Also, British Columbia and Nova Scotia also require that all visitors, including EFCs are fully vaccinated before visiting.

Booster shots for residents in LTCFs were recommended on 28th September 2021 by the National Advisory Community on Immunization (NACI). This recommendation is supported by increasing evidence from studies in nursing homes and assisted living facilities (see, for example, Zhang et al. 2021).

References:

Zhang, A. et al. (2021). ‘Antibody Responses to 3^rd Dose mRNA Vaccines in Nursing Home and Assisted Living Residents’. doi.org/10.1101/2021.12.17.21267996. Retrieved from: Ontario study (pre-print).

Update for: Canada Last updated: February 11th, 2022

3.11. Vaccination policies for people using and providing Long-Term Care

Phase 1 prioritized LTC: residents and staff of LTC facilities, individuals assessed and waiting for LTC, residents and staff of assisted living residences, essential visitors to LTC and AL facilities (https://www2.gov.bc.ca/gov/content/safety/emergency-preparedness-response-recovery/covid-19-provincial-support/vaccines). Distribution depends on the province/territory jurisdiction – distribution difficult in northern areas, Moderna vaccine may easier to deliver than Pfizer (https://ltccovid.org/2021/01/25/the-rollout-of-the-covid-19-vaccines-in-care-homes-in-canada/). Pfizer’s discontinuation of shipment for week of Jan 25 sets back vaccination schedule (https://ltccovid.org/2021/01/25/the-rollout-of-the-covid-19-vaccines-in-care-homes-in-canada/). All LTC facility residents and the people who care for them have been offered vaccine in all health authorities around the province, as of February 9. Uptake is quite high, 87% of long-term care residents have received their 1st dose (https://bc.ctvnews.ca/all-residents-and-staff-of-b-c-s-long-term-care-homes-have-been-offered-vaccines-top-doctor-1.5288511).

Covid-19 vaccinations are not mandatory for long-term staff or any sector. As of April 30, 2021, 142,000 healthcare, assisted-living and long-term care staff in British Columbia (B.C.) had received vaccinations but the percentage of vaccinated staff in the province is unknown because not all provincial health authorities report total number of registered staff. 82.9 per cent of Vancouver Coastal Health’s eligible staff had received a first dose of COVID-19 vaccine, leaving more than 4,200 workers unvaccinated (https://www.cbc.ca/news/canada/british-columbia/bc-health-care-worker-vaccination-1.6008486).

The Ministry of Health is taking an educational approach, informing staff working in Long-Term Care instead of making vaccines compulsory (https://vancouversun.com/news/covid-19-high-rate-of-vaccinations-among-care-home-staff-dispels-anti-vax-fears).

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

3.12. Measures to support unpaid carers

The Canada Emergency Response Benefit (CERB) was offered between March 15, 2020 and September 26, 2020. Individuals were eligible if they stopped working due to taking care of a family member with COVID-19, having a disability with usual care not available because of COVID-19, or a child because schools are closed. CERB has now been discontinued; however, unpaid carers are eligible for the Canada Recovery Care Benefit (CRCB). CRCB provides income support to employed and self-employed individuals who are unable to work because they must care for their child under 12 years old or a family member who needs supervised care (https://www.canada.ca/en/services/benefits/ei/cerb-application.html#eligible; https://www.canada.ca/en/revenue-agency/services/benefits/recovery-caregiving-benefit.html).

As part of British Columbia’s emergency COVID-19 response plan, BC doubled 2020 funding for Family Caregivers of British Columbia to $1 million CAD. Family Caregivers of British Columbia is a non-for-profit organization that provides support for over 1 million unpaid carers (https://news.gov.bc.ca/releases/2020HLTH0141-000763).

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

4.04. Reforms to improve care coordination

As of March 2021, Canada has announced a number of LTC reforms, including reforms intended at improving coordination of LTC services across the health system, and particularly integration at the level of local community services (source: Long-Term Care Services – HSO Health Standards Organization).

Update for: Canada Last updated: February 11th, 2022

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

4.07. Reforms to Long-term care regulatory and quality assurance systems

Health Standards Organization (HSO) is developing (as of November 2021) a National Standard of Canada (NSC) for the co-design and delivery of integrated, resident-and-family-centred LTC services across Canada. The HSO National Long-Term Care Services Standard will provide LTC homes across Canada with evidence-informed practices that define how LTC homes and LTC teams can work collaboratively to keep people safe, provide safe, reliable, and high-quality care, and demonstrate positive, outcomes-focused change (source: Long-Term Care Services – HSO Health Standards Organization).

Update for: Canada Last updated: February 11th, 2022

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