Long-Term Care Facility Workers' Perceptions of the Impact of Subcontracting on their Conditions of Work and the Quality of Care: A Qualitative Study in British Columbia

The association of facility ownership with COVID-19 outbreaks in long-term care homes in British Columbia, Canada: a retrospective cohort study

BACKGROUND

Long-term care (LTC) in Canada is delivered by a mix of government-, for-profit- and nonprofit-owned facilities that receive public funding to provide care, and were sites of major outbreaks during the early stages of the COVID-19 pandemic. We sought to assess whether facility ownership was associated with COVID-19 outbreaks among LTC facilities in British Columbia, Canada.

METHODS

We conducted a retrospective observational study in which we linked LTC facility data, collected annually by the Office of the Seniors Advocate BC, with public health data on outbreaks. A facility outbreak was recorded when 1 or more residents tested positive for SARS-CoV-2 between Mar. 1, 2020, and Jan. 31, 2021. We used the Cox proportional hazards method to calculate the adjusted hazard ratio (HR) of the association between risk of COVID-19 outbreak and facility ownership, controlling for community incidence of COVID-19 and other facility characteristics.

RESULTS

Overall, 94 outbreaks involved residents in 80 of 293 facilities. Compared with health authority-owned facilities, for-profit and nonprofit facilities had higher risks of COVID-19 outbreaks (adjusted HR 1.99, 95% confidence interval [CI] 1.12-3.52 and adjusted HR 1.84, 95% CI 1.00-3.36, respectively). The model adjusted for community incidence of infection (adjusted HR 1.12, 95% CI 1.07-1.17), total nursing hours per resident-day (adjusted HR 0.84, 95% CI 0.33-2.14), facility age (adjusted HR 1.01, 95% CI 1.00-1.02), number of facility beds (adjusted HR 1.20, 95% CI 1.12-1.30) and facilities with beds in shared rooms (adjusted HR 1.16, 95% CI 0.73-1.85).

INTERPRETATION

Findings suggest that ownership of LTC facilities by health authorities in BC offered some protection against COVID-19 outbreaks. Further study is needed to unpack the underlying pathways behind this observed association.

Biopower under a state of exception: stories of dying and grieving alone during COVID-19 emergency measures

During the COVID-19 pandemic, restrictions for visitors and caregivers in healthcare settings and long-term care (LTC) facilities were enacted in the larger context of public health policies that included physical distancing and shelter-in-place orders. Older persons residing in LTC facilities constituted over half of the mortality statistics across Canada during the first wave of the COVID-19 pandemic. Using the poststructuralist work of Agamben, Foucault and Mbembe we conducted a thematic analysis on news reports. The extracts of media stories presented in our paper suggest that the scholarship on (bio)power and necropolitics is central for understanding the ways the COVID-19 crisis reveals the pragmatic priorities-and the 'health' and political values-that undergird the moral imagination of the public, including the educated classes of advanced Western democracies. Our critical analysis shows that by isolating individuals who were sick, fragile, and biologically and socially vulnerable, undifferentiated population management policies like social distancing, when piled on the structural weakness of health systems, reproduced inequities and risk for those in need of medical care, advocacy, and social companionship in acute moments of illness, death and grief. Considering the unprecedented deployment of governmental power via public health interventions based on social regulation to protect the population during the crisis-how can we understand so much death and suffering among the most vulnerable?