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Senthinathan A, Tadrous M, Hussain S, McKay S, Moineddin R, Chu C, Jaglal SB, Shepherd J, Cadel L, Noonan VK, Craven BC, Tu K, Guilcher SJT. Examining the impact of the COVID-19 pandemic on homecare services among individuals with traumatic and non-traumatic spinal cord injuries. Spinal Cord 2024; 62:406-413. [PMID: 38811768 DOI: 10.1038/s41393-024-00999-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/17/2024] [Accepted: 05/22/2024] [Indexed: 05/31/2024]
Abstract
STUDY DESIGN Descriptive repeated-cross sectional retrospective longitudinal cohort study. OBJECTIVE To investigate the impact of the COVID-19 pandemic on homecare services in individuals with traumatic or non-traumatic Spinal Cord Injury (SCI). SETTING Health administrative database in Ontario, Canada. METHODS A repeated cross-sectional study using linked health administrative databases from March 2015 to June 2022. Monthly homecare utilization was assessed in 3381 adults with SCI using Autoregressive Integrated Moving Average (ARIMA) models. RESULTS Compared to pre-pandemic levels, between March 2020 to June 2022, the traumatic group experienced a decrease in personal and/or homemaking services, as well as an increase in nursing visits from April 2020-March 2022 and June 2022. Case management increased at various times for the traumatic group, however therapies decreased in May 2020 only. The non-traumatic group experienced a decrease in personal and/or homemaking services in July 2020, as well as an increase in nursing visits from March 2020 to February 2021 and sporadically throughout 2020. Case management also increased at certain points for the non-traumatic group, but therapies decreased in April 2020, July 2020, and September 2021. CONCLUSION The traumatic group had decreases in personal and/or homemaking services. Both groups had increases in nursing services, increases in case management, and minimal decreases in therapies at varying times during the pandemic. Investigation is warranted to understand the root cause of these changes, and if they resulted in adverse outcomes.
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Affiliation(s)
| | - Mina Tadrous
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Swaleh Hussain
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
| | - Sandra McKay
- VHA Home HealthCare, Toronto, ON, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Ted Rogers School of Management, Toronto Metropolitan University, Toronto, ON, Canada
| | - Rahim Moineddin
- ICES, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Cherry Chu
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Susan B Jaglal
- ICES, Toronto, ON, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - John Shepherd
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- KITE (Knowledge Innovation Talent Everywhere), Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
| | - Lauren Cadel
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Vanessa K Noonan
- Praxis Spinal Cord Institute, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries, Vancouver, BC, Canada
| | - B Catharine Craven
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
- KITE (Knowledge Innovation Talent Everywhere), Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
| | - Karen Tu
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- North York General Hospital, Toronto, ON, Canada
- Toronto Western Family Health Team, University Health Network, Toronto, ON, Canada
| | - Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Wyer L, Guterman Y, Ewa V, Lang E, Faris P, Holroyd-Leduc J. The impact of the COVID-19 pandemic on transfers between long-term care and emergency departments across Alberta. BMC Emerg Med 2024; 24:9. [PMID: 38185672 PMCID: PMC10773029 DOI: 10.1186/s12873-023-00926-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/27/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Long-term care (LTC) was overwhelmingly impacted by COVID-19 and unnecessary transfer to emergency departments (ED) can have negative health outcomes. This study aimed to explore how the COVID-19 pandemic impacted LTC to ED transfers and hospitalizations, utilization of community paramedics and facilitated conversations between LTC and ED physicians during the first four waves of the pandemic in Alberta, Canada. METHODS In this retrospective population-based study, administrative databases were linked to identify episodes of care for LTC residents who resided in facilities in Alberta, Canada. This study included data from January 1, 2018 to December 31, 2021 to capture outcomes prior to the onset of the pandemic and across the first four waves. Individuals were included if they visited an emergency department, received care from a community paramedic or whose care involved a facilitated conversation between LTC and ED physicians during this time period. RESULTS Transfers to ED and hospitalizations from LTC have been gradually declining since 2018 with a sharp decline seen during wave 1 of the pandemic that was greatest in the lowest-priority triage classification (CTAS 5). Community paramedic visits were highest during the first two waves of the pandemic before declining in subsequent waves; facilitated calls between LTC and ED physicians increased during the waves. CONCLUSIONS There was a reduction in number of transfers from LTC to EDs and in hospitalizations during the first four waves of the pandemic. This was supported by increased conversations between LTC and ED physicians, but was not associated with increased community paramedic visits. Additional work is needed to explore how programs such as community paramedics and facilitated conversations between LTC and ED providers can help to reduce unnecessary transfers to hospital.
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Affiliation(s)
- Leanna Wyer
- Alberta Health Services, Calgary, AB, Canada.
| | | | - Vivian Ewa
- Alberta Health Services, Calgary, AB, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Eddy Lang
- Alberta Health Services, Calgary, AB, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Peter Faris
- Alberta Health Services, Calgary, AB, Canada
| | - Jayna Holroyd-Leduc
- Alberta Health Services, Calgary, AB, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Awosoga OA, Odole AC, Onyeso OK, Doan J, Nord C, Nwosu IB, Steinke C, Ojo JO, Ekediegwu EC, Murphy S. Well-being of professional older adults' caregivers in Alberta's assisted living and long-term care facilities: a cross-sectional study. BMC Geriatr 2023; 23:85. [PMID: 36755216 PMCID: PMC9908505 DOI: 10.1186/s12877-023-03801-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/06/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND For the care need of older adults, long-term care (LTC) and assisted living (AL) facilities are expanding in Alberta, but little is known about the caregivers' well-being. The purpose of the study was to investigate the physical health conditions, mental and emotional health (MEH), health behaviour, stress levels, quality of life (QOL), and turnover and absenteeism (TAA) among professional caregivers in Alberta's LTC and AL facilities. METHODS This cross-sectional survey involved 933 conveniently selected caregivers working in Alberta's LTC and AL facilities. Standardised questions were selected from the Canadian Community Health Survey, Patient Health Questionnaire-9, and Short Form-36 QOL survey revalidated and administered to the participants. The new questionnaire was used to assess the caregivers' general health condition (GHC), physical health, health behaviour, stress level, QOL, and TAA. Data were analysed using descriptive statistics, Cronbach alpha, Pearson's correlation, one-way analysis of variance, and multiple linear regression. RESULTS Of 1385 surveys sent to 39 facilities, 933 valid responses were received (response rate = 67.4%). The majority of the caregivers were females (90.8%) who were ≥ 35 years (73.6%), worked between 20 to 40 h weekly (67.3%), and were satisfied with their GHC (68.1%). The Registered Nurses had better GHC (mean difference [MD] = 0.18, p = 0.004) and higher TAA than the Health Care Aides (MD = 0.24, p = 0.005). There were correlations between caregivers' TAA and each of MEH (r = 0.398), QOL (r = 0.308), and stress (r = 0.251); p < 0.001. The most significant predictors of TAA were the propensity to quit a workplace or the profession, illness, job stress, and work-related injury, F (5, 551) = 76.62, p < 0.001, adjusted R2 = 0.998. CONCLUSION Reducing the caregivers' job stressors such as work overload, inflexible schedule, and poor remuneration, and improving their quality of life, health behaviour, and mental, emotional, and physical health conditions may increase their job satisfaction and reduce turnover and absenteeism.
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Affiliation(s)
- Oluwagbohunmi A. Awosoga
- grid.47609.3c0000 0000 9471 0214Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB Canada
| | - Adesola Christiana Odole
- grid.9582.60000 0004 1794 5983Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Oyo Nigeria
| | - Ogochukwu Kelechi Onyeso
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB, Canada. .,Emerging Researchers and Professionals in Ageing-African Network, Abuja, Nigeria.
| | - Jon Doan
- grid.47609.3c0000 0000 9471 0214Faculty of Art and Sciences, University of Lethbridge, Lethbridge, AB Canada
| | - Christina Nord
- grid.47609.3c0000 0000 9471 0214Faculty of Art and Sciences, University of Lethbridge, Lethbridge, AB Canada
| | - Ifeoma Blessing Nwosu
- grid.412207.20000 0001 0117 5863Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Health Sciences, Nnamdi Azikiwe University, Awka, Anambra Nigeria
| | - Claudia Steinke
- grid.47609.3c0000 0000 9471 0214Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB Canada
| | - Joshua O. Ojo
- grid.9582.60000 0004 1794 5983Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Oyo Nigeria
| | - Ezinne Chika Ekediegwu
- Emerging Researchers and Professionals in Ageing-African Network, Abuja, Nigeria ,grid.412207.20000 0001 0117 5863Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Health Sciences, Nnamdi Azikiwe University, Awka, Anambra Nigeria
| | - Sheli Murphy
- Rural Health, Professional Practice, Research and Libraries, Covenant Care, Edmonton, AB Canada
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4
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Awosoga OA, Odole AC, Onyeso OK, Ojo JO, Ekediegwu EC, Nwosu IB, Nord C, Steinke C, Varsanyi S, Doan J. Perceived strategies for reducing staff-turnover and improving well-being and retention among professional caregivers in Alberta's continuing-care facilities: A qualitative study. Home Health Care Serv Q 2023:1-23. [PMID: 36646111 DOI: 10.1080/01621424.2023.2166889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This qualitative study explored potential factors that lead to turnover and absenteeism and how to improve well-being and retention among professional older-adult-caregivers in Alberta's assisted living (AL) and long-term care (LTC) facilities. Four hundred and forty-seven participants aged 45-54 years were interviewed through a five-item, content-validated open-ended questionnaire. The questionnaire was self-administered in the English language and the soft copy of their responses was transferred into NVIVO version 12 software for coding. A thematic narrative analysis grounded in the "happy productive worker" theory was completed. The main themes were caregivers' perception of the factors affecting their well-being, absenteeism, and turnover, and caregivers' suggestions on ways to improve their well-being and retention. Participants reported that their professional well-being was suboptimal. They suggested that their employers should provide them with the needed social, psychological, and professional support, improve wages and hire more staff to ameliorate absenteeism and turnover rates.
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Affiliation(s)
| | - Adesola Christiana Odole
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - Ogochukwu Kelechi Onyeso
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, Alberta, Canada.,Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Health Sciences, Nnamdi Azikiwe University, Awka, Anambra, Nigeria.,Department of Physiotherapy, Faculty of Health Sciences, Bayelsa Medical University, Yenagoa, Bayelsa, Nigeria
| | - Joshua O Ojo
- Department of Physiotherapy, University of Benin Teaching Hospital, Benin, Edo, Nigeria
| | - Ezinne Chika Ekediegwu
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Health Sciences, Nnamdi Azikiwe University, Awka, Anambra, Nigeria
| | - Ifeoma Blessing Nwosu
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Health Sciences, Nnamdi Azikiwe University, Awka, Anambra, Nigeria
| | - Christina Nord
- Faculty of Art and Sciences, University of Lethbridge, Lethbridge, Alberta, Canada
| | - Claudia Steinke
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, Alberta, Canada
| | - Stephanie Varsanyi
- Faculty of Art and Sciences, University of Lethbridge, Lethbridge, Alberta, Canada
| | - Jon Doan
- Faculty of Art and Sciences, University of Lethbridge, Lethbridge, Alberta, Canada
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Khadka J, Hutchinson C, Milte R, Cleland J, Muller A, Bowes N, Ratcliffe J. Assessing feasibility, construct validity, and reliability of a new aged care-specific preference-based quality of life instrument: evidence from older Australians in residential aged care. Health Qual Life Outcomes 2022; 20:159. [PMID: 36456953 PMCID: PMC9713096 DOI: 10.1186/s12955-022-02065-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/31/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Quality of Life-Aged Care Consumers (QOL-ACC) is a new older-person-specific quality of life instrument designed for application in quality assessment and economic evaluation in aged care. The QOL-ACC was designed from its inception with older people receiving aged care services ensuring its strong content validity. Given that the QOL-ACC has already been validated in home care settings and a preference-weighted value set developed, we aimed to assess feasibility, construct validity and reliability of the QOL-ACC in residential aged care settings. METHODS: Individuals living in residential aged care facilities participated in an interviewer-facilitated survey. The survey included the QOL-ACC, QCE-ACC (quality of aged care experience measure) and two other preference-based quality of life instruments (ASCOT and EQ-5D-5L). Feasibility was assessed using missing data and ceiling/floor effects. Construct validity was assessed by exploring the relationship between the QOL-ACC and other instruments (convergent validity) and the QOL-ACC's ability to discriminate varying levels of self-rated health and quality of life. Internal consistency reliability was assessed using Cronbach's alpha (α). RESULTS Of the 200 residents (mean age, 85 ± 7.7 years) who completed the survey, 60% were female and 69% were born in Australia. One in three participating residents self-rated their health as fair/poor. The QOL-ACC had no missing data but had small floor effects (0.5%) and acceptable ceiling effects (7.5%). It demonstrated moderate correlation with ASCOT (r = 0.51, p < 0.001) and EQ-5D-5L (r = 0.52, p < 0.001) and a stronger correlation with the QCE-ACC (r = 0.57, p < 0.001). Residents with poor self-rated health and quality of life had significantly lower scores on the QOL-ACC. The internal consistency reliability of the QOL-ACC and its dimensions was good (α = 0.70-0.77). CONCLUSIONS The QOL-ACC demonstrated good feasibility, construct validity and internal consistency reliability to assess aged care-related quality of life. Moderate correlations of the QOL-ACC and other instruments provide evidence of its construct validity and signifies that the QOL-ACC adds non-redundant and non-interchangeable information beyond the existing instruments. A stronger correlation with the QCE-ACC than other instruments may indicate that quality of life is more intimately connected with the care experience than either health- or social-related quality of life in residential aged care settings.
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Affiliation(s)
- J Khadka
- grid.1014.40000 0004 0367 2697Health and Social Care Economics Group, Caring Future Institute, College of Nursing and Health Sciences, Flinders University, Sturt North, GPO Box 2100, Adelaide, South Australia 5001 Australia ,grid.430453.50000 0004 0565 2606Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia Australia
| | - C Hutchinson
- grid.1014.40000 0004 0367 2697Health and Social Care Economics Group, Caring Future Institute, College of Nursing and Health Sciences, Flinders University, Sturt North, GPO Box 2100, Adelaide, South Australia 5001 Australia
| | - R Milte
- grid.1014.40000 0004 0367 2697Health and Social Care Economics Group, Caring Future Institute, College of Nursing and Health Sciences, Flinders University, Sturt North, GPO Box 2100, Adelaide, South Australia 5001 Australia
| | - J Cleland
- grid.1014.40000 0004 0367 2697Health and Social Care Economics Group, Caring Future Institute, College of Nursing and Health Sciences, Flinders University, Sturt North, GPO Box 2100, Adelaide, South Australia 5001 Australia
| | - A Muller
- grid.1014.40000 0004 0367 2697College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia Australia
| | - N Bowes
- Uniting AgeWell, Melbourne, VIC Australia
| | - J Ratcliffe
- grid.1014.40000 0004 0367 2697Health and Social Care Economics Group, Caring Future Institute, College of Nursing and Health Sciences, Flinders University, Sturt North, GPO Box 2100, Adelaide, South Australia 5001 Australia
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The Quebec Observatory on End-of-Life Care for People with Dementia: Implementation and Preliminary Findings. Can J Aging 2022; 41:631-640. [PMID: 35137682 DOI: 10.1017/s0714980821000659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Most Canadians with dementia die in long-term care (LTC) facilities. No data are routinely collected in Canada on the quality of end-of-life care provided to this vulnerable population, leading to significant knowledge gaps. The Quebec Observatory on End-of-Life Care for People with Dementia was created to address these gaps. The Observatory is a research infrastructure designed to support the collection of data needed to better understand, and subsequently enhance, care quality for residents dying with dementia. This article reports on the main steps involved in setting up the Observatory, as well as a pilot study that involved 172 residents with dementia who died between 2016 and 2018 in one of 13 participating facilities. It describes the data gathered, methodological changes that were made along the way, feedback from participating facilities, and future developments of the Observatory.
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COVID-19 and the Experiences and Needs of Staff and Management Working at the Front Lines of Long-Term Care in Central Canada. Can J Aging 2022; 41:614-619. [PMID: 35135643 DOI: 10.1017/s0714980821000696] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Across the globe, long-term care has been under increased pressure throughout the COVID-19 pandemic. This is the first study to examine the experiences and needs of long-term care staff and management during COVID-19, in the Canadian context. Our group conducted online survey research with 70 staff and management working at public long-term care facilities in central Canada, using validated quantitative measures to examine perceived stress and caregiver burden; and open-ended items to explore stressors, ways of coping, and barriers to accessing mental health supports. Findings indicate moderate levels of stress and caregiver burden, and highlight the significant stressors associated with working in long-term care during the COVID-19 pandemic (i.e., rapid changes in pandemic guidelines, increased workload, "meeting the needs of residents and families", fear of contracting COVID-19 and COVID-19 coming into long-term care facilities, and concern over a negative public view of long-term care staff and facilities). A small subset (13.2%) of our sample identified accessing mental health supports to cope with work-related stress, with most participants identifying barriers to seeking help. Novel findings of this research highlight the significant and unmet needs of this high-risk segment of the population.
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Culture Change in Long-Term Care-Post COVID-19: Adapting to a New Reality Using Established Ideas and Systems. Can J Aging 2022; 42:351-358. [PMID: 36349718 DOI: 10.1017/s0714980822000344] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Abstract
The response to the COVID-19 pandemic in long-term care (LTC) has threatened to undo efforts to transform the culture of care from institutionalized to de-institutionalized models characterized by an orientation towards person- and relationship-centred care. Given the pandemic’s persistence, the sustainability of culture-change efforts has come under scrutiny. Drawing on seven culture-change models implemented in Canada, we identify organizational prerequisites, facilitatory mechanisms, and frontline changes relevant to culture change that can strengthen the COVID-19 pandemic response in LTC homes. We contend that a reversal to institutionalized care models to achieve public health goals of limiting COVID-19 and other infectious disease outbreaks is detrimental to LTC residents, their families, and staff. Culture change and infection control need not be antithetical. Both strategies share common goals and approaches that can be integrated as LTC practitioners consider ongoing interventions to improve residents’ quality of life, while ensuring the well-being of staff and residents’ families.
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Schneider J, Tsoukalas T, Zulla R, Nicholas D, Hewson J. Exploring the COVID-19 Practice Experiences of Social Workers Working in Long Term Care. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2022:1-13. [PMID: 36285417 DOI: 10.1080/01634372.2022.2139321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/11/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023]
Abstract
The COVID-19 pandemic ushered in multiple public health protocols that shaped the service delivery system supporting older adults, their family caregivers and their formal care providers. In this qualitative study, sixteen social workers employed in long term care facilities in a western province of Canada shared their perspectives about the impacts of the COVID-19 pandemic on their practice early in the pandemic. Participants responded to nine open-ended online survey questions about their practice and experiences. Four themes were identified: (1) a changing and demanding work environment, (2) witnessing transitions in residents' quality of life, (3) impacts on relationships and work climate, and (4) personal impacts on social workers. Recommendations for enhancing capacity in the system were identified. Implications of findings illuminate a need for proactive preparedness approaches in order for social workers to address emergent and changing needs of residents and their families during a pandemic.
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Affiliation(s)
- Joann Schneider
- Continuing Care, Edmonton Zone, Alberta Health Services, Edmonton, Canada
| | | | - Rosslynn Zulla
- Faculty of Social Work, University of Calgary, Calgary, Canada
| | - David Nicholas
- Faculty of Social Work, University of Calgary, Calgary, Canada
| | - Jennifer Hewson
- Faculty of Social Work, University of Calgary, Calgary, Canada
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Moosavi A, Ozturk O, Patrick J. Staff scheduling for residential care under pandemic conditions: The case of COVID-19. OMEGA 2022; 112:102671. [PMID: 35530747 PMCID: PMC9065499 DOI: 10.1016/j.omega.2022.102671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 04/30/2022] [Indexed: 06/14/2023]
Abstract
The COVID-19 pandemic severely impacted residential care delivery all around the world. This study investigates the current scheduling methods in residential care facilities in order to enhance them for pandemic conditions. We first define the basic problem that addresses decisions associated with the assignment and scheduling of staff members, who perform a set of tasks required by residents during a planning horizon. This problem includes the minimization of costs associated with the salary of part-time staff members, total overtime, and violations of service time windows. Subsequently, we adapt the basic problem to pandemic conditions by considering the impacts of communal spaces (e.g., shared rooms) and a cohorting policy (classification of residents based on their risk of infection) on the spread of infectious diseases. We introduce a new objective function that minimizes the number of distinct staff members serving each room of residents. Likewise, we propose a new objective function for the cohorting policy that aims to minimize the number of distinct cohorts served by each staff member. A new constraint is incorporated that forces staff members to serve only one cohort within a shift. We present a population-based heuristic algorithm to solve this problem. Through a comparison with two benchmark solution approaches (a mathematical programme and a non-dominated archiving ant colony optimization algorithm), the superiority of the heuristic algorithm is shown regarding solution quality and CPU time. Finally, we conduct numerical analyses to present managerial implications.
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Affiliation(s)
- Amirhossein Moosavi
- University of Ottawa, Telfer School of Management, 55 Laurier Avenue East, Ottawa, Ontario K1N 6N5, Canada
| | - Onur Ozturk
- University of Ottawa, Telfer School of Management, 55 Laurier Avenue East, Ottawa, Ontario K1N 6N5, Canada
| | - Jonathan Patrick
- University of Ottawa, Telfer School of Management, 55 Laurier Avenue East, Ottawa, Ontario K1N 6N5, Canada
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Assessing the construct validity of the Quality-of-Life-Aged Care Consumers (QOL-ACC): an aged care-specific quality-of-life measure. Qual Life Res 2022; 31:2849-2865. [PMID: 35680733 PMCID: PMC9181894 DOI: 10.1007/s11136-022-03142-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 10/28/2022]
Abstract
PURPOSE To evaluate the construct (convergent and known group) validity of the Quality-of-Life-Aged Care Consumer (QOL-ACC), an older-person-specific quality-of-life measure designed for application in quality assessment and economic evaluation in aged care. METHODS Convergent validity was assessed by examining relationships with other validated preference-based measures (EQ-5D-5L, ASCOT), quality of aged care experience (QCE-ACC) and life satisfaction (PWI) through an online survey. Known-group validity was assessed by testing the ability to discriminate varying levels of care needs, self-reported health and quality of life. RESULTS Older people (aged ≥ 65 years) receiving community-aged care (N = 313) responded; 54.6% were female, 41.8% were living alone and 56.8% were receiving higher-level care. The QOL-ACC and its six dimensions were low to moderately and significantly correlated with the EQ-5D-5L (correlation co-efficient range, ρ = 0.39-0.56). The QOL-ACC demonstrated moderate and statistically significant correlations with ASCOT (ρ = 0.61), the QCE-ACC (ρ = 0.51) and the PWI (ρ = 0.70). Respondents with poorer self-reported health status, quality of life and/or higher-level care needs demonstrated lower QOL-ACC scores (P < 0.001), providing evidence of known-group validity. CONCLUSIONS The study provides evidence of the construct validity of the QOL-ACC descriptive system. A preference-weighted value set is currently being developed for the QOL-ACC, which when finalised will be subjected to further validation assessments.
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12
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Godefroy R, Lewis J. What explains the socioeconomic status-health gradient? Evidence from workplace COVID-19 infections. SSM Popul Health 2022; 18:101124. [PMID: 35669891 PMCID: PMC9150908 DOI: 10.1016/j.ssmph.2022.101124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 05/04/2022] [Accepted: 05/11/2022] [Indexed: 01/08/2023] Open
Abstract
This paper studies the contribution of the workplace to the SES-health gradient. Our analysis is based on a unique dataset that tracks various health outcomes and workplace risks among healthcare workers during the first four months of the coronavirus 2019 (COVID-19) pandemic. The setting provides an exceptional opportunity to test for work-related disparities in health, while controlling for confounding determinants of the SES-health gradient. We find that low-SES nurses were systematically more likely to contract COVID-19 as a result of workplace exposure. These differentials existed in all healthcare institutions, but were particularly large in non-hospital settings. In contrast, we find no relationship between SES and nonwork-related infection rates. The differences in workplace infection rates are substantially larger than those implied by standard ‘task-based’ indices of transmission risk, and cannot be attributable to easily identifiable metrics of workplace risk. Together, our results show how subtle differences in work conditions or job duties can substantially contribute to the SES-health gradient.
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Affiliation(s)
- Raphael Godefroy
- Department of Economics, Université de Montréal, 3150, Rue Jean-Brillant, Montreal, QC, H3T1N8, Canada
| | - Joshua Lewis
- Department of Economics, Université de Montréal, 3150, Rue Jean-Brillant, Montreal, QC, H3T1N8, Canada
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13
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San Román J, Candel FJ, del Mar Carretero M, Sanz JC, Pérez-Abeledo M, Barreiro P, Viñuela-Prieto JM, Ramos B, Canora J, Barba R, Zapatero A, Martínez-Peromingo FJ. Cross-Sectional Analysis of Risk Factors for Outbreak of COVID-19 in Nursing Homes for Older Adults in the Community of Madrid. Gerontology 2022; 69:163-171. [PMID: 35654010 PMCID: PMC9393782 DOI: 10.1159/000524553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 04/10/2022] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Nursing homes for older adults have been hot spots for SARS-CoV-2 infections and mortality. Factors that facilitate COVID-19 outbreaks in these settings need to be assessed. METHODS A retrospective cross-sectional study of a cohort of residents and workers in nursing homes taking occasion of a point seroprevalence survey was done in the Community of Madrid. Factors related to outbreaks in these facilities were analyzed. RESULTS A total of 369 nursing homes for older adults, making a population of 23,756 residents and 20,795 staff members, were followed from July to December 2020. There were 54.2% SARS-CoV-2 IgG+ results in residents and in 32.2% of workers. Sixty-two nursing homes (16.8%) had an outbreak during the follow-up. Nursing homes with outbreaks had more residents than those without (median number of 81 [IQR, 74] vs. 50 [IQR, 56], p < 0.001). Seropositivity for SARS-CoV-2 was lower in facilities with versus without outbreaks, for residents (42.2% [IQR, 55.7] vs. 58.7% [IQR, 43.4], p = 0.002) and for workers (23.9% [IQR, 26.4] vs. 32.8% [IQR, 26.3], p = 0.01). For both residents and staff, the number of infections in outbreaks was larger in centers with lower, as compared with intermediate or high seroprevalence. The size of the facility did not correlate with the number of cases in the outbreak. Taking the incidence of cases in the community as a time-dependent variable (p = 0.03), a Cox analysis (HR [95% CI], p) showed that intermediate or high seroprevalence among residents in the facility was related to a reduction of 55% (0.45 [0.25-0.80], p = 0.007) and 78% (0.22 [0.10-0.48], p < 0.001) in the risk of outbreaks, respectively, as compared with low sero-prevalence. Also, as compared with smaller, medium (1.91 [1.00-3.65], p = 0.05) or large centers (4.57 [2.38-8.75], p < 0.001) had more respective risk of outbreaks. CONCLUSIONS The size of the facility and the seroprevalence among residents in nursing homes, and the incidence of infections in the community, are associated with the risk of outbreaks of COVID-19. Facilities with greater proportion of seropositives had smaller number of cases. Monitoring of immunity in nursing homes may help detect those at a greater risk of future cases.
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Affiliation(s)
- Jesús San Román
- Department of Medical Specialties and Public Health, Rey Juan Carlos University, Madrid, Spain
| | - Francisco J. Candel
- Clinical Microbiology and Infectious Diseases, IdISSC and IML Health Institutes, Hospital Universitario San Carlos, Madrid, Spain
| | | | - Juan Carlos Sanz
- Regional Public Health Laboratory, Community of Madrid, Madrid, Spain
| | | | - Pablo Barreiro
- Infectious Diseases, Internal Medicine, Hospital General Universitario La Paz, Madrid, Spain,*Pablo Barreiro,
| | | | - Belén Ramos
- Regional Public Health Laboratory, Community of Madrid, Madrid, Spain
| | - Jesús Canora
- Assistant to the Vice-counselor of Public Health, Community of Madrid, Madrid, Spain
| | - Raquel Barba
- Service of Internal Medicine, Hospital Universitario Rey Juan Carlos, Madrid, Spain
| | - Antonio Zapatero
- Vice-counselor of Healthcare and Public Health, Community of Madrid, Madrid, Spain
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14
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Abstract
In the late stages of dementia, individuals rely on others for their wellbeing and this creates an ethical imperative for responsive dementia care. Through a qualitative evidence synthesis of literature on what constitutes responsive dementia care, we identified dignity of identity as a central theme. Dignity of identity is the status each of us holds in relation to others and reflects our past experiences and our aspirations for the future. We did a qualitative evidence synthesis of 10 qualitative studies conducted with a total of 149 research participants, 95 of whom had dementia, and 54 of whom were paid and family member caregivers to people with dementia. Using "new materialism disability studies" as our theoretical framework, we illustrate how environments, both material and discursive, shape the abilities of people with dementia in residential care settings (RSCs) to live well and we use our findings to point to ways forward in dignity of identity-enhancing dementia care practice. Echoing the literature, we observe that people with dementia have the virtual capacity to live with dignity of identity and illustrate how material conditions and discourse influence the transition of dignity of identity in people with dementia from a virtual capacity to an actual capacity and how demonstrated capacity in turn influences material conditions and discourse surrounding care for people with dementia in RSCs. We call for a greater acknowledgement within literature on dignity and dementia of structural barriers to dignity of identity-enhancing care. The COVID-19 pandemic has shown us the fatal consequences of insufficient material conditions in RCSs and we hope that on a societal level there is improvement to both the material conditions in RCSs as well as an improvement in discourse about those who live and work in RCSs.
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Affiliation(s)
- Cera E Cruise
- Department of Community Health Sciences, Cumming School of Medicine, 70401University of Calgary, Calgary, AB, Canada
| | - Bonnie M Lashewicz
- Department of Community Health Sciences, Cumming School of Medicine, 70401University of Calgary, Calgary, AB, Canada
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15
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Reynolds KA, Pankratz L, Jain B, Grocott B, Bonin L, King G, Sommer JL, El-Gabalawy R, Giuliano RJ, Kredentser M, Mota N, Roos LE. Moral Injury Among Frontline Long-Term Care Staff and Management During the COVID-19 Pandemic. FRONTIERS IN HEALTH SERVICES 2022; 2:841244. [PMID: 36925899 PMCID: PMC10012813 DOI: 10.3389/frhs.2022.841244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/07/2022] [Indexed: 11/13/2022]
Abstract
Background A growing body of research highlights the experiences of moral injury among healthcare professionals during the COVID-19 pandemic. Moral injury (i.e., participating in or witnessing acts that violate one's central moral values), is associated with a host of psychological sequelae and corresponding negative psychosocial impacts. There is a lack of research examining the experiences of moral injury among those working in long-term care settings during the COVID-19 pandemic. Given the drastic impact that the COVID-19 pandemic has had on long-term care facilities in Canada, it is important to understand the experiences of moral injury among those working in long-term care settings to inform the development of effective prevention and intervention strategies. Objectives & Method The objectives of this study were to understand the experiences and impact of moral injury among Canadian frontline long-term care workers (staff and management) during the COVID-19 pandemic. Participants (N = 32 long-term care staff and management working in Ottawa and Manitoba) completed in-depth, semi-structured qualitative interviews and clinical diagnostic assessments (Mini International Neuropsychiatric Interviews; MINI; Version 7.0.2) between March 2021-June 2021. Findings The core category of our qualitative grounded theory model of moral injury in long-term care exemplified four shared types of morally injurious experiences, paired with cognitive, affective, and physiological symptom domains. Seven associated main themes emerged, contributing to the experiences and impact of moral injury in long-term care: 1) Beliefs about older adults and long-term care; 2) Interpretation of morally injurious experiences; 3) Management of morally injurious experiences; 4) Long-term care pandemic impacts; 5) Personal pandemic impacts; 6) Structural impacts in long-term care; and 7) Mental health needs and supports. Clinical assessments demonstrated anxiety disorders (n = 4) and feeding and eating disorders (n = 3) were among the most frequently classified current psychiatric disorders among long-term care workers. Conclusions This is the first Canadian study to examine the experiences and impact of moral injury in long-term care during the COVID-19 pandemic using qualitative and clinical diagnostic methodologies. Implications and insights for screening and intervention are offered.
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Affiliation(s)
- Kristin A Reynolds
- Department of Psychology, Faculty of Arts, University of Manitoba, Winnipeg, MB, Canada.,Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Lily Pankratz
- Department of Psychology, Faculty of Arts, University of Manitoba, Winnipeg, MB, Canada
| | - Barbie Jain
- Department of Psychology, Faculty of Arts, University of Manitoba, Winnipeg, MB, Canada
| | - Bronwen Grocott
- Department of Psychology, Faculty of Arts, University of Manitoba, Winnipeg, MB, Canada
| | - Lynette Bonin
- Department of Psychology, Faculty of Arts, University of Manitoba, Winnipeg, MB, Canada
| | | | - Jordana L Sommer
- Department of Psychology, Faculty of Arts, University of Manitoba, Winnipeg, MB, Canada
| | - Renée El-Gabalawy
- Department of Psychology, Faculty of Arts, University of Manitoba, Winnipeg, MB, Canada.,Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Ryan J Giuliano
- Department of Psychology, Faculty of Arts, University of Manitoba, Winnipeg, MB, Canada
| | - Maia Kredentser
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Natalie Mota
- Department of Psychology, Faculty of Arts, University of Manitoba, Winnipeg, MB, Canada.,Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Leslie E Roos
- Department of Psychology, Faculty of Arts, University of Manitoba, Winnipeg, MB, Canada.,Department of Pediatrics, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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16
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Stein DR, Osiowy C, Gretchen A, Thorlacius L, Fudge D, Lang A, Sekirov I, Morshed M, Levett PN, Tran V, Kus JV, Gubbay J, Mohan V, Charlton C, Kanji JN, Tipples G, Serhir B, Therrien C, Roger M, Jiao L, Zahariadis G, Needle R, Gilbert L, Desnoyers G, Garceau R, Bouhtiauy I, Longtin J, El-Gabalawy N, Dibernardo A, Lindsay LR, Drebot M. Evaluation of commercial SARS-CoV-2 serological assays in Canadian public health laboratories. Diagn Microbiol Infect Dis 2021; 101:115412. [PMID: 34425450 PMCID: PMC8377389 DOI: 10.1016/j.diagmicrobio.2021.115412] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 04/12/2021] [Accepted: 04/18/2021] [Indexed: 01/22/2023]
Abstract
The COVID-19 pandemic has led to the influx of immunoassays for the detection of antibodies towards severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) into the global market. The Canadian Public Health Laboratory Network Serology Task Force undertook a nationwide evaluation of twelve laboratory and 6 point-of-care based commercial serological assays for the detection of SARS-CoV-2 antibodies. We determined that there was considerable variability in the performance of individual tests and that an orthogonal testing algorithm should be prioritized to maximize the accuracy and comparability of results across the country. The manual enzyme immunoassays and point-of-care tests evaluated had lower specificity and increased coefficients of variation compared to automated enzyme immunoassays platforms putting into question their utility for large-scale sero-surveillance. Overall, the data presented here provide a comprehensive approach for applying accurate serological assays for longitudinal sero-surveillance and vaccine trials while informing Canadian public health policy.
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Affiliation(s)
- Derek R Stein
- Cadham Provincial Laboratory, Serology and Parasitology, Winnipeg, Manitoba, Canada.
| | - Carla Osiowy
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Ainsley Gretchen
- Cadham Provincial Laboratory, Serology and Parasitology, Winnipeg, Manitoba, Canada
| | | | - Denise Fudge
- Shared Health Manitoba, Winnipeg, Manitoba, Canada
| | - Amanda Lang
- Roy Romanow Provincial Laboratory, Regina, Saskatchewan, Canada
| | - Inna Sekirov
- British Columbia Centre for Disease Control Public Health Laboratory, Vancouver, British Columbia, Canada
| | - Muhammad Morshed
- British Columbia Centre for Disease Control Public Health Laboratory, Vancouver, British Columbia, Canada
| | - Paul N Levett
- British Columbia Centre for Disease Control Public Health Laboratory, Vancouver, British Columbia, Canada
| | - Vanessa Tran
- Public Health Ontario Laboratory, Toronto, Ontario Canada
| | - Julianne V Kus
- Public Health Ontario Laboratory, Toronto, Ontario Canada
| | | | - Vandana Mohan
- Public Health Ontario Laboratory, Toronto, Ontario Canada
| | - Carmen Charlton
- Public Health Laboratory, Alberta Precision Laboratories, Edmonton, Alberta, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada; Li Ka Shing Institute of Virology, Edmonton, Alberta
| | - Jamil N Kanji
- Public Health Laboratory, Alberta Precision Laboratories, Edmonton, Alberta, Canada
| | - Graham Tipples
- Public Health Laboratory, Alberta Precision Laboratories, Edmonton, Alberta, Canada; Li Ka Shing Institute of Virology, Edmonton, Alberta
| | - Bouchra Serhir
- Laboratoire de santé publique du Quebec, Montreal, Quebec, Canada
| | | | - Michel Roger
- Laboratoire de santé publique du Quebec, Montreal, Quebec, Canada
| | - Lei Jiao
- Newfoundland and Labrador Public Health Microbiology Laboratory, St. John's, Newfoundland and Labrador, Canada
| | - George Zahariadis
- Newfoundland and Labrador Public Health Microbiology Laboratory, St. John's, Newfoundland and Labrador, Canada
| | - Robert Needle
- Newfoundland and Labrador Public Health Microbiology Laboratory, St. John's, Newfoundland and Labrador, Canada
| | - Laura Gilbert
- Newfoundland and Labrador Public Health Microbiology Laboratory, St. John's, Newfoundland and Labrador, Canada
| | - Guillaume Desnoyers
- New Brunswick Virology Reference Centre, CHU Dumont, Moncton, New Brunswick, Canada
| | - Richard Garceau
- New Brunswick Virology Reference Centre, CHU Dumont, Moncton, New Brunswick, Canada
| | | | - Jean Longtin
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Nadia El-Gabalawy
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Antonia Dibernardo
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - L Robbin Lindsay
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Michael Drebot
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
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17
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Vijh R, Prairie J, Otterstatter MC, Hu Y, Hayden AS, Yau B, Daly P, Lysyshyn M, McKee G, Harding J, Forsting S, Schwandt M. Evaluation of a multisectoral intervention to mitigate the risk of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) transmission in long-term care facilities. Infect Control Hosp Epidemiol 2021; 42:1181-1188. [PMID: 33397533 PMCID: PMC7853754 DOI: 10.1017/ice.2020.1407] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE A Canadian health authority implemented a multisectoral intervention designed to control severe acute respiratory coronavirus virus 2 (SARS-CoV-2) transmission during long-term care facility (LTCF) outbreaks. The primary objective was to evaluate the effectiveness of the intervention 14 days after implementation. DESIGN Quasi-experimental, segmented regression analysis. INTERVENTION A series of outbreak measures classified into 4 categories: case and contact management, proactive case detection, rigorous infection control practices and resource prioritization and stewardship. METHODS A mixed-effects segmented Poisson regression model was fitted to the incidence rate of coronavirus disease 2019 (COVID-19), calculated every 2 days, within each facility and case type (staff vs residents). For each facility, the outbreak time period was segmented into an early outbreak period (within 14 days of the intervention) and postintervention period (beyond 14 days following the intervention). Model outputs quantified COVID-19 incidence trend and rate changes between these 2 periods. A secondary model was constructed to identify effect modification by case type. RESULTS The significant upward trend in COVID-19 incidence rate during the early outbreak period (rate ratio [RR], 1.07; 95% confidence interval [CI], 1.03-1.11; P < .001) reversed during the postintervention period (RR, 0.73; 95% CI, 0.67-0.80; P < .001). The average trend did not differ by case type during the early outbreak period (P > .05) or the postintervention period (P > .05). However, staff had a 70% larger decrease in the average rate of COVID-19 during the postintervention period than residents (RR, 0.30; 95% CI, 0.10-0.88; P < .05). CONCLUSIONS Our study provides evidence for the effectiveness of this intervention to reduce the transmission of COVID-19 in LTCFs. This intervention can be adapted and utilized by other jurisdictions to protect the vulnerable individuals in LTCFs.
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Affiliation(s)
- Rohit Vijh
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jessica Prairie
- Communicable Disease Control, Vancouver Coastal Health, Vancouver, British Columbia, Canada
- Canadian Field Epidemiology Training Program, Public Health Agency of Canada, Ottawa, Canada
| | - Michael C. Otterstatter
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Yumian Hu
- Communicable Disease Control, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Althea S. Hayden
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Communicable Disease Control, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Brandon Yau
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Patricia Daly
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Communicable Disease Control, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Mark Lysyshyn
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Communicable Disease Control, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Geoff McKee
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Communicable Disease Control, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - John Harding
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Communicable Disease Control, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Sara Forsting
- Communicable Disease Control, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Michael Schwandt
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Communicable Disease Control, Vancouver Coastal Health, Vancouver, British Columbia, Canada
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18
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“Be Their Advocate”: Families’ Experience with a Relative in LTC during the COVID-19 Pandemic. Can J Aging 2021. [DOI: 10.1017/s0714980821000398] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AbstractShortly after the COVID-19 pandemic was declared, strict visitor restrictions were issued for long-term care facilities (LTCFs). A year later, restrictions are still in place and they continue to impact family members who have limited or no in-person contact with their relative in LTCFs. The goal of this qualitative longitudinal focused ethnography was to understand the experience of family members who have a relative in a LTCF where visiting has been restricted during the pandemic. Seventeen family members participated in two interviews that were 6 months apart. Data analysis highlighted five key drivers, defined as the workforce, communication deficits, characteristics of care, public health directives, and autonomy of relative which in turn resulted in three main themes: psychological distress, surveillance, and visiting challenges. This study provides a glimpse into the difficult experiences of families with a relative residing in a LTCF in the province of New Brunswick.
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19
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Combden S, Forward A, Sarkar A. COVID-19 pandemic responses of Canada and United States in first 6 months: A comparative analysis. Int J Health Plann Manage 2021; 37:50-65. [PMID: 34514624 PMCID: PMC8652721 DOI: 10.1002/hpm.3323] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 08/16/2021] [Accepted: 08/23/2021] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Canada and the United States have distinct health care and social policies, and it is important to see how they had been responding to the ongoing COVID-19 pandemic. METHODS The study period was limited to the first 6 months of the pandemic and aimed to explore the responses by public health authorities, media, general population, and law makers during the initial phase of pandemic. RESULTS Social disparity, underfunded pandemic preparation, and the initial failure to act appropriately have resulted in the rapid spread of infection in both countries. In the United States, prevailing social inequalities and racism, inaccessible health care, higher rates of preexisting medical conditions and disputed political leadership have further deteriorated the situation and enhanced public suffering, particularly for the black and Indigenous communities. In Canada, its poorly regulated services of long-term care facilities, initial restriction of testing and lack of access to epidemiological data have helped spread the infection and increased casualties in vulnerable populations. CONCLUSION Analysis of the pandemic responses of the United States and Canada has revealed how existing social disparity, underfunded pandemic preparation, and the initial failure to act appropriately have resulted in the rapid spread of infection.
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Affiliation(s)
- Shianne Combden
- Division of Community Health and Humanities, Faculty of Medicine, Health Sciences Centre, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Anita Forward
- Division of Community Health and Humanities, Faculty of Medicine, Health Sciences Centre, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Atanu Sarkar
- Division of Community Health and Humanities, Faculty of Medicine, Health Sciences Centre, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
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20
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Kapiriri L, Essue B, Bwire G, Nouvet E, Kiwanuka S, Sengooba F, Reeleder D. A framework to support the integration of priority setting in the preparedness, alert, control and evaluation stages of a disease pandemic. Glob Public Health 2021; 17:1479-1491. [PMID: 34293263 DOI: 10.1080/17441692.2021.1931402] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The COVID-19 pandemic, where the need-resource gap has necessitated decision makers in some contexts to ration access to life-saving interventions, has demonstrated the critical need for systematic and fair priority setting and resource allocation mechanisms. Disease outbreaks are becoming increasingly common and priority setting lessons from previous disease outbreaks could be better harnessed to inform decision making and planning for future disease outbreaks. The purpose of this paper is to discuss how priority setting and resource allocation could, ideally, be integrated into the WHO pandemic planning and preparedness framework and used to inform the COVID-19 pandemic recovery plans and plans for future outbreaks. Priority setting and resource allocation during disease outbreaks tend to evoke a process similar to the 'rule of rescue'. This results in inefficient and unfair resource allocation, negative effects on health and non-health programs and increased health inequities. Integrating priority setting and resource allocation activities throughout the four phases of the WHO emergency preparedness framework could ensure that priority setting during health emergencies is systematic, evidence informed and fair.
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Affiliation(s)
- Lydia Kapiriri
- Department of Health, Aging and Society, McMaster University, Hamilton, Canada
| | | | - Godfrey Bwire
- Department of Integrated Epidemiology Surveillance and Public Health Emergencies, Ministry of Health, Kampala, Uganda
| | | | - Suzanne Kiwanuka
- Department of Health Policy Planning and Management, Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda
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21
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Chu CH, Ronquillo C, Khan S, Hung L, Boscart V. Technology Recommendations to Support Person-Centered Care in Long-Term Care Homes during the COVID-19 Pandemic and Beyond. J Aging Soc Policy 2021; 33:539-554. [PMID: 34278980 DOI: 10.1080/08959420.2021.1927620] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The COVID-19 pandemic has exposed persistent inequities in the long-term care sector and brought strict social/physical distancing distancing and public health quarantine guidelines that inadvertently put long-term care residents at risk for social isolation and loneliness. Virtual communication and technologies have come to the forefront as the primary mode for residents to maintain connections with their loved ones and the outside world; yet, many long-term care homes do not have the technological capabilities to support modern day technologies. There is an urgent need to replace antiquated technological infrastructures to enable person-centered care and prevent potentially irreversible cognitive and psychological declines by ensuring residents are able to maintain important relationships with their family and friends. To this end, we provide five technological recommendations to support the ethos of person-centered care in residential long-term care homes during the pandemic and in a post-COVID-19 pandemic world.
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Affiliation(s)
- Charlene H Chu
- Assistant Professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.,Assistant Professor (cross-appointed), Institute for Life Course and Aging, University of Toronto, Toronto, Ontario, Canada.,Affiliate Scientist, KITE, Toronto Rehabilitation Institution, Toronto, Ontario, Canada
| | - Charlene Ronquillo
- Scientist, School of Nursing, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Shehroz Khan
- Affiliate Scientist, KITE, Toronto Rehabilitation Institution, Toronto, Ontario, Canada
| | - Lillian Hung
- Assistant Professor, School of Nursing, University of British of Columbia, Vancouver, British Columbia, Canada
| | - Veronique Boscart
- Affiliate Scientist, KITE, Toronto Rehabilitation Institution, Toronto, Ontario, Canada.,Executive Dean, School of Health & Life Sciences, Conestoga College Institute of Technology and Advanced Learning, Kitchener, Ontario, Canada
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22
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Alami H, Lehoux P, Fleet R, Fortin JP, Liu J, Attieh R, Cadeddu SBM, Abdoulaye Samri M, Savoldelli M, Ag Ahmed MA. How Can Health Systems Better Prepare for the Next Pandemic? Lessons Learned From the Management of COVID-19 in Quebec (Canada). Front Public Health 2021; 9:671833. [PMID: 34222176 PMCID: PMC8249772 DOI: 10.3389/fpubh.2021.671833] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/10/2021] [Indexed: 12/19/2022] Open
Abstract
The magnitude of the COVID-19 pandemic challenged societies around our globalized world. To contain the spread of the virus, unprecedented and drastic measures and policies were put in place by governments to manage an exceptional health care situation while maintaining other essential services. The responses of many governments showed a lack of preparedness to face this systemic and global health crisis. Drawing on field observations and available data on the first wave of the pandemic (mid-March to mid-May 2020) in Quebec (Canada), this article reviewed and discussed the successes and failures that characterized the management of COVID-19 in this province. Using the framework of Palagyi et al. on system preparedness toward emerging infectious diseases, we described and analyzed in a chronologically and narratively way: (1) how surveillance was structured; (2) how workforce issues were managed; (3) what infrastructures and medical supplies were made available; (4) what communication mechanisms were put in place; (5) what form of governance emerged; and (6) whether trust was established and maintained throughout the crisis. Our findings and observations stress that resilience and ability to adequately respond to a systemic and global crisis depend upon preexisting system-level characteristics and capacities at both the provincial and federal governance levels. By providing recommendations for policy and practice from a learning health system perspective, this paper contributes to the groundwork required for interdisciplinary research and genuine policy discussions to help health systems better prepare for future pandemics.
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Affiliation(s)
- Hassane Alami
- Center for Public Health Research of the University of Montreal, Montreal, QC, Canada
- Department of Health Management, Evaluation and Policy, University of Montreal, Montreal, QC, Canada
| | - Pascale Lehoux
- Center for Public Health Research of the University of Montreal, Montreal, QC, Canada
- Department of Health Management, Evaluation and Policy, University of Montreal, Montreal, QC, Canada
| | - Richard Fleet
- VITAM Research Centre on Sustainable Health, Laval University, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Laval University, Quebec, QC, Canada
- Research Chair in Emergency Medicine Université Laval-CHAU Hôtel-Dieu de Lévis, Lévis, QC, Canada
| | - Jean-Paul Fortin
- VITAM Research Centre on Sustainable Health, Laval University, Quebec, QC, Canada
- Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Joanne Liu
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Randa Attieh
- Research Centre of the University of Montreal Hospital Centre, University of Montreal, Montreal, QC, Canada
| | - Stéphanie Bernadette Mafalda Cadeddu
- Research Centre of the University of Montreal Hospital Centre, University of Montreal, Montreal, QC, Canada
- Faculty of Law, University of Montreal, Montreal, QC, Canada
| | | | | | - Mohamed Ali Ag Ahmed
- Research Chair on Chronic Diseases in Primary Care, Sherbrooke University, Chicoutimi, QC, Canada
- The Institute of Tropical Medicine, Antwerp, Belgium
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Abstract
Over 80% of Canadian COVID-19 first wave deaths occurred in long-term care homes. Focussing on Ontario, I trace the antecedents of the COVID-19 crisis in long-term care and document experiences of frontline staff and family members of residents during the pandemic. Following Povinelli, I 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. I also question broader societal attitudes toward aging, disability and death that make possible the abandonment of the frail elderly.
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Affiliation(s)
- Ellen Badone
- Department of Anthropology and Department of Religious Studies, McMaster University, ON, Canada
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24
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Sutherland JM. COVID-19 and a Window into Healthcare Providers' Resiliency. Healthc Policy 2021; 16:6-15. [PMID: 34129474 PMCID: PMC8200832 DOI: 10.12927/hcpol.2021.26503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
As contemporaneous data emerge from publicly funded healthcare providers, the COVID-19 pandemic provides a unique opportunity to measure their resiliency. Resiliency matters because it connotes a higher level of confidence in being able to provide needed healthcare during times of health, social or environmental stress or calamity. At the beginning of the first wave of the COVID-19 pandemic in early 2020, there were warnings regarding hospitals' ability to successfully manage large surges of critically ill COVID-19 patients who were expected to soon be presenting at hospitals in every province and territory. Shortly thereafter, hospitals implemented policies to clear hospital beds - there were public reports that hospitals rapidly went from nearly full occupancy to below 50% (CIHI 2020a; Howlett 2020; Zeidler 2020).
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The performance of phenomenological models in providing near-term Canadian case projections in the midst of the COVID-19 pandemic: March - April, 2020. Epidemics 2021; 35:100457. [PMID: 33857889 DOI: 10.1016/j.epidem.2021.100457] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/20/2020] [Accepted: 02/13/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has had an unprecedented impact on citizens and health care systems globally. Valid near-term projections of cases are required to inform the escalation, maintenance and de-escalation of public health measures, and for short-term health care resource planning. METHODS Near-term case and epidemic growth rate projections for Canada were estimated using three phenomenological models: the logistic model, Generalized Richard's model (GRM) and a modified Incidence Decay and Exponential Adjustment (m-IDEA) model. Throughout the COVID-19 epidemic in Canada, these models have been validated against official national epidemiological data on an ongoing basis. RESULTS The best-fit models estimated that the number of COVID-19 cases predicted to be reported in Canada as of April 1, 2020 and May 1, 2020 would be 11,156 (90 % prediction interval: 9,156-13,905) and 54,745 (90 % prediction interval: 54,252-55,239). The three models varied in their projections and their performance over the first seven weeks of their implementation. Both the logistic model and GRM under-predicted cases reported a week following the projection date in nearly all instances. The logistic model performed best at the early stages, the m-IDEA model performed best at the later stages, and the GRM performed most consistently during the full period assessed. CONCLUSIONS All three models have yielded qualitatively comparable near-term forecasts of cases and epidemic growth for Canada. Under or over-estimation of projected cases and epidemic growth by these models could be associated with changes in testing policies and/or public health measures. Simple forecasting models can be invaluable in projecting the changes in trajectory of subsequent waves of cases to provide timely information to support the pandemic response.
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26
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Liu A, Miller W, Crompton G, Zedan S. Has COVID-19 lockdown impacted on aged care energy use and demand? ENERGY AND BUILDINGS 2021; 235:110759. [PMID: 35996478 PMCID: PMC9387169 DOI: 10.1016/j.enbuild.2021.110759] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 12/23/2020] [Accepted: 01/13/2021] [Indexed: 05/31/2023]
Abstract
In late March to April 2020 residential aged care facilities (RAC) in Australia were under COVID-19 lockdown. This paper explores whether the resultant restrictions on entry and exit and elimination of site group activities within RACs impacted on the total electricity use, peak demand and electrical load profiles. Six RACs in four different climate zones are analysed, comparing historical electricity load and demand profiles with the lockdown period. The facilities in warm regions showed largest reductions in energy use and peak demands. There was a peak demand timing shift in temperate regions and hot regions' changes were negligible for energy use or peak demands. This study revealed the limitations of using aggregate data as the key performance indicator (KPI) - energy use per bed. Also, KPIs in relation to cooling degree days (or total cooling and heating degree days) have been examined and are not recommended for temperate regions or temperate seasons. The potential CO2 emission reduction from onsite renewable generation is quantified. Further research is to investigate energy use changes at circuit levels under lockdowns, and develop more nuanced KPIs that include the rate of energy use and the timing of that use.
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Affiliation(s)
- Aaron Liu
- Queensland University of Technology (QUT), 2 George St, Brisbane QLD4000, Australia
| | - Wendy Miller
- Queensland University of Technology (QUT), 2 George St, Brisbane QLD4000, Australia
| | - Glenn Crompton
- Queensland University of Technology (QUT), 2 George St, Brisbane QLD4000, Australia
| | - Sherif Zedan
- Queensland University of Technology (QUT), 2 George St, Brisbane QLD4000, Australia
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27
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Abstract
The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has caused the Coronavirus Disease 2019 (COVID-19) worldwide pandemic in 2020. In response, most countries in the world implemented lockdowns, restricting their population's movements, work, education, gatherings, and general activities in attempt to "flatten the curve" of COVID-19 cases. The public health goal of lockdowns was to save the population from COVID-19 cases and deaths, and to prevent overwhelming health care systems with COVID-19 patients. In this narrative review I explain why I changed my mind about supporting lockdowns. The initial modeling predictions induced fear and crowd-effects (i.e., groupthink). Over time, important information emerged relevant to the modeling, including the lower infection fatality rate (median 0.23%), clarification of high-risk groups (specifically, those 70 years of age and older), lower herd immunity thresholds (likely 20-40% population immunity), and the difficult exit strategies. In addition, information emerged on significant collateral damage due to the response to the pandemic, adversely affecting many millions of people with poverty, food insecurity, loneliness, unemployment, school closures, and interrupted healthcare. Raw numbers of COVID-19 cases and deaths were difficult to interpret, and may be tempered by information placing the number of COVID-19 deaths in proper context and perspective relative to background rates. Considering this information, a cost-benefit analysis of the response to COVID-19 finds that lockdowns are far more harmful to public health (at least 5-10 times so in terms of wellbeing years) than COVID-19 can be. Controversies and objections about the main points made are considered and addressed. Progress in the response to COVID-19 depends on considering the trade-offs discussed here that determine the wellbeing of populations. I close with some suggestions for moving forward, including focused protection of those truly at high risk, opening of schools, and building back better with a economy.
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Affiliation(s)
- Ari R. Joffe
- Division of Critical Care Medicine, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
- John Dossetor Health Ethics Center, University of Alberta, Edmonton, AB, Canada
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28
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Liu M, Maxwell CJ, Armstrong P, Schwandt M, Moser A, McGregor MJ, Bronskill SE, Dhalla IA. La COVID-19 dans les foyers de soins de longue durée en Ontario et en Colombie-Britannique. CMAJ 2021; 193:E263-E269. [PMID: 33593958 PMCID: PMC8034325 DOI: 10.1503/cmaj.201860-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Michael Liu
- Faculté de médecine de Harvard (Liu), Boston, Mass.; Département de politiques et d'interventions sociales (Liu), Université d'Oxford, Oxford, R.-U.; Écoles de pharmacie, de santé publique et de système de santé (Maxwell), Université de Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Département de sociologie (Armstrong), Université York; Département de médecine familiale et communautaire (Moser); Institut de politiques, de gestion et d'évaluation de la santé (Bronskill, Dhalla), École de santé publique Dalla Lana, et Département de médecine (Dhalla), Université de Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculté de médecine (Schwandt), École de la santé publique et des populations, et Département de pratique familiale (McGregor), Université de la Colombie-Britannique; Vancouver Coastal Health (Schwandt); Vancouver, C.-B
| | - Colleen J Maxwell
- Faculté de médecine de Harvard (Liu), Boston, Mass.; Département de politiques et d'interventions sociales (Liu), Université d'Oxford, Oxford, R.-U.; Écoles de pharmacie, de santé publique et de système de santé (Maxwell), Université de Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Département de sociologie (Armstrong), Université York; Département de médecine familiale et communautaire (Moser); Institut de politiques, de gestion et d'évaluation de la santé (Bronskill, Dhalla), École de santé publique Dalla Lana, et Département de médecine (Dhalla), Université de Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculté de médecine (Schwandt), École de la santé publique et des populations, et Département de pratique familiale (McGregor), Université de la Colombie-Britannique; Vancouver Coastal Health (Schwandt); Vancouver, C.-B
| | - Pat Armstrong
- Faculté de médecine de Harvard (Liu), Boston, Mass.; Département de politiques et d'interventions sociales (Liu), Université d'Oxford, Oxford, R.-U.; Écoles de pharmacie, de santé publique et de système de santé (Maxwell), Université de Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Département de sociologie (Armstrong), Université York; Département de médecine familiale et communautaire (Moser); Institut de politiques, de gestion et d'évaluation de la santé (Bronskill, Dhalla), École de santé publique Dalla Lana, et Département de médecine (Dhalla), Université de Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculté de médecine (Schwandt), École de la santé publique et des populations, et Département de pratique familiale (McGregor), Université de la Colombie-Britannique; Vancouver Coastal Health (Schwandt); Vancouver, C.-B
| | - Michael Schwandt
- Faculté de médecine de Harvard (Liu), Boston, Mass.; Département de politiques et d'interventions sociales (Liu), Université d'Oxford, Oxford, R.-U.; Écoles de pharmacie, de santé publique et de système de santé (Maxwell), Université de Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Département de sociologie (Armstrong), Université York; Département de médecine familiale et communautaire (Moser); Institut de politiques, de gestion et d'évaluation de la santé (Bronskill, Dhalla), École de santé publique Dalla Lana, et Département de médecine (Dhalla), Université de Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculté de médecine (Schwandt), École de la santé publique et des populations, et Département de pratique familiale (McGregor), Université de la Colombie-Britannique; Vancouver Coastal Health (Schwandt); Vancouver, C.-B
| | - Andrea Moser
- Faculté de médecine de Harvard (Liu), Boston, Mass.; Département de politiques et d'interventions sociales (Liu), Université d'Oxford, Oxford, R.-U.; Écoles de pharmacie, de santé publique et de système de santé (Maxwell), Université de Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Département de sociologie (Armstrong), Université York; Département de médecine familiale et communautaire (Moser); Institut de politiques, de gestion et d'évaluation de la santé (Bronskill, Dhalla), École de santé publique Dalla Lana, et Département de médecine (Dhalla), Université de Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculté de médecine (Schwandt), École de la santé publique et des populations, et Département de pratique familiale (McGregor), Université de la Colombie-Britannique; Vancouver Coastal Health (Schwandt); Vancouver, C.-B
| | - Margaret J McGregor
- Faculté de médecine de Harvard (Liu), Boston, Mass.; Département de politiques et d'interventions sociales (Liu), Université d'Oxford, Oxford, R.-U.; Écoles de pharmacie, de santé publique et de système de santé (Maxwell), Université de Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Département de sociologie (Armstrong), Université York; Département de médecine familiale et communautaire (Moser); Institut de politiques, de gestion et d'évaluation de la santé (Bronskill, Dhalla), École de santé publique Dalla Lana, et Département de médecine (Dhalla), Université de Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculté de médecine (Schwandt), École de la santé publique et des populations, et Département de pratique familiale (McGregor), Université de la Colombie-Britannique; Vancouver Coastal Health (Schwandt); Vancouver, C.-B
| | - Susan E Bronskill
- Faculté de médecine de Harvard (Liu), Boston, Mass.; Département de politiques et d'interventions sociales (Liu), Université d'Oxford, Oxford, R.-U.; Écoles de pharmacie, de santé publique et de système de santé (Maxwell), Université de Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Département de sociologie (Armstrong), Université York; Département de médecine familiale et communautaire (Moser); Institut de politiques, de gestion et d'évaluation de la santé (Bronskill, Dhalla), École de santé publique Dalla Lana, et Département de médecine (Dhalla), Université de Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculté de médecine (Schwandt), École de la santé publique et des populations, et Département de pratique familiale (McGregor), Université de la Colombie-Britannique; Vancouver Coastal Health (Schwandt); Vancouver, C.-B
| | - Irfan A Dhalla
- Faculté de médecine de Harvard (Liu), Boston, Mass.; Département de politiques et d'interventions sociales (Liu), Université d'Oxford, Oxford, R.-U.; Écoles de pharmacie, de santé publique et de système de santé (Maxwell), Université de Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Département de sociologie (Armstrong), Université York; Département de médecine familiale et communautaire (Moser); Institut de politiques, de gestion et d'évaluation de la santé (Bronskill, Dhalla), École de santé publique Dalla Lana, et Département de médecine (Dhalla), Université de Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculté de médecine (Schwandt), École de la santé publique et des populations, et Département de pratique familiale (McGregor), Université de la Colombie-Britannique; Vancouver Coastal Health (Schwandt); Vancouver, C.-B
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29
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Suppan L, Abbas M, Catho G, Stuby L, Regard S, Harbarth S, Achab S, Suppan M. Impact of a Serious Game on the Intention to Change Infection Prevention and Control Practices in Nursing Homes During the COVID-19 Pandemic: Protocol for a Web-Based Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e25595. [PMID: 33296329 PMCID: PMC7744143 DOI: 10.2196/25595] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/02/2020] [Accepted: 12/08/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Nursing home residents are at high risk of complications and death due to COVID-19. Lack of resources, both human and material, amplifies the likelihood of contamination in these facilities where a single employee can contaminate dozens of residents and colleagues. Improving the dissemination of and adhesion to infection prevention and control (IPC) guidelines is therefore essential. Serious games have been shown to be effective in developing knowledge and in increasing engagement, and could motivate nursing home employees to change their IPC practices. OBJECTIVE Our aim is to assess the impact of "Escape COVID-19," a serious game designed to enhance knowledge and application of IPC procedures, on the intention of nursing home employees to change their IPC practices. METHODS We will carry out a web-based randomized controlled trial following the CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile Health Applications and Online Telehealth) guidelines and incorporating relevant elements of CHERRIES (Checklist for Reporting Results of Internet E-Surveys). Participants will be randomized to either the control or the serious game (intervention) group. First, both groups will be asked to answer a questionnaire designed to gather demographic data and assess baseline knowledge. The control group will then receive a quick reminder of the current national guidelines and links to IPC guidelines for health care professionals, while the other group will play the game. Both groups will then have to answer a second questionnaire designed to assess their willingness to change their IPC practices after having followed their respective material. After completing this questionnaire, they will be granted access to the material presented to the group they were not assigned to and receive a course completion certificate. The primary outcome will be the proportion of participants willing to change their IPC practices according to group. Secondary outcomes will include the analysis of specific questions detailing the exact changes considered by the participants. Factors associated with participant willingness or reluctance to change behavior will also be assessed. Attrition will also be assessed at each stage of the study. RESULTS The study protocol has been presented to our regional ethics committee (Req-2020-01262), which issued a declaration of no objection as such projects do not fall within the scope of the Swiss federal law on human research. Data collection began on November 5, 2020, and should be completed by December 4, 2020. CONCLUSIONS This study should determine whether "Escape COVID-19," a serious game designed to improve compliance with COVID-19 safe practices, modifies the intention to follow IPC guidelines among nursing home employees. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/25595.
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Affiliation(s)
- Laurent Suppan
- Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Mohamed Abbas
- Infection Control Programme, WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Gaud Catho
- Infection Control Programme, WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | | | - Simon Regard
- Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.,Division of General Surgeon, Geneva Directorate of Health, Geneva, Switzerland
| | - Stephan Harbarth
- Infection Control Programme, WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Sophia Achab
- Specialized Facility in Behavioral Addictions ReConnecte, Geneva University Hospitals, Geneva, Switzerland.,WHO Collaborating Center in Training and Research in Mental Health, University of Geneva, Geneva, Switzerland
| | - Mélanie Suppan
- Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
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30
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Tupper SM, Ward H, Parmar J. Family Presence in Long-Term Care During the COVID-19 Pandemic: Call to Action for Policy, Practice, and Research. Can Geriatr J 2020; 23:335-339. [PMID: 33282052 PMCID: PMC7704077 DOI: 10.5770/cgj.23.476] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Family presence in long-term care (LTC) homes is crucial for meeting the health, psychosocial, and practical needs of residents. Initially during the COVID-19 pandemic, visitation restrictions essentially locked-out families as public health orders prioritized prevention of harm from spread of infection. Although telephone and technology-assisted communication with families was encouraged, many residents were unable to participate. The outcry from families on the injustice of disruption of family units and emerging reports of harms arising from prolonged restrictions highlight the need for provincial and organizational policies to recognize the impact of resident and family separation on well-being. In this commentary we describe family caregiving, review the impact of visitation restrictions on residents, families, and LTC staff, and provide a resident- and family-oriented perspective on policy implications that challenge the outdated notion that extreme restrictions to family presence protect resident health.
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Affiliation(s)
- Susan M Tupper
- Quality, Safety & Strategy, Saskatchewan Health Authority, Royal University Hospital, Saskatoon, SK
| | - Heather Ward
- Department of Medicine, University of Saskatchewan, Saskatoon, SK
| | - Jasneet Parmar
- Department of Family Medicine, University of Alberta, Edmonton, AB
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31
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Dougherty BP, Smith BA, Carson CA, Ogden NH. Exploring the percentage of COVID-19 cases reported in the community in Canada and associated case fatality ratios. Infect Dis Model 2020; 6:123-132. [PMID: 33313456 PMCID: PMC7718109 DOI: 10.1016/j.idm.2020.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 11/30/2020] [Indexed: 01/02/2023] Open
Abstract
While surveillance can identify changes in COVID-19 transmission patterns over time and space, sections of the population at risk, and the efficacy of public health measures, reported cases of COVID-19 are generally understood to only capture a subset of the actual number of cases. Our primary objective was to estimate the percentage of cases reported in the general community, considered as those that occurred outside of long-term care facilities (LTCFs), in specific provinces and Canada as a whole. We applied a methodology using the delay-adjusted case fatality ratio (CFR) to all cases and deaths, as well as those representing the general community. Our second objective was to assess whether the assumed CFR (mean = 1.38%) was appropriate for calculating underestimation of cases in Canada. Estimates were developed for the period from March 11th, 2020 to September 16th, 2020. Estimates of the percentage of cases reported (PrCR) and CFR varied spatially and temporally across Canada. For the majority of provinces, and for Canada as a whole, the PrCR increased through the early stages of the pandemic. The estimated PrCR in general community settings for all of Canada increased from 18.1% to 69.0% throughout the entire study period. Estimates were greater when considering only those data from outside of LTCFs. The estimated upper bound CFR in general community settings for all of Canada decreased from 9.07% on March 11th, 2020 to 2.00% on September 16th, 2020. Therefore, the true CFR in the general community in Canada was likely less than 2% on September 16th. According to our analysis, some provinces, such as Alberta, Manitoba, Newfoundland and Labrador, Nova Scotia, and Saskatchewan reported a greater percentage of cases as of September 16th, compared to British Columbia, Ontario, and Québec. This could be due to differences in testing rates and criteria, demographics, socioeconomic factors, race, and access to healthcare among the provinces. Further investigation into these factors could reveal differences among provinces that could partially explain the variation in estimates of PrCR and CFR identified in our study. The estimates provide context to the summative state of the pandemic in Canada, and can be improved as knowledge of COVID-19 reporting rates and disease characteristics are advanced.
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Affiliation(s)
- Brendan P. Dougherty
- Centre for Food-borne and Environmental Zoonotic Infectious Diseases, Public Health Agency of Canada, 370 Speedvale Ave W., Guelph, ON, N1H 7M7, Canada
| | - Ben A. Smith
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, 370 Speedvale Ave W., Guelph, ON, N1H 7M7, Canada
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, St. Hyacinthe, QC, J2S 2M2, Canada
| | - Carolee A. Carson
- Centre for Food-borne and Environmental Zoonotic Infectious Diseases, Public Health Agency of Canada, 370 Speedvale Ave W., Guelph, ON, N1H 7M7, Canada
| | - Nicholas H. Ogden
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, 370 Speedvale Ave W., Guelph, ON, N1H 7M7, Canada
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, St. Hyacinthe, QC, J2S 2M2, Canada
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32
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Kitching GT, Zhong A, Kogel E, Wilson K, Létourneau S, Ge Y, Sayed C. The role of medical students in the COVID-19 pandemic response: A call for ethical guidelines. CANADIAN MEDICAL EDUCATION JOURNAL 2020; 11:e176-e178. [PMID: 33349774 PMCID: PMC7749677 DOI: 10.36834/cmej.70307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- George T. Kitching
- Schulich School of Medicine and Dentistry, Western University, Ontario, Canada
| | - Adrina Zhong
- Schulich School of Medicine and Dentistry, Western University, Ontario, Canada
| | - Emily Kogel
- Schulich School of Medicine and Dentistry, Western University, Ontario, Canada
| | - Krista Wilson
- Schulich School of Medicine and Dentistry, Western University, Ontario, Canada
| | | | - Yipeng Ge
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Céline Sayed
- Faculty of Medicine, University of Ottawa, Ontario, Canada
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Stall NM, Jones A, Brown KA, Rochon PA, Costa AP. Risque d’éclosions de COVID-19 et de décès de résidents dans les foyers de soins de longue durée à but lucratif. CMAJ 2020; 192:E1662-E1672. [PMID: 33257337 PMCID: PMC7721392 DOI: 10.1503/cmaj.201197-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2020] [Indexed: 11/01/2022] Open
Abstract
CONTEXTE: Les foyers de soins de longue durée (SLD) ont jusqu’à présent été l’épicentre de la pandémie de maladie à coronavirus 2019 (COVID-19) au Canada. Selon des études antérieures, les soins offerts dans les foyers de SLD à but lucratif sont de qualité inférieure pour toute une gamme d’indicateurs de résultats et de processus, ce qui soulève la question suivante: les conséquences de la COVID-19 ont-elles été pires dans les foyers à but lucratif que dans ceux à but non lucratif? MÉTHODES: Une étude de cohorte rétrospective basée sur l’ensemble des foyers de SLD en Ontario a été menée pour la période du 29 mars au 20 mai 2020 à partir de la base de données sur les éclosions de COVID-19 alimentée par le ministère des Soins de longue durée de l’Ontario. Des méthodes logistiques hiérarchiques et basées sur des données de comptage ont été utilisées pour modéliser les associations entre le statut financier des foyers de SLD (à but lucratif, à but non lucratif ou municipal) et les éclosions de COVID-19 dans ces derniers, l’ampleur des éclosions (nombre de résidents infectés) et le nombre de décès de résidents attribuables à la COVID-19. RÉSULTATS: L’analyse portait sur les 623 foyers de SLD de l’Ontario, qui comptent 75 676 résidents. Parmi ces foyers, 360 (57,7 %) sont à but lucratif; 162 (26,0 %) sont à but non lucratif; et 101 (16,2 %) sont des foyers municipaux. Au total, 190 (30,5 %) éclosions de COVID-19 ont été enregistrées dans des foyers de SLD. Elles ont touché 5218 résidents et entraîné 1452 décès, ce qui représente un taux de létalité général de 27,8 %. Les probabilités d’une éclosion dans un foyer ont été associées à l’incidence de la COVID-19 dans la circonscription sanitaire entourant celui-ci (rapport de cotes [RC] ajusté 1,91; intervalle de confiance [IC] à 95 % 1,19–3,05), au nombre de résidents dans l’établissement (RC ajusté 1,38; IC à 95 % 1,18–1,61) et à l’application des anciennes normes d’aménagement (RC ajusté 1,55; IC à 95 % 1,01–2,38), mais pas au statut financier d’un foyer. Comparativement au statut « à but non lucratif », le statut « à but lucratif » a été associé à l’ampleur d’une éclosion dans un foyer de SLD (risque relatif [RR] 1,96; IC à 95 % 1,26–3,05) ainsi qu’au nombre de décès de résidents (RR ajusté 1,78; IC à 95 % 1,03–3,07). Ces associations s’expliquent par une plus grande prévalence des anciennes normes d’aménagement dans les foyers de SLD à but lucratif ainsi qu’à l’appartenance à une chaîne de propriétés. INTERPRÉTATION: Le statut « à but lucratif » est associé à l’ampleur d’une éclosion de COVID-19 et au nombre de décès de résidents dans un foyer de SLD, mais pas au risque d’éclosion. Deux principaux facteurs expliquent les différences entre les foyers à but lucratif et non lucratif, soit l’application des anciennes normes d’aménagement et l’appartenance à une chaîne de propriétés. Ceux-ci devraient être au coeur des futures mesures et politiques de lutte contre les infections.
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Affiliation(s)
- Nathan M Stall
- Division de médecine interne générale et de gériatrie (Stall), Système de santé Sinaï et Réseau universitaire de santé; Institut de recherche du Women's College (Stall, Rochon), Hôpital Women's College; Département de médecine (Stall, Rochon) et Institut des politiques, de la gestion et de l'évaluation de la santé (Stall, Rochon), Université de Toronto, Toronto (Ontario); Département des méthodes, des données et de l'incidence de la recherche en santé (Jones, Costa), Université McMaster, Hamilton (Ontario); Prévention et contrôle des infections (Brown), Santé publique Ontario; École de santé publique Dalla Lana (Brown), Université de Toronto, Toronto (Ontario); Chaire de l'Institut Schlegel en épidémiologie clinique et en vieillissement (Costa), Université McMaster; Centre de soins intégrés (Costa), Système de soins de santé St-Joseph, Hamilton (Ontario)
| | - Aaron Jones
- Division de médecine interne générale et de gériatrie (Stall), Système de santé Sinaï et Réseau universitaire de santé; Institut de recherche du Women's College (Stall, Rochon), Hôpital Women's College; Département de médecine (Stall, Rochon) et Institut des politiques, de la gestion et de l'évaluation de la santé (Stall, Rochon), Université de Toronto, Toronto (Ontario); Département des méthodes, des données et de l'incidence de la recherche en santé (Jones, Costa), Université McMaster, Hamilton (Ontario); Prévention et contrôle des infections (Brown), Santé publique Ontario; École de santé publique Dalla Lana (Brown), Université de Toronto, Toronto (Ontario); Chaire de l'Institut Schlegel en épidémiologie clinique et en vieillissement (Costa), Université McMaster; Centre de soins intégrés (Costa), Système de soins de santé St-Joseph, Hamilton (Ontario)
| | - Kevin A Brown
- Division de médecine interne générale et de gériatrie (Stall), Système de santé Sinaï et Réseau universitaire de santé; Institut de recherche du Women's College (Stall, Rochon), Hôpital Women's College; Département de médecine (Stall, Rochon) et Institut des politiques, de la gestion et de l'évaluation de la santé (Stall, Rochon), Université de Toronto, Toronto (Ontario); Département des méthodes, des données et de l'incidence de la recherche en santé (Jones, Costa), Université McMaster, Hamilton (Ontario); Prévention et contrôle des infections (Brown), Santé publique Ontario; École de santé publique Dalla Lana (Brown), Université de Toronto, Toronto (Ontario); Chaire de l'Institut Schlegel en épidémiologie clinique et en vieillissement (Costa), Université McMaster; Centre de soins intégrés (Costa), Système de soins de santé St-Joseph, Hamilton (Ontario)
| | - Paula A Rochon
- Division de médecine interne générale et de gériatrie (Stall), Système de santé Sinaï et Réseau universitaire de santé; Institut de recherche du Women's College (Stall, Rochon), Hôpital Women's College; Département de médecine (Stall, Rochon) et Institut des politiques, de la gestion et de l'évaluation de la santé (Stall, Rochon), Université de Toronto, Toronto (Ontario); Département des méthodes, des données et de l'incidence de la recherche en santé (Jones, Costa), Université McMaster, Hamilton (Ontario); Prévention et contrôle des infections (Brown), Santé publique Ontario; École de santé publique Dalla Lana (Brown), Université de Toronto, Toronto (Ontario); Chaire de l'Institut Schlegel en épidémiologie clinique et en vieillissement (Costa), Université McMaster; Centre de soins intégrés (Costa), Système de soins de santé St-Joseph, Hamilton (Ontario)
| | - Andrew P Costa
- Division de médecine interne générale et de gériatrie (Stall), Système de santé Sinaï et Réseau universitaire de santé; Institut de recherche du Women's College (Stall, Rochon), Hôpital Women's College; Département de médecine (Stall, Rochon) et Institut des politiques, de la gestion et de l'évaluation de la santé (Stall, Rochon), Université de Toronto, Toronto (Ontario); Département des méthodes, des données et de l'incidence de la recherche en santé (Jones, Costa), Université McMaster, Hamilton (Ontario); Prévention et contrôle des infections (Brown), Santé publique Ontario; École de santé publique Dalla Lana (Brown), Université de Toronto, Toronto (Ontario); Chaire de l'Institut Schlegel en épidémiologie clinique et en vieillissement (Costa), Université McMaster; Centre de soins intégrés (Costa), Système de soins de santé St-Joseph, Hamilton (Ontario)
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Siu HYH, Kristof L, Elston D, Hafid A, Mather F. A cross-sectional survey assessing the preparedness of the long-term care sector to respond to the COVID-19 pandemic in Ontario, Canada. BMC Geriatr 2020; 20:421. [PMID: 33092541 PMCID: PMC7578587 DOI: 10.1186/s12877-020-01828-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/12/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic is a significant public health emergency that impacts all sectors of healthcare. The negative health outcomes for the COVID-19 infection have been most severe in the frail elderly dwelling in Canadian long-term care (LTC) homes. METHODS An online cross-sectional survey of Ontario LTC Clinicians working in LTC homes in Ontario Canada was conducted to provide the clinician perspective on the preparedness and engagement of the LTC sector during the COVID-19 pandemic. The survey questionnaire was developed in collaboration with the Ontario Long-Term Care Clinicians organization (OLTCC) and was distributed between March 30, 2020 to May 25, 2020. All registered members of the OLTCC and Nurse-led LTC Outreach Teams were invited to participate. The primary outcomes were: 1) the descriptive report of the screening measures implemented, communication and information received, and the preparation of the respondent's LTC home to a potential COVID-19 outbreak; and 2) the level of agreement, as reported using a five-point Likert scale), to COVID-19 preparedness statements for the respondent's LTC home was also assessed. RESULTS The overall response rate was 54% (160/294). LTC homes implemented a wide range of important interventions (e.g. instituting established respiratory isolation protocols, active screening of new LTC admissions, increasing education on infection control processes, encouraging sick staff to take time off, etc). Ample communications pertinent to the pandemic were received from provincial LTC organizations, the government and public health officials. However, the feasibility of implementing public health recommendations, as well as the engagement of the LTC sector in pandemic planning were identified as areas of concern. Medical director status was associated with an increased knowledge of local implementation of interventions to mitigate COVID-19, as well as endorsing increased access to reliable COVID-19 information and resources to manage a potential COVID-19 outbreak in their LTC home. CONCLUSIONS This study highlights the communication and implementation of recommendations in the Ontario LTC sector, despite some concerns regarding feasibility. Importantly, LTC clinician respondents clearly indicated that better engagement with LTC leaders is needed to plan a coordinated pandemic response.
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Affiliation(s)
- Henry Yu-Hin Siu
- , 1475 Upper Ottawa Street, Hamilton, Ontario, L8W 3J6, Canada. .,Department of Family Medicine, McMaster University, 5th Floor, 100 Main Street West, Hamilton, Ontario, L8P 1H6, Canada.
| | - Lorand Kristof
- Department of Family Medicine, McMaster University, 5th Floor, 100 Main Street West, Hamilton, Ontario, L8P 1H6, Canada.,Ontario Long-Term Care Clinicians, 202-1143 Wentworth Street West, Oshawa, Ontario, L1J 8P7, Canada
| | - Dawn Elston
- Department of Family Medicine, McMaster University, 5th Floor, 100 Main Street West, Hamilton, Ontario, L8P 1H6, Canada
| | - Abe Hafid
- Department of Family Medicine, McMaster University, 5th Floor, 100 Main Street West, Hamilton, Ontario, L8P 1H6, Canada
| | - Fred Mather
- Ontario Long-Term Care Clinicians, 202-1143 Wentworth Street West, Oshawa, Ontario, L1J 8P7, Canada
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Liu M, Maxwell CJ, Armstrong P, Schwandt M, Moser A, McGregor MJ, Bronskill SE, Dhalla IA. COVID-19 in long-term care homes in Ontario and British Columbia. CMAJ 2020; 192:E1540-E1546. [PMID: 32998943 DOI: 10.1503/cmaj.201860] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Michael Liu
- Harvard Medical School (Liu), Boston, Mass.; Department of Social Policy and Intervention (Liu), University of Oxford, Oxford, UK; Schools of Pharmacy and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Department of Sociology (Armstrong), York University; Department of Family and Community Medicine (Moser); Institute of Health Policy, Management and Evaluation (Bronskill, Dhalla), Dalla Lana School of Public Health, and Department of Medicine (Dhalla), University of Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculty of Medicine (Schwandt), School of Population and Public Health, and Department of Family Practice (McGregor), University of British Columbia; Vancouver Coastal Health (Schwandt); Vancouver, BC
| | - Colleen J Maxwell
- Harvard Medical School (Liu), Boston, Mass.; Department of Social Policy and Intervention (Liu), University of Oxford, Oxford, UK; Schools of Pharmacy and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Department of Sociology (Armstrong), York University; Department of Family and Community Medicine (Moser); Institute of Health Policy, Management and Evaluation (Bronskill, Dhalla), Dalla Lana School of Public Health, and Department of Medicine (Dhalla), University of Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculty of Medicine (Schwandt), School of Population and Public Health, and Department of Family Practice (McGregor), University of British Columbia; Vancouver Coastal Health (Schwandt); Vancouver, BC
| | - Pat Armstrong
- Harvard Medical School (Liu), Boston, Mass.; Department of Social Policy and Intervention (Liu), University of Oxford, Oxford, UK; Schools of Pharmacy and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Department of Sociology (Armstrong), York University; Department of Family and Community Medicine (Moser); Institute of Health Policy, Management and Evaluation (Bronskill, Dhalla), Dalla Lana School of Public Health, and Department of Medicine (Dhalla), University of Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculty of Medicine (Schwandt), School of Population and Public Health, and Department of Family Practice (McGregor), University of British Columbia; Vancouver Coastal Health (Schwandt); Vancouver, BC
| | - Michael Schwandt
- Harvard Medical School (Liu), Boston, Mass.; Department of Social Policy and Intervention (Liu), University of Oxford, Oxford, UK; Schools of Pharmacy and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Department of Sociology (Armstrong), York University; Department of Family and Community Medicine (Moser); Institute of Health Policy, Management and Evaluation (Bronskill, Dhalla), Dalla Lana School of Public Health, and Department of Medicine (Dhalla), University of Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculty of Medicine (Schwandt), School of Population and Public Health, and Department of Family Practice (McGregor), University of British Columbia; Vancouver Coastal Health (Schwandt); Vancouver, BC
| | - Andrea Moser
- Harvard Medical School (Liu), Boston, Mass.; Department of Social Policy and Intervention (Liu), University of Oxford, Oxford, UK; Schools of Pharmacy and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Department of Sociology (Armstrong), York University; Department of Family and Community Medicine (Moser); Institute of Health Policy, Management and Evaluation (Bronskill, Dhalla), Dalla Lana School of Public Health, and Department of Medicine (Dhalla), University of Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculty of Medicine (Schwandt), School of Population and Public Health, and Department of Family Practice (McGregor), University of British Columbia; Vancouver Coastal Health (Schwandt); Vancouver, BC
| | - Margaret J McGregor
- Harvard Medical School (Liu), Boston, Mass.; Department of Social Policy and Intervention (Liu), University of Oxford, Oxford, UK; Schools of Pharmacy and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Department of Sociology (Armstrong), York University; Department of Family and Community Medicine (Moser); Institute of Health Policy, Management and Evaluation (Bronskill, Dhalla), Dalla Lana School of Public Health, and Department of Medicine (Dhalla), University of Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculty of Medicine (Schwandt), School of Population and Public Health, and Department of Family Practice (McGregor), University of British Columbia; Vancouver Coastal Health (Schwandt); Vancouver, BC
| | - Susan E Bronskill
- Harvard Medical School (Liu), Boston, Mass.; Department of Social Policy and Intervention (Liu), University of Oxford, Oxford, UK; Schools of Pharmacy and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Department of Sociology (Armstrong), York University; Department of Family and Community Medicine (Moser); Institute of Health Policy, Management and Evaluation (Bronskill, Dhalla), Dalla Lana School of Public Health, and Department of Medicine (Dhalla), University of Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculty of Medicine (Schwandt), School of Population and Public Health, and Department of Family Practice (McGregor), University of British Columbia; Vancouver Coastal Health (Schwandt); Vancouver, BC
| | - Irfan A Dhalla
- Harvard Medical School (Liu), Boston, Mass.; Department of Social Policy and Intervention (Liu), University of Oxford, Oxford, UK; Schools of Pharmacy and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Department of Sociology (Armstrong), York University; Department of Family and Community Medicine (Moser); Institute of Health Policy, Management and Evaluation (Bronskill, Dhalla), Dalla Lana School of Public Health, and Department of Medicine (Dhalla), University of Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculty of Medicine (Schwandt), School of Population and Public Health, and Department of Family Practice (McGregor), University of British Columbia; Vancouver Coastal Health (Schwandt); Vancouver, BC
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Hendren EM, Matthews N, Oliver M, Rice J, Tobe SW, Auguste BL. An Interprofessional Approach in Caring for a Patient on Maintenance Hemodialysis with COVID-19 in Toronto, Canada: An Educational Case Report. Can J Kidney Health Dis 2020; 7:2054358120957473. [PMID: 32953129 PMCID: PMC7485156 DOI: 10.1177/2054358120957473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 08/01/2020] [Indexed: 11/16/2022] Open
Abstract
Rationale Hemodialysis patients are at significant risk from COVID-19 due to their frequent interaction with the health care system and medical comorbidities. We followed up the trajectory of the first COVID-19-positive maintenance hemodialysis patient at Sunnybrook Health Sciences Centre in Toronto. We present the lessons learned and changes in practices that occurred to prevent an outbreak in our center. Presenting concerns of the patient The patient, a 66-year-old woman on in-center hemodialysis, initially presented with a 2-day history of a productive cough. She subsequently developed a fever, was placed on contact and droplet isolation, and admitted to hospital. Diagnoses On March 13, 2020, the patient tested positive for COVID-19. Within the next 48 hours, she developed hypoxia and acute respiratory distress syndrome as a complication of her illness requiring an extended critical care stay. This extended critical care stay resulted in critical illness-associated secondary sclerosing cholangitis. Interventions An interprofessional team was established, performing rapid Plan-Do-Study-Act quality improvement cycles to improve screening practices and promote the safety of patients and staff in the hemodialysis unit. Outcomes We present here the lessons learned, the changes to our screening protocols, and the clinical course of our first in-center hemodialysis patient with SARS-CoV-2. Teaching points Regular review of the infection screening processes is paramount in preventing outbreaks of COVID-19, particularly in hemodialysis units. Hospital admission should be arranged if a patient exhibits any clinical signs of hemodynamic compromise or hypoxia. Early education for health care practitioners caring for patients with COVID-19 and refresher information regarding personal protective equipment helped promote the safety of staff and prevent health care-associated outbreaks.
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Affiliation(s)
- Elizabeth M Hendren
- Division of Nephrology, Department of Medicine, University of Toronto, ON, Canada
| | - Nicola Matthews
- Division of Nephrology, Department of Medicine, University of Toronto, ON, Canada
| | - Mathew Oliver
- Division of Nephrology, Department of Medicine, University of Toronto, ON, Canada.,Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Julie Rice
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Sheldon W Tobe
- Division of Nephrology, Department of Medicine, University of Toronto, ON, Canada.,Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Northern Ontario School of Medicine, Sudbury, Canada
| | - Bourne L Auguste
- Division of Nephrology, Department of Medicine, University of Toronto, ON, Canada.,Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Stall NM, Jones A, Brown KA, Rochon PA, Costa AP. For-profit long-term care homes and the risk of COVID-19 outbreaks and resident deaths. CMAJ 2020; 192:E946-E955. [PMID: 32699006 PMCID: PMC7828970 DOI: 10.1503/cmaj.201197] [Citation(s) in RCA: 123] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Long-term care (LTC) homes have been the epicentre of the coronavirus disease 2019 (COVID-19) pandemic in Canada to date. Previous research shows that for-profit LTC homes deliver inferior care across a variety of outcome and process measures, raising the question of whether for-profit homes have had worse COVID-19 outcomes than nonprofit homes. METHODS We conducted a retrospective cohort study of all LTC homes in Ontario, Canada, from Mar. 29 to May 20, 2020, using a COVID-19 outbreak database maintained by the Ontario Ministry of Long-Term Care. We used hierarchical logistic and count-based methods to model the associations between profit status of LTC homes (for-profit, nonprofit or municipal) and COVID-19 outbreaks in LTC homes, the extent of COVID-19 outbreaks (number of residents infected), and deaths of residents from COVID-19. RESULTS The analysis included all 623 Ontario LTC homes, comprising 75 676 residents; 360 LTC homes (57.7%) were for profit, 162 (26.0%) were nonprofit, and 101 (16.2%) were municipal homes. There were 190 (30.5%) outbreaks of COVID-19 in LTC homes, involving 5218 residents and resulting in 1452 deaths, with an overall case fatality rate of 27.8%. The odds of a COVID-19 outbreak were associated with the incidence of COVID-19 in the public health unit region surrounding an LTC home (adjusted odds ratio [OR] 1.91, 95% confidence interval [CI] 1.19-3.05), the number of residents (adjusted OR 1.38, 95% CI 1.18-1.61), and older design standards of the home (adjusted OR 1.55, 95% CI 1.01-2.38), but not profit status. For-profit status was associated with both the extent of an outbreak in an LTC home (adjusted risk ratio [RR] 1.96, 95% CI 1.26-3.05) and the number of resident deaths (adjusted RR 1.78, 95% CI 1.03-3.07), compared with nonprofit homes. These associations were mediated by a higher prevalence of older design standards in for-profit LTC homes and chain ownership. INTERPRETATION For-profit status is associated with the extent of an outbreak of COVID-19 in LTC homes and the number of resident deaths, but not the likelihood of outbreaks. Differences between for-profit and nonprofit homes are largely explained by older design standards and chain ownership, which should be a focus of infection control efforts and future policy.
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Affiliation(s)
- Nathan M Stall
- Division of General Internal Medicine and Geriatrics (Stall), Sinai Health System and the University Health Network; Women's College Research Institute (Stall, Rochon), Women's College Hospital; Department of Medicine (Stall, Rochon) and Institute of Health Policy, Management and Evaluation (Stall, Rochon), University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Jones, Costa), McMaster University, Hamilton, Ont.; Infection Prevention and Control (Brown), Public Health Ontario; Dalla Lana School of Public Health (Brown), University of Toronto, Toronto, Ont.; Schlegel Chair in Clinical Epidemiology and Aging (Costa), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont.
| | - Aaron Jones
- Division of General Internal Medicine and Geriatrics (Stall), Sinai Health System and the University Health Network; Women's College Research Institute (Stall, Rochon), Women's College Hospital; Department of Medicine (Stall, Rochon) and Institute of Health Policy, Management and Evaluation (Stall, Rochon), University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Jones, Costa), McMaster University, Hamilton, Ont.; Infection Prevention and Control (Brown), Public Health Ontario; Dalla Lana School of Public Health (Brown), University of Toronto, Toronto, Ont.; Schlegel Chair in Clinical Epidemiology and Aging (Costa), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont
| | - Kevin A Brown
- Division of General Internal Medicine and Geriatrics (Stall), Sinai Health System and the University Health Network; Women's College Research Institute (Stall, Rochon), Women's College Hospital; Department of Medicine (Stall, Rochon) and Institute of Health Policy, Management and Evaluation (Stall, Rochon), University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Jones, Costa), McMaster University, Hamilton, Ont.; Infection Prevention and Control (Brown), Public Health Ontario; Dalla Lana School of Public Health (Brown), University of Toronto, Toronto, Ont.; Schlegel Chair in Clinical Epidemiology and Aging (Costa), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont
| | - Paula A Rochon
- Division of General Internal Medicine and Geriatrics (Stall), Sinai Health System and the University Health Network; Women's College Research Institute (Stall, Rochon), Women's College Hospital; Department of Medicine (Stall, Rochon) and Institute of Health Policy, Management and Evaluation (Stall, Rochon), University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Jones, Costa), McMaster University, Hamilton, Ont.; Infection Prevention and Control (Brown), Public Health Ontario; Dalla Lana School of Public Health (Brown), University of Toronto, Toronto, Ont.; Schlegel Chair in Clinical Epidemiology and Aging (Costa), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont
| | - Andrew P Costa
- Division of General Internal Medicine and Geriatrics (Stall), Sinai Health System and the University Health Network; Women's College Research Institute (Stall, Rochon), Women's College Hospital; Department of Medicine (Stall, Rochon) and Institute of Health Policy, Management and Evaluation (Stall, Rochon), University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Jones, Costa), McMaster University, Hamilton, Ont.; Infection Prevention and Control (Brown), Public Health Ontario; Dalla Lana School of Public Health (Brown), University of Toronto, Toronto, Ont.; Schlegel Chair in Clinical Epidemiology and Aging (Costa), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont
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Estabrooks CA, Straus SE, Flood CM, Keefe J, Armstrong P, Donner GJ, Boscart V, Ducharme F, Silvius JL, Wolfson MC. Restoring trust: COVID-19 and the future of long-term care in Canada. Facets (Ott) 2020. [DOI: 10.1139/facets-2020-0056] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The Royal Society of Canada Task Force on COVID-19 was formed in April 2020 to provide evidence-informed perspectives on major societal challenges in response to and recovery from COVID-19. The Task Force established a series of working groups to rapidly develop policy briefings, with the objective of supporting policy makers with evidence to inform their decisions. This paper reports the findings of the COVID-19 Long-Term Care (LTC) working group addressing a preferred future for LTC in Canada, with a specific focus on COVID-19 and the LTC workforce. First, the report addresses the research context and policy environment in Canada’s LTC sector before COVID-19 and then summarizes the existing knowledge base for integrated solutions to challenges that exist in the LTC sector. Second, the report outlines vulnerabilities exposed because of COVID-19, including deficiencies in the LTC sector that contributed to the magnitude of the COVID-19 crisis. This section focuses especially on the characteristics of older adults living in nursing homes, their caregivers, and the physical environment of nursing homes as important contributors to the COVID-19 crisis. Finally, the report articulates principles for action and nine recommendations for action to help solve the workforce crisis in nursing homes.
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Affiliation(s)
| | - Sharon E. Straus
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Janice Keefe
- Department of Family Studies and Gerontology, Mount Saint Vincent University, Halifax, NS, Canada
| | - Pat Armstrong
- Department of Sociology, York University, Toronto, ON, Canada
| | - Gail J. Donner
- Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Véronique Boscart
- CIHR/Schlegel Industrial Research Chair for Colleges in Seniors Care, Conestoga College, Kitchener, ON, Canada
| | | | - James L. Silvius
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Michael C. Wolfson
- School of Epidemiology and Public Health and Faculty of Law, University of Ottawa, Ottawa, ON, Canada
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