Addressing data gaps on long-term care in Canada through data linkage

Care Aides Working Multiple Jobs: Considerations for Staffing Policies in Long-Term Care Homes During and After the COVID-19 Pandemic

While debate over the appropriate scope and goals of COVID‐19 lockdowns has raged, all public health agencies have been clear on one matter: older adults have the highest rates of mortality (Comas‐Herrera et al., 2020) and should be isolated (Public Health Agency of Canada, 2020). Older adults and individuals with complex health conditions are most vulnerable to the virus. Yet, social isolation contributes to the onset and intensifies depression, feelings of despair and, in older adults with dementia, further cognitive decline.

Robotics and autonomous systems have been dubbed as viable technological solutions to address the incessant demand for long-term care (LTC) across the world, which is exacerbated by ageing populations. However, similar to other emerging technologies, the adoption of robotics and autonomous systems in LTC pose risks and unintended consequences. In the health and LTC sectors, there are additional bioethics concerns that are associated with novel technology applications. Using an in-depth case study, we examined the adoption of novel technologies such as robotics and autonomous systems in LTC to meet the rising social care demand in Singapore consequent to its ageing population. We first described the LTC sector in Singapore and traced the development of robotics and autonomous systems deployed in the LTC setting. We then examined technological risks and ethical issues that are associated with their applications. In addressing these technological risks and ethical concerns, Singapore has adopted a regulatory sandbox approach that fosters experimentation through the creation of a robotics test-bed and the initiation of various robotics pilots in different health clusters. The stakeholders largely envision positive scenarios of human-robot coexistence in the LTC setting. When robots can take over routine and manual care duties in the future, human care workers can be freed up to provide more personalised care to the care recipients. We also highlighted existing gaps in the governance of technological risks and ethical issues surrounding the deployment of robotics and autonomous systems in LTC that can be advanced as future research agendas.

Governing the Adoption of Robotics and Autonomous Systems in Long-Term Care in Singapore

Nursing Home Reform in the Context of National Long-Term Care Services and Policy: The Devil in the Details of the National Academies Report.

Excess Mortality in Long-Term Care Residents With and Without Personal Contact With Family or Friends During the COVID-19 Pandemic

<strong>Brief Summary:</strong> Residents in long-term care facilities in Canada with mental and cognitive disorders have complex care needs. To meet these needs an integrated model of care is recommended. <strong>Context:</strong> The high prevalence of mental disorders in residents of long-term care (LTC) facilities raises serious concerns for facility operators and staff. These residents have multiple vulnerabilities that facility staff should have the necessary knowledge and skills to properly meet their needs. <strong>Objectives:</strong> To describe the profile of residents with mental disorders (MD) and Alzheimer’s Disease and Related Dementias (ADRD) in Canadian long-term care (LTC) facilities. <strong>Findings:</strong> Seventy-six percent of residents had MD (40%) and ADRD (36%). These residents compared to those without such disorders were more likely to be cognitively impaired, manifest aggressive behavior, receive psychotropic drugs, and physically restrained, and less likely to be socially engaged. <strong>Strengths and Limitations:</strong> The large representative sample was a key strength. The findings add to the knowledge about the profile of LTC residents. The cross-sectional design of the study limits the findings to the population studied. <strong>Implications:</strong> Residents with MD and ADRD compared to those without such disorders are highly vulnerable because of their double burden of mental and physical comorbidities. Their profile may be of interest to LTC facility operators, clinicians, and policy makers about their complex care needs. Our findings raise awareness of the need for trained LTC facility staff for knowledge and skills in psychogeriatric conditions to assess, plan, and implement appropriate interventions for these residents. Coordinated and integrated models of care with access to psychogeriatric specialists such as psychiatrists or advanced practice nurses will also be of benefit to them.

Social Isolation of Older Adults in Long Term Care as a Result of COVID-19 Mitigation Measures During the COVID-19 Pandemic

A Case for Community and Hospital-Based Long-Term Care Facilities in Saudi Arabia

BackgroundThe 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.MethodsAn 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.ResultsThe 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.ConclusionsThis 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.

Developmental trajectories of health and long-term care systems: The transitions of solidarity in four Asian countries

Long-term care (LTC) residents may be susceptible to social isolation if living in facilities located in neighborhoods lacking social connection. To characterize the social isolation of residents living in LTC facilities in the US. This cross-sectional study included 730 524 LTC residents from 14 224 LTC facilities in 8652 zip code tabulation areas (ZCTAs) in the US in 2011. A nationwide LTC database with ZCTA data was linked to population-level geographic data from the US Census Bureau. Statistical analysis was performed from January 2019 to December 2020. The primary variable of interest was the social isolation of LTC neighborhoods defined as the percentage of households in the ZCTA with individuals aged 65 years or older who lived alone and categorized into quartiles of social isolation. Maps were generated to illustrate geographic variation of LTC facilities at the ZCTA level by the quartile of socially isolated neighborhoods. Generalized estimating equations were used to estimate the adjusted likelihood that LTC facilities were located in areas of highest social isolation. We also used multilevel logistic regression models to assess the association between the social isolation of neighborhoods of LTC facilities and 30-day all-cause mortality after LTC admission. Subgroup analyses were conducted by race and ethnicity. Among 33 120 ZCTAs in the US, 8652 (26.1%) had at least 1 LTC facility. Among the 730 524 LTC residents included in the study's 14 224 LTC facilities, 458 136 (62.71%) were female, 610 802 (83.61%) were non-Hispanic White, and 419 654 (57.45%) were aged 80 years or older. Location of LTC facilities was associated with increasing levels of social isolation (quartile 1 = 9.72% [n = 840]; quartile 2 = 18.60% [n = 1607]; quartile 3 = 32.23% [n = 2784]; quartile 4 = 39.45% [n = 3408]; P < .001). In multivariate models, LTC facilities were 8 times more likely to be located in ZCTAs with the highest percentages of older adults residing in single-occupancy households (odds ratio [OR], 8.46; 95% CI, 7.44-9.65; P < .001), compared with ZCTAs with the lowest percentages. This association held across ZCTAs with a majority population of African American and Hispanic individuals, although it was strongest in ZCTAs with a majority population of White individuals. LTC residents entering facilities in neighborhoods with the highest levels of social isolation among older adults had a 17% higher risk of 30-day mortality (OR, 1.17; 95% CI, 1.10-1.25; P < .001) compared with those in neighborhoods with the lowest levels of social isolation among older adults. This study found that LTC facilities were often located in socially isolated neighborhoods, suggesting the need for special attention and strategies to keep LTC residents connected to their family and friends for optimal health.

We study private equity involvement (or lack thereof) in the long-term care (LTC) sector and its recent developments in the United States, Ireland and Poland. Based on the similarities and differences across these countries' LTC systems, which can be treated as ideal types of the variety in typical models of LTC systems, we develop a systematic approach to the analysis of private equity engagement in the sector. Specifically, we define the comparison criteria as follows: the debates about the role and place of private equity in LTC; the extent of private equity investments in LTC; the reasons for private equity entry into the LTC sector; the business strategies of private equity firms; the regulations relative to private equity in LTC. Our case study comparison demonstrates that policy responses to population aging and care needs are deeply political processes, leading to a variety of solutions shaped by institutional legacies, cultural contexts, and the power dynamics between states, markets, and civil society.

BackgroundThe prevalence of COVID-19 in the United States led to mandated lockdowns for long-term care (LTC) facilities, resulting in loss of in-person contact with social ties for LTC residents. Though information and communication technologies (ICTs) can be used by LTC residents to support their socioemotional needs, residents must have access to ICTs to use them.ObjectiveThis study explored ICT access and use in LTC facilities and how LTC facilities adapted to try to enhance social connections for their residents during the COVID-19 pandemic.MethodsLTC administrators in South Carolina (United States) were invited to complete a web-based survey exploring ICT access and use in LTC facilities and whether access and use changed as a result of the COVID-19 pandemic.ResultsLTC administrators (N=70, 12 nursing homes [NHs], and 58 assisted living facilities [ALFs]) completed the web-based survey. Since March 2020, a total of 53% (37/70) of the LTC facilities have purchased ICTs for residents’ use. ICTs have mainly been used for videoconferencing with family members (31/36, 86%), friends (25/36, 69%), and health care providers (26/36, 72%). NHs were 10.23 times more likely to purchase ICTs for residents’ use during the COVID-19 pandemic than ALFs (odds ratio 11.23, 95% CI 1.12-113.02; P=.04). Benefits of ICT use included residents feeling connected to their family members, friends, and other residents. Barriers to ICT use included staff not having time to assist residents with using the technology, nonfunctional technology, and residents who do not want to share technology.ConclusionsOur results suggest that over half of the LTC facilities in this study were able to acquire ICTs for their residents to use during the COVID-19 pandemic. Additional research is needed to explore how residents adapted to using the ICTs and whether LTC facilities developed and adopted technology integration plans, which could help them be prepared for future situations that may affect LTC residents’ engagement and communication opportunities, such as another pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has been particularly severe among individuals residing in long-term care (LTC) facilities. As of April 10, 2020, half of Canada's COVID-19 deaths had occurred in LTC facilities. To better understand trends and risk factors associated with COVID-19 death in LTC facilities in Ontario, Canada. This cohort study of 627 LTC facilities included 269 total individuals who died of COVID-19 in Ontario to April 11, 2020, and 83 individuals who died of COVID-19 in Ontario LTC facilities to April 7, 2020. Because population denominators were not available for LTC residents, they were approximated as the total number of LTC facility beds in Ontario (79 498), assuming complete occupancy. Confirmed or suspected COVID-19 outbreaks; confirmed COVID-19 infection among residents and staff, diagnosed by real-time polymerase chain reaction testing. COVID-19-specific mortality incidence rate ratios (IRRs) for LTC residents were calculated with community-living Ontarians older than 69 years as the comparator group. Count-based regression methods were used to model temporal trends and to identify associations of infection risk among staff and residents with subsequent LTC resident death. Model-derived IRRs for COVID-19-specific mortality were generated through bootstrap resampling (1000 replicates) to generate median and 95% credible intervals for IRR over time. Of 627 LTC facilities, 272 (43.4%) reported COVID-19 infection in residents or staff. Of 1 731 315 total individuals older than 69 years living in Ontario during the study period, 229 (<0.1%) died; of 79 498 potential residents in LTC facilities, 83 (0.1%) died. The IRR for COVID-19-related death in LTC residents was 13.1 (95% CI, 9.9-17.3) compared with community-living adults older than 69 years. The IRR increased sharply over time and was 87.3 (95% credible interval, 6.4-769.8) by April 11, 2020. Infection among LTC staff was associated with death among residents with a 6-day lag (eg, adjusted IRR for death per infected staff member, 1.17; 95% CI, 1.11-1.26). In this cohort study of COVID-19-related deaths during the pandemic in Ontario, Canada, mortality risk was concentrated in LTC residents and increased during a short period. Early identification of risk requires a focus on testing, providing personal protective equipment to staff, and restructuring the LTC workforce to prevent the movement of COVID-19 between facilities.