COVID-19 Measures Enacted by the Governments of Ontario and British Columbia to Protect Older Adult Residents of Long-Term Care Homes

Author & Credentials: Tessa Weinberg, MB BCh BAO (MD), MSc Candidate, incoming PGY1 Resident Physician in Family Medicine

Affiliated Institutions: AGE-WELL National Innovation Hub APPTA, McMaster University (MSc), The Royal College of Surgeons in Ireland (MD), University of Manitoba (Resident Physician)

What inspired you to begin researching this area? Describe the main issue or challenge you intend to address with this project. 

I was inspired to start researching this topic after seeing news media coverage relating to the proportion of cases and deaths in Canada from COVID-19 occurring in long-term care facilities. When I began in April, I had read that British Columbia had restricted staff to only work at one facility while Ontario had not. I knew that these provinces had been two of the hardest hit with both COVID-19 as well as outbreaks in long-term care, and that it would be interesting to compare their policy measures. I wanted to understand what was done to prevent outbreaks in these homes in order to derive opportunities for change in the provision of long-term care as well as lessons in planning for future pandemics or other emergent situations.

Briefly summarize your research project. 

My research project involves summarizing and analyzing the policy measures put in place by the provincial governments of Ontario and British Columbia to protect older adults living in long-term care facilities from the spread of COVID-19. The project also maps the timing of these measures relative to key pandemic events, including the overall number of cases as well as outbreaks in long-term care. Some of the key measures I found that were taken by both provinces included: single site orders restricting staff to working at a single facility, recommendations around the use of personal protective equipment (PPE), visitor limitations, screening of visitors, cohorting and isolation precautions after an outbreak has been declared, and testing policies. British Columbia arguably had a head start shifting focus to long-term care since they had the first case within a facility on March 5th, and this is reflected in their earlier issuance of a single site order on March 27th. Interestingly, Ontario has taken a more aggressive approach with respect to universal masking and the use of PPE than British Columbia, as well as more recently deciding to test all residents and staff of care homes throughout the province. The project also explores some background around what is known about the provision of long-term care generally in both provinces, as well as drawing some parallels from SARS (now SARS-Cov-1). Although the pandemic is still ongoing and further analyses should be conducted at its conclusion, my research project aims to draw preliminary lessons learned from policy directions taken thus far. 

Discuss some of the past, present, and/ or intended future real-world applications of this research 

This research is highly relevant to future changes and improvements to long-term care, as the likely causes of increased spread of COVID-19 within long-term care homes are reflective of systemic challenges within these facilities at baseline. It can be argued that having staff work part-time at multiple facilities may have increased spread within and between homes, given that both provinces studied issued single site orders. In addition, most measures became more aggressive over the course of the pandemic. For example, recommending universal masking for all staff for the duration of shifts in Ontario as well as developing more comprehensive testing strategies (with the broadest being testing of all staff and residents of these facilities in Ontario). In reading the report by the National Advisory Committee on SARS and Public Health from 2003, I was struck by the similarity between the challenges highlighted and the current situation. The report listed insufficient surge capacity in the clinical and public health systems, barriers in timely access to testing and results, absent protocols for data sharing between levels of government and inadequate capacity for epidemiologic investigations of outbreaks as key issues. All of the same challenges have been raised during the COVID-19 pandemic. In addition, similar restrictions limiting nurses to only work at one healthcare organization were issued in 2003, which resulted in huge staff shortages in long-term care and home care, due to nurses opting to work in hospitals.The broadening and increasingly aggressive measures as well as the high proportion of deaths within long-term care beg the question whether guidelines should be developed in order to implement protective measures faster and more effectively in future pandemics. Further, there have been concerns around training on the proper use of PPE among staff and chronic understaffing compromising quality of care. These are longstanding issues around the provision of long-term care that have been highlighted by the pandemic and are important policy directions for provincial governments to consider going forward.