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The COVID-19 pandemic has impacted long-term care facilities and nursing homes around the world. [1] Thousands of residents of these facilities, who are a high-risk group, have died of the disease.
The U.S. Centers for Disease Control and Prevention has issued guidance on prevention and management strategies for COVID-19 in long-term care facilities. Prevention strategies include educating residents and staff on COVID-19, symptom screening, visitor restrictions, wearing face coverings, and installing sanitizer stations. Face masks should not be worn by those who have difficulty breathing. At least one staff member with training in infection prevention and control can serve as on-site management. Space should be set aside to isolate and care for confirmed cases of COVID-19. Staff members need flexible sick policies and should be encouraged to self-monitor for symptoms. [2]
 | This article needs to be updated.(July 2020) |
As of July 2020, there were 9000 COVID-19 deaths in Canadian long-term care homes. Of those, more than 5600 were in Quebec, and nearly 2800 were in Ontario. British Columbia had less than 200 deaths in LTC facilities. [3]
As of mid-April 2020, nearly half of the COVID-19 deaths in Canada were at long-term care facilities. [4] Residences are provincially-regulated, meaning that standards are inconsistent on the worker to resident ratios and standards of training. [5]
Outcomes have varied across a wide range from province to province, with Quebec experiencing an extremely large problem centered around the Island of Montreal (materially affecting national statistics). The populous province of Ontario also experienced a large problem, centered around Toronto.[ citation needed ]
The western province of British Columbia, with Canada's third-largest urban center, Vancouver, experienced one of the earliest cases in Canada involving long-term care: a health care worker at the Lynn Valley Care Centre in North Vancouver, announced on 5 March as the first known community transmission in BC. Two days later, the first death from a resident in long-term care was announced in connection with the same facility.[ citation needed ]
Aggressive measures were implemented on 18 March with the announcement of a $10 million per month government program to increase salaries for long-term care workers in support of a directive limiting care workers to work at a single facility only. As of 30 May, BC has reported 113 deaths involving residents and workers associated with long-term care, against a provincial population of 5 million. At this same date, Quebec—on a population of 8.5 million—has reported 3,694 death associated with long-term care: 2,786 deaths associated with government-managed facilities and another 908 deaths associated with private care. [ citation needed ]
In Quebec, a team of health care professionals inspecting Résidence Herron after a resident's death from COVID-19 found the facility largely abandoned by staff. Living conditions inside were similar to "a concentration camp", according to the officials. [6]
In Ontario on 18 March, an outbreak began in the Pinecrest Nursing Home in Bobcaygeon, and as of 6 April, 29 of its 65 residents have died as a result of COVID-19. [7] [8] On 6 April, the City of Toronto discovered that a large shipment of Chinese-made masks delivered to its long-term care facilities were defective. [9] On April 16, the province decided to halt transfers to long-term care homes. [10] Assistance from the Canadian Armed Forces at five Toronto-area nursing homes, beginning in April, led to a report by the Brigadier General in charge documenting extreme conditions and abuse. [11] The Ontario Ombudsman announced the launch an investigation into long-term care facilities on June 1. [12]
A study published by the Canadian Medical Association Journal found that while outbreaks occurred equally in Ontario's for-profit and non-for-profit long-term care homes, negative outcomes were more prevalent in for-profit facilities. They found a 196% increase in cases, and a 178% increase in deaths. [3] A rapid review of COVID-19 outcomes found a significant relationship in the unadjusted statistics between ownership status and effectiveness in response to the COVID-19 pandemic. This relationship was attenuated after looking at the adjusted figures; the relationship seemed to be mediated by other organizational (e.g., size), process (e.g., staff shortages) and contextual factors (e.g., regional spread of COVID-19) in comparison to ownership directly. [13]
In July, the Canadian Broadcasting Corporation reported on a provincial long-term care home inspector, in Ontario, who was under investigation for her use of social media to post health misinformation. [14] [15] Her views were described by the Registered Nurses Association of Ontario CEO as "the most extreme example I have seen in my own profession." [16]
Six corporations together owning and operating 200 long-term care homes—experienced "unusually high rates of COVID-19 infection and related deaths." [17] In March 2024, the Ontario Superior Court certified class action lawsuits against Chartwell Retirement Residences, Extendicare, Responsive Group, Revera, Schlegel Villages, and Sienna Senior Living for gross negligence on behalf of thousands of people who contracted COVID-19 during the pandemic after visiting these homes or residing in them. [18]
About a third of reported coronavirus deaths have occurred among residents—more than 3,000 [8] —causing the homes to run low on body bags. [19] More than 2,300 homes have had at least one case reported. [8] Nursing home residents are being isolated in their rooms to slow the spread of the disease, while hospitals are reluctant to admit patients who have little chance of recovering. [19] Most elderly requiring care in France live in EHPADs. [20]
On 18 March, the first case was identified at the Hanns-Lije retirement home in Wolfsburg. [21] On 31 March, at least 17 died from COVID-19 in this residence. [22]
On 2 April, Robert Koch of the Institute in Germany affirmed that as of 1000 German deceased, [23] 87% were older than 70 years. Of these, more than 50 were residents in nursing homes in Bavaria, Cologne and Wolfsburg. [24] By 9 April, 29 residents of the nursing home in the city of Wolfsbrg died. [25]
As of 9 April, 3,859 people have died in care homes operated by RSA since 1 February of whom 133 tested positive and 1,310 had symptoms consistent with coronavirus. Prosecutors are investigating a home in Milan where 27 residents died of suspected coronavirus infection during the first week of April. [8]
The first officially confirmed case of Coronavirus disease 2019 (COVID-19) in Russian nursing homes for elderly and disabled people was located the town of Vyazma, on April 11, 2020. [26] [27]
Deputy Minister of Ministry of Labour and Social Protection Olga Batalina reported on April 23, 2020, that 450 Russians living in nursing homes were infected with the COVID-19, and diseases were registered in seven regions of Russia. The Ministry of Labor and Social Protection of the Russian Federation called in April 2020 to close all care homes in full quarantine. [28] At the beginning of May 2020, Elizaveta Oleskina, an employee of the Charity Fund "Starost v Radost" (Old Age in Joy), reported that there were cases of COVID-19 in nursing homes for elderly people in 20 Russian regions. [27]
The number of the elderly or disabled people living in Russian nursing homes is estimated (as on 2020) about 280.000. [27]
Russia has also increasing number of the private elderly care homes. The number of the elderly, living in Russian private care homes, was estimated (as on 2020) about 25.000, but no open information available about the cases of the COVID-19 in the private care homes. [29]
Human Rights Watch declared on 2 June 2020, that Russian government must openly publish all the data about the cases of COVID-19 in the Russian care homes because there were information about silencing of the facts that may increase risk of occurring of the disease outbreaks in the care homes. [29]
The death rate in care homes accelerated in April. Beginning 29 April, health secretary Matt Hancock said the government would begin daily reports of separate statistics for these facilities. This announcement was made after 4,343 deaths were reported in care homes between April 10–24; half of those deaths occurred during the last five days of the period. [35]
Sky News correspondent Alex Crawford wrote an editorial about care homes in general, and in relation to COVID, suggesting the situation was a "scandal" that future generations would question. She also noted care assistants' working conditions, including zero hour contracts, and homes urging sick employees to come in anyway. [36]
To prevent bringing COVID-19 into the facility, assistants at Liverpool's Beechside Home have moved in, as of April 2020. [36] Nearby Oak Spring has had 14 deaths in two weeks, as of mid-April; only two of the deceased were tested, and both were positive for COVID-19. [36] As of early April, that facility was operating with a quarter of its normal staffing, after the staff or their families were exhibiting symptoms, and were self isolating. Two-thirds of remaining residents were exhibiting symptoms. [37] [38] The Member of Parliament for Liverpool, Paula Barker, has criticised the lack of PPE at social care facilities, compared to NHS workers. [39]
By mid-April 2020, over 7,000 deaths were reported in American nursing homes—about a fifth of the national death toll—and over 36,500 residents and employees had tested positive. (Many facilities were not reporting cases or deaths, implying that the actual toll was higher.) [40] By mid-June, 50,000 deaths—nearly half the national death toll—had been reported in nursing homes. [41] [42]
By April, in addition to steps taken by individual facilities, the federal government had barred visitors, ended group activities, and instituted a mandatory testing regime for workers. These steps alone do not necessarily prevent infections. [43] Infection control problems were identified at nine locations of Life Care Centers of America during April and early May, as government inspectors identified violations of federal standards. [44]
While some affected facilities are understaffed and have a history of safety violations, others are luxury facilities with excellent records. [40] Regarding testing for coronavirus, the federal government designated long-term care facilities as lower priority than hospitals, leading to longer wait times for test results. [40]
Even though the COVID-19 being widely available, by June 13, 2021, approximately 40 percent of nursing home staff members remained unvaccinated. Long-term care facilities offered incentives such as gift cards, raffles, cash, and T-shirts to staff members in an attempt to increase the vaccination rate. [45]
Studies have found that unionized nursing homes had lower resident COVID-19 death rates and lower infection rates for workers. [46] [47]
Data analysis by the Los Angeles Times in May found that about half of all coronavirus deaths happened in skilled nursing or assisted living facilities. [48] Governor Gavin Newsom had announced on April 10 that some healthy residents at nursing homes would be transferred to USNS Mercy, a US Navy hospital ship. The vessel previously was only expected to take patients from southern California hospitals, to free up space there for COVID-19 patients. [49] Six hundred nurses with infectious disease control training were being dispatched to nursing homes and adult care facilities to contain the disease. [49] Some facilities have reorganized residents into discreet buildings for those with and without the virus. [49]
As of mid-April 2020, Florida Governor Ron DeSantis was considering a request to grant nursing homes "sovereign immunity" from negligence lawsuits during the pandemic. The request was made by a trade group that represents nearly 700 nursing homes in the state. [50]
Life Care Center of Nashoba Valley experienced an outbreak in April 2020. [51] [52] The nurse who reported the outbreak later died of the virus. [53]
One of the most severe outbreaks was at the state-run Holyoke Soldiers' Home for aging veterans. In late March, there were 210 residents; by late May, 74 of them had died with a COVID-19 diagnosis. [54] Dozens of employees also tested positive. [55] Because the facility is funded by taxpayers and not by Medicare, it is not subject to inspections by Centers for Medicare Services. It is not inspected by the Massachusetts Department of Public Health, either. Following the outbreak, at least four state and federal investigations were opened into the facility. [56] [57]
Sagepoint Senior Living was fined $10,000/day by state regulators. The facility was notified on May 6, 2020, that the fine would be retroactive to March 30 and would continue until Sagepoint complied with state health regulations. At the time of the notification, 34 residents and 1 employee had died from COVID-19 in the 165-bed facility. [58]
Gov. Gretchen Whitmer issued an executive order that nursing homes must readmit residents previously diagnosed with COVID-19. [59] [60]
The state of Minnesota held a legislative hearing on 7 April into the senior care industry, weeks into a lockdown. The executive director of one facility noted that her residents are showing signs of depression and anxiety from the confinement. [61] Not only does the elderly population in long-term care facilities face depression, the disabled population in both long-term care facilities and independent people are struggling with depression and anxiety.[ citation needed ]
As of 17 April, two thirds of the state's long-term facilities—a total of 394—had reported cases of the virus, with 1,500 deaths linked to nursing facilities, [40] about 40% of the state's death count. One facility, Andover Subacute and Rehabilitation Center II, with 543 beds, had a record of safety problems and inadequate staffing. After an anonymous tip, police found seventeen bodies in bags on 13 April. Seventy residents had died of the disease by 19 April. Federal and state investigators have launched an investigation into the facility. [62]
As of early April, in New York state's 613 licensed facilities, there were nearly 5,000 COVID diagnoses. [63] By mid-April, 72 facilities had five or more confirmed deaths; Cobble Hill Health Center in Brooklyn reported 55 deaths. [40] By early May, it was estimated that 5,000 people had died in nursing homes in New York state. [64] On February 12, 2021, it was reported that the office of New York Governor Andrew Cuomo had sent over 9,000 patients into nursing homes early in the pandemic. [65]
A Life Care Center facility in Kirkland, Washington was the source of a major outbreak of COVID-19 first reported on 19 February 2020, which became the first outbreak in a United States nursing home. [40] On February 19 there were 120 residents and 180 Center employees at the facility. By 18 March, 101 of the residents had been diagnosed with COVID-19, and thirty-four residents had died, for a case fatality rate of 33.7%. [66] On 2 April 2020 Life Care Center was fined $611,000 for deficiencies in its response to the outbreak, and has until 16 September 2020 to correct the deficiencies, or else face termination of its participation in the Medicare/Medicaid program. [67]
A nursing home is a facility for the residential care of older people, senior citizens, or disabled people. Nursing homes may also be referred to as care homes, skilled nursing facilities (SNF) or long-term care facilities. Often, these terms have slightly different meanings to indicate whether the institutions are public or private, and whether they provide mostly assisted living, or nursing care and emergency medical care. Nursing homes are used by people who do not need to be in a hospital, but require care that is hard to provide in a home setting. The nursing home staff attends to the patients' medical and other needs. Most nursing homes have nursing aides and skilled nurses on hand 24 hours a day.
Extendicare Inc. is a Canadian for-profit long-term care (LTC) provider that offers housing, care and related services to seniors. It operates over 100 care facilities and is based in Markham, Ontario. The company operates retirement residences and long-term care facilities under the Extendicare, Esprit Lifestyle and ParaMed brands, with 23,000 employees.
The American Health Care Association (AHCA) is a non-profit federation of affiliated state health organizations that represents more than 14,000 non-profit and for-profit nursing homes, assisted living communities, and facilities for individuals with disabilities. The organization's president and CEO is Mark Parkinson, a former governor of Kansas. The National Center for Assisted Living (NCAL) is a part of the AHCA.
Life Care Centers of America is the largest privately held long-term elderly care company in the U.S., with facilities across 27 states, and the third largest in the U.S. It is headquartered in Cleveland, Tennessee. According to data from the Centers for Medicare & Medicaid, Life Care Centers of America operates 254 nursing homes with 32,966 beds.
The Soldiers' Home in Holyoke is a full-service veterans center and hospital located in Holyoke, Massachusetts, which maintains 247 beds in its main nursing facility, and a separate domiciliary care building with 30 full-time residents. The facility provides long-term care and outpatient medical services, as well as dental and social services, and programming and events for veterans. Operated by the Massachusetts Department of Veterans' Services, it is inspected annually by both the state and the United States Department of Veterans' Affairs.
The COVID-19 pandemic in Canada is part of the ongoing worldwide pandemic of coronavirus disease 2019. It is caused by severe acute respiratory syndrome coronavirus 2. Most cases over the course of the pandemic have been in Ontario, Quebec, British Columbia and Alberta. Confirmed cases have been reported in all of Canada's provinces and territories.
The first confirmed case relating to the COVID-19 pandemic in the United States was announced by the state of Washington on January 21, 2020. Washington made the first announcement of a death from the disease in the U.S. on February 29 and later announced that two deaths there on February 26 were also due to COVID-19. Until mid-March, Washington had the highest absolute number of confirmed cases and the highest number per capita of any state in the country, until it was surpassed by New York state on April 10, 2020. Many of the deceased were residents of a nursing home in Kirkland, an Eastside suburb of Seattle in King County.
The COVID-19 pandemic in Massachusetts was part of an ongoing pandemic of coronavirus disease 2019 (COVID-19) in the U.S. state of Massachusetts. The first confirmed case was reported on February 1, 2020, and the number of cases began increasing rapidly on March 5. Governor Charlie Baker declared a state of emergency on March 10. By March 12, more than a hundred people had tested positive for the virus. Massachusetts experienced a first wave of COVID-19 that peaked in late April 2020, with almost 4,000 people hospitalized with the disease, and a rolling seven-day average of 2,300 new confirmed cases and 175 confirmed deaths a day. A second wave began in the autumn of the same year and peaked in January 2021, seeing higher daily case numbers but fewer deaths and hospitalizations than the first wave. There was a smaller third spike of increased cases and hospitalizations in March and April 2021, which resulted in significantly fewer deaths than the first two waves. A fourth wave began in July and August 2021. Another wave occurred in the winter of 2021 to 2022, coinciding with the emergence of the SARS-CoV-2 Omicron variant in the state, and exceeding the peak number of cases in any previous wave. As of January 13, 2022, Massachusetts was experiencing a rolling average of 13,314 new confirmed cases and 43 confirmed deaths per day.
The COVID-19 pandemic reached Colorado on March 5, 2020, when the state's first two cases were confirmed. Many of the early COVID-19 cases in Colorado occurred in mountain resort towns such as Crested Butte, Aspen, and Vail, apparently brought in, and sometimes taken home, by international ski tourists.
The COVID-19 pandemic in New Hampshire is part of an ongoing pandemic of coronavirus disease 2019 (COVID-19) in the U.S. state of New Hampshire. The first confirmed case was reported on March 2, 2020. A state of emergency was declared March 13, which included a ban on gatherings of 50 or more people. A small group filed a lawsuit claiming the order infringed on their right to assemble and worship; a judge dismissed the suit. On March 26, all nonessential businesses were closed and Governor Chris Sununu advised people to only leave home for essential necessities. That stay-at-home order was extended several times before being allowed to expire on June 15. Through November 22, a total of 74 emergency orders had been issued by Sununu. Sununu lifted the mask mandate as of April 16, 2021.
The COVID-19 pandemic was confirmed to have reached the U.S. state of North Carolina on March 3, 2020.
The COVID-19 pandemic in Ontario was a viral pandemic of coronavirus disease 2019 (COVID-19), a novel infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first confirmed case of COVID-19 in Canada was announced on January 25, 2020, involving a traveller who had recently returned to Toronto from travel in China, including Wuhan. Ontario has had the largest number of confirmed COVID-19 cases among Canada's provinces and territories, but due to having the largest population, only ranks sixth adjusted per capita. Ontario surpassed one million lab-confirmed COVID-19 cases on January 24, 2022; one day before the anniversary of the first confirmed case on January 25, 2020.
The COVID-19 pandemic in British Columbia forms part of an ongoing worldwide pandemic of coronavirus disease 2019 (COVID-19), a novel infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). On January 28, 2020, British Columbia became the second province to confirm a case of COVID-19 in Canada. The first case of infection involved a patient who had recently returned from Wuhan, Hubei, China. The first case of community transmission in Canada was confirmed in British Columbia on March 5, 2020.
The COVID-19 pandemic in Quebec was part of the global pandemic of coronavirus disease 2019 (COVID-19), a novel infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
Allison Joan McGeer is a Canadian infectious disease specialist in the Sinai Health System, and a professor in the Department of Laboratory Medicine and Pathobiology at the University of Toronto. She also appointed at the Dalla Lana School of Public Health and a Senior Clinician Scientist at the Lunenfeld-Tanenbaum Research Institute, and is a partner of the National Collaborating Centre for Infectious Diseases. McGeer has led investigations into the severe acute respiratory syndrome outbreak in Toronto and worked alongside Donald Low. During the COVID-19 pandemic, McGeer has studied how SARS-CoV-2 survives in the air and has served on several provincial committees advising aspects of the Government of Ontario's pandemic response.
The COVID-19 pandemic is an ongoing viral pandemic of coronavirus disease 2019 (COVID-19), a novel infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The pandemic has affected the Cities of Mississauga and Brampton, and the Town of Caledon, within the Regional Municipality of Peel. As part of the larger closure decisions in Ontario, a stay-at-home order shuttered all nonessential businesses, and caused event cancellations.
The COVID-19 pandemic in Toronto is a viral pandemic of coronavirus disease 2019 (COVID-19), a novel infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), localized in Toronto. Toronto is the most populous city in Canada, and the fourth most populous city in North America.
Operation Laser is a domestic operation of the Canadian Armed Forces for contingency planning and response in the event of a pandemic. Its three goals are: protecting CAF personnel and capability, assessing CAF capabilities to respond to a pandemic, and assisting other government departments in the event of a pandemic.
Camilla Care Community is a 236-resident long-term care home in Mississauga, Ontario, owned by Partners Community Health. It is located next to Trillium Health Partners' Mississauga Hospital. The facility was taken over, temporarily, by the Province of Ontario in May 2020, as a result of extensive deaths from COVID-19.
Eatonville Care Centre is a privately owned long-term care facility in the Eatonville area of Etobicoke, Toronto, Ontario, Canada. As of 2020, it is owned by Rykka Care Centres. During the COVID-19 pandemic, it was particularly hard-hit, with 142 resident cases and 40 resident deaths. A report by the Canadian Armed Forces — who had been deployed to the facility, to assist — recorded "aggressive behaviour" by staff and drugging of residents that the Forces deemed unnecessary.
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Media related to COVID-19 pandemic in long-term care facilities at Wikimedia Commons