Research published in the Canadian Medical Association Journal (CMAJ) has suggested that for-profit ownership of long-term care (LTC) homes is related to lower staffing and more COVID-19 outbreaks, when compared to non-profit and municipal facilities.
The article, published on Aug. 17, further suggested that the for-profit status of LTC homes may be linked to the higher incidence of COVID-19 deaths in those homes, when compared to the non-profits and municipal homes.
"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, said the research paper, authored by Nathan M. Stall, Aaron Jones, Kevin A. Brown, Paula A. Rochon and Andrew P. Costa.
“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.”
Their study was approved by the Research Ethics Board of the University of Toronto, as well as the Hamilton Integrated Research Ethics Board, said the CMAJ.
The study took results from all LTC homes in Ontario from the period of March 29 to May 20, 2020, a period of seven and a half weeks. It measured the number of COVID-19 outbreaks, the number of residents infected and the number of deaths.
The research found that while coronavirus outbreaks occurred in 30.4 per cent of Ontario LTC homes, most of the individual outbreaks occurred in for-profit homes.
The breakdown was 85 per thousand at for-profit homes; 61 per thousand at non-profit homes and 23 per thousand at municipal homes.
To take those numbers further, in LTC homes where outbreaks occurred, 6.5 per cent of residents in for-profit homes died of COVID-19. In non-profit homes the average number of deaths was 5.5 per cent and in municipal homes, the average number of deaths of deaths was 1.7 per cent, said the study.
Infected workers?
One of the interpretations the researchers found is that staff members might actually be contributing to the outbreaks in the LTC homes.
"The significant association between the risk of an outbreak at an LTC home and the incidence of COVID-19 in the surrounding public health unit region is consistent with emerging literature showing that LTC home staff are important vectors for SARS-CoV-2 transmission," said the study.
"During the COVID-19 pandemic, most LTC homes have become relatively closed environments because of restrictions on visitors and resident transfers, meaning that through no fault of their own, infected health-care workers are the probable source of many outbreaks,” said the study.
It also suggested from an earlier study of COVID-19 outbreaks there was a delay in determining staff members who might have become infected.
“Screening protocols may be missing infected staff who are asymptomatic or minimally symptomatic, and low wages and scarce sick benefits mean that others may be working while ill," the study said.
In conclusion, the study said the risk of an outbreak at an LTC home was more related to the incidence of COVID-19 in the public health jurisdiction surrounding the home, along with the total number of beds and older design standards (such as four people to a room) rather than the for-profit or non-profit status.
"We did find evidence that for-profit LTC homes have larger COVID-19 outbreaks and more deaths of residents from COVID-19 than non-profit and municipal homes, and that this finding was mediated by the higher number of for-profit homes with outdated design standards and chain ownership," said the study.
"The COVID-19 pandemic has laid bare long-standing issues in how LTC homes are financed, operated and regulated. As health systems scramble to prepare LTC homes for successive waves of the COVID-19 pandemic and others search for accountability and solutions to the crisis in the sector, it is important to examine all potential explanations for observed differences in COVID-19 outcomes across LTC homes."
