Long-term care residents got less medical care in first wave of pandemic: report

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TORONTO — A new study shows residents in long-term care homes in several provinces received less medical care and had less contact with family and friends during the first wave of the COVID-19 pandemic than the previous year.

In a report released Tuesday, the Canadian Institute for Health Information says the proportion of long-term care residents who received a visit from a physician between March 1 and Aug. 31 of last year was down 16 per cent compared with that same period in 2019.

The report says that drop was seen in all five provinces where data were available – Ontario, Manitoba, Alberta, British Columbia and Newfoundland and Labrador –even when homes did not have an outbreak.

There was a similar decrease in physician care orders for long-term care residents, which suggests virtual visits from doctors did not replace in-person ones, it says.

The document says 11 per cent of assessments during the first wave found the resident had not had any contact with friends or relatives over the previous week, even by phone or video -- three times more than the same period in 2019.

Residents who had no contact with friends or family were more likely to be assessed with depression -- 36 per cent compared with 23 per cent for those who were in touch with loved ones.

Meanwhile, the report shows there was a slight increase in antipsychotic drugs prescribed to long-term care residents in six provinces during the first wave compared with the previous year.

"It would appear that care changed significantly for these people," said Tracy Johnson, director of health system analysis and emerging issues at CIHI.

While it's impossible to determine the impact of those changes based on the data, there were also more deaths from any cause among long-term care residents between March 1 and June 30 of last year than during that same time in each of the previous five years, Johnson said.

"If you have nursing staff who are run off their feet, taking care of people with COVID, you don't have as many...physicians in to see people, and you have less visitors to note that their loved one has changed in some way, people possibly got sick, and possibly some of the unintended consequences here were more deaths," she said.

Long-term care homes in many parts of Canada experienced staffing shortages during the first wave of the pandemic, and most provinces imposed restrictions on visitors, including family members and caregivers.

The report also notes fewer patients were transferred from long-term care to hospital, with the number of transfers down by 27 per cent.

The drop was the biggest in Ontario, where hospital transfers decreased by 30 per cent, and the lowest in Newfoundland and Alberta, which each saw a reduction of 13 per cent, the document says.

The most significant decreases were seen in transfers for infections and other medical conditions such as chronic obstructive pulmonary disease or heart failure, the report says. Those saw between 51 and 58 per cent fewer transfers, it says.

Some provinces had recommendations that discouraged hospital transfers from the long-term care sector during the pandemic, the report says.

"There may be some argument that says that we send people to hospital from long-term care, which is their home, and we could have provided better ongoing care for some of this in a home. So, we're always looking at whether or not some of these kinds of transfers are appropriate," Johnson said.

"But a 50 per cent decrease seems like a lot, and when you combine that with less physicians visiting and less people around to understand this person, very potentially they didn't receive care that they needed."

Forty per cent fewer people were also admitted to long-term care homes during the first wave than during the same period in 2019, the report says.

The biggest reduction -- 58 per cent -- was seen in admissions from the community, which suggests Canadians may have been reluctant to place their relatives in long-term care during the pandemic, Johnson said. Homes may also have been hesitant to bring in more residents at that time, she said.

A spokesperson for Ontario's minister of long-term care said COVID-19 has exposed systemic issues in the LTC system, and the report shows "almost all provinces and territories faced challenges" in dealing with the pandemic.

The province is taking steps to modernize the sector, including boosting staffing levels and prioritizing staff and residents when it comes to vaccination, Krystle Caputo said in an email.

"The vast majority of residents have received both doses of a vaccine and we have made significant progress in vaccinating staff and essential caregivers," she said.

This report by The Canadian Press was first published March 30, 2021.

Paola Loriggio, The Canadian Press