Protecting vulnerable residents and staff in continuing care homes must be a priority

Addressing the underlying problems in continuing care homes that were exposed by the coronavirus disease 2019 (COVID-19) pandemic is key to ensuring we protect vulnerable residents and staff in the future, argues an editorial in CMAJ (Canadian Medical Association Journal)

“After COVID-19, Canada’s health care systems will be forever changed,” writes Dr. Jayna Holroyd-Leduc, a geriatrician and associate editor, CMAJ, with Dr. Andreas Laupacis, editor-in-chief, CMAJ. “The tragic death toll among continuing care residents demands that the needs of this sector be at the top of the planning process, not at the bottom where they have traditionally been.”

An estimated 62% to 82% of all COVID-19 deaths in Canada have been among residents of continuing care facilities, which include nursing homes, long-term care and supportive living facilities. Many measures that may have protected vulnerable residents and staff were implemented after outbreaks began, rather than proactively before they occurred.

“By any measure, what has happened in continuing care is a national tragedy,” write the authors. “Although a high death rate from COVID-19 in residents of continuing care homes might be expected given their age, frailty and comorbidities, a death rate of such magnitude need not have occurred.”

Systemic problems, such as an undervalued, underpaid and overburdened workforce; communal living, which makes spread of infection challenging to control; lack of coordination between hospitals and continuing care in many provinces; and shortages of personal protective equipment contributed to the high infection and death rates.

Solutions include increased pay for staff, hiring additional staff and emphasizing person-centred care for complex health and emotional needs. Redesigning continuing care facilities and introducing innovative technologies that can function during physical distancing can also help prevent disease spread.

“The premature deaths of the people in continuing care, whom we failed to protect from COVID-19, should be a call to action. They built this country. They deserved better, as do those currently living and working in continuing care.”