People living in long-term care (LTC) homes in across the globe have been far more likely to die of COVID-19 than the rest of the population. However, the effect of COVID-19 on residents in LTC has varied widely within countries. What lessons can be learned from COVID-19?
- The lack of pandemic planning in the sector, outdated building standards, poor staffing practices and the reluctance by government to hold service providers accountable to ensure quality resident outcomes has contributed significantly to the high death rates in long term care.
- LTC residents in many countries are more likely to reside in shared rooms. In Ontario, Canada for example approximately 63% of residents are in shared rooms. Rates of infection associated with the LTC and the health care sectors are lower where facilities have single patient/resident rooms.
- Shared resident living arrangements have contributed significantly to the spread of Covid-19 and other outbreaks such as influenza in LTC. In Ontario, Canada for example, the maximum resident home area (RHA) caters to 32 residents, but the standards do not specify that all must be single rooms. It is not mandated that resident ensuites or shared washrooms have showering or bathing facilities, instead there must be a shower/bathroom within each RHA.
- Building standards for long-term care must provide for single resident rooms with a full ensuite to include showering facilities and resident home areas (RHA’s) should be no greater than 16 resident care places. Single rooms with ensuites should be 250 square feet as the minimum standard.
- A high quality of nursing home care requires adequate levels of competent staff, but mandating staffing levels does not ensure quality resident outcomes. A sophisticated quality of care standards framework in itself can ensure appropriate staffing based on the resident care mix and measured against legislated resident outcome standards. Mandated staffing profiles or hours of direct care in long term care will never ensure quality of care.
- Government policy and funding support for long-term care needs to be reprioritised from the built environment to community-based supports into the homes or dwellings where people live. Adopting a planning framework based on population demographics and socio-economic status of people over the age of 70 in a defined geographical area should be adopted. For every 1000 people over the age of 70 there should be 65-70 residential care (nursing home) places and 75-80 community care (packaged care) places. This shifts the focus and priority to care at home.
Answers by International Federation on Ageing