For-profit long-term care homes and the risk of COVID-19 outbreaks and resident deaths

Stall, Nathan M.; Jones, Aaron; Brown, Kevin A.; Rochon, Paula A.; Costa, Andrew P.

doi:10.1503/cmaj.201197

Cited by 188 publications

(239 citation statements)

References 33 publications

(31 reference statements)

Supporting

Mentioning

216

Contrasting

Unclassified

Order By: Relevance

“…Geographically we report evidence from eleven countries, the majority (20 studies) are from USA [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] and UK. [36][37][38][39][40] We report evidence from Canada, [41][42][43] France, 44,45 Hong Kong, 46,47 Belgium, 48 Germany, 49 Ireland, 50 Japan, 51 Korea, 52 and Spain 53 (Table 1).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Twenty studies report the nature of LTCFs related with outbreaks and transmission of COVID-19 infection (Table 2; 16,23,28,29,31,33,[35][36][37][38][39][41][42][43][45][46][47][50][51][52] ). Thirty studies (Table 3a; [17][18][19][20][21][22][23][24][25][26][27][28][29][32][33][34][37][38][39][40][41][42][43][45][46][47][48][49][50]53 ) report evidence of measures to ...…”

Section: Infection Control Measuresmentioning

confidence: 99%

“…Morbidity and mortality results from included studies are presented for residents (Table 3a), staff (Table 3b), and visitors (Table 3c). Prevalence of COVID-19 infection was reported in 29 studies, including prevalence in residents (27 studies; [17][18][19][20][21][22][23][24][25][26][27][28][29][32][33][34]38,39,41,43,[45][46][47][48][49][50]53 ) and staff (22 studies; 17,[19][20][21][22]24,[26][27][28][29][30]32,34,38,39,[44][45][46][47][48]…”

Section: Morbidity and Mortalitymentioning

confidence: 99%

“…positive staff, the proportion of symptomatic cases ranged from 6.4% 26 to 100%, 32 and asymptomatic cases ranged from 23.6% 50 to 100%. 20,22 Mortality results were reported in 22 studies, including information on mortality of residents (22 studies; [17][18][19][22][23][24][27][28][29]33,34,[37][38][39][40][41][42][43]45,47,49,50 ), staff (4 studies; 28,34,45,47 ), and visitors (2 studies; 28,47 ). Mortality rates in COVID-19 positive residents ranged from 5.3% 19 to 55.3%.…”

Section: Morbidity and Mortalitymentioning

confidence: 99%

“…Numerous facility-specific characteristics were linked with risk of COVID-19 cases (Table 2). These include size of LTCF; 16,37,38,51 staffing levels and/or use of agency care staff; 28,31,36,38,39,43,50 part of larger chain of organisations and/or for profit status; 16,31,35,42,43,50 and related staffing, crowding, or availability of single rooms. 23,29,39,41,43,[45][46][47] 25 Facility characteristics 7 staff COVID-19 positive prior to intervention 0 further staff positive after intervention implemented Heung et al (2006) 46 Hand hygiene, contact precautions PPE, personal protective equipment…”

Section: Characteristics Of Ltcfs On Covid-19 Transmissionmentioning

confidence: 99%

See 4 more Smart Citations

A rapid systematic review of measures to protect older people in long term care facilities from COVID-19

Frazer

Mitchell

Stokes

et al. 2020

Preprint

View full text Add to dashboard Cite

The global COVID-19 pandemic produced large-scale health and economic complications. Older people and those with comorbidities are particularly vulnerable to this virus, with nursing homes and long term care facilities experiencing significant morbidity and mortality associated with COVID-19 outbreaks. The aim of this rapid systematic review was to investigate measures implemented in long term care facilities to reduce transmission of COVID-19 and their effect on morbidity and mortality of residents, staff, and visitors. Databases (including MedRXiv pre-published repository) were systematically searched to identify studies reporting assessment of interventions to reduce transmission of COVID-19 in nursing homes among residents, staff, or visitors. Outcome measures include facility characteristics, morbidity data, case fatalities, and transmission rates. Due to study quality and heterogeneity, no meta-analysis was conducted. The search yielded 1414 articles, with 38 studies included. Reported interventions include mass testing, use of personal protective equipment, symptom screening, visitor restrictions, hand hygiene and droplet/contact precautions, and resident cohorting. Prevalence rates ranged from 1.2-85.4% in residents and 0.6-62.6% in staff. Mortality rates ranged from 5.3-55.3% in residents. Novel evidence in this review details the impact of facility size, availability of staff and practices of operating between multiple facilities, and for-profit status of facilities as factors contributing to the size and number of COVID-19 outbreaks. No causative relationships can be determined; however, this review provides evidence of interventions that reduce transmission of COVID-19 in long term care facilities.

show abstract

Section: Study Characteristicsmentioning

confidence: 99%

Section: Infection Control Measuresmentioning

confidence: 99%

Section: Morbidity and Mortalitymentioning

confidence: 99%

Section: Morbidity and Mortalitymentioning

confidence: 99%

Section: Characteristics Of Ltcfs On Covid-19 Transmissionmentioning

confidence: 99%

See 3 more Smart Citations

A rapid systematic review of measures to protect older people in long term care facilities from COVID-19

Frazer

Mitchell

Stokes

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

Association Between Nursing Home Crowding and COVID-19 Infection and Mortality in Ontario, Canada

et al. 2021

Self Cite

View full text Add to dashboard Cite

IMPORTANCE Nursing home residents have been disproportionately affected by coronavirus disease 2019 . Prevention recommendations emphasize frequent testing of health care personnel and residents, but additional strategies are needed.OBJECTIVE To develop a reproducible index of nursing home crowding and determine whether crowding was associated with COVID-19 cases and mortality in the first months of the COVID-19 epidemic.DESIGN, SETTING, AND PARTICIPANTS This population-based retrospective cohort study included more than 78 000 residents across more than 600 nursing homes in Ontario, Canada, and was conducted from March 29 to May 20, 2020.EXPOSURES The nursing home crowding index equaled the mean number of residents per bedroom and bathroom. MAIN OUTCOMES AND MEASURESThe cumulative incidence of COVID-19 cases confirmed by a validated nucleic acid amplification assay and mortality per 100 residents; the introduction of COVID-19 into a home (Ն1 resident case) was a negative tracer. RESULTSOf 623 homes in Ontario, we obtained complete information on 618 homes (99%) housing 78 607 residents (women, 54 160 [68.9%]; age Ն85 years, 42 919 [54.6%]). A total of 5218 residents (6.6%) developed COVID-19 infection, and 1452 (1.8%) died of COVID-19 infection as of May 20, 2020. COVID-19 infection was distributed unevenly across nursing homes; 4496 infections (86%) occurred in 63 homes (10%). The crowding index ranged across homes from 1.3 (mainly single-occupancy rooms) to 4.0 (exclusively quadruple occupancy rooms); 308 homes (50%) had a high crowding index (Ն2). Incidence in high crowding index homes was 9.7% vs 4.5% in low crowding index homes (P < .001), while COVID-19 mortality was 2.7% vs 1.3%, respectively (P < .001). The likelihood of COVID-19 introduction did not differ (high = 31.3% vs low = 30.2%; P = .79). After adjustment for regional, nursing home, and resident covariates, the crowding index remained associated with an increased incidence of infection (relative risk [RR] = 1.73, 95% CI, 1.10-2.72) and mortality (RR, 1.69; 95% CI, 0.99-2.87). A propensity score analysis yielded similar conclusions for infection (RR, 2.09; 95% CI, 1.30-3.38) and mortality (RR, 1.83; 95% CI, 1.09-3.08). Simulations suggested that converting all 4-bed rooms to 2-bed rooms would have averted 998 COVID-19 cases (19.1%) and 263 deaths (18.1%). CONCLUSIONS AND RELEVANCEIn this cohort of Canadian nursing homes, crowding was common and crowded homes were more likely to experience larger and deadlier COVID-19 outbreaks.

show abstract

Non-pharmacological measures implemented in the setting of long-term care facilities to prevent SARS-CoV-2 infections and their consequences: a rapid review

Stratil

Biallas

Burns

et al. 2021

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

For-profit long-term care homes and the risk of COVID-19 outbreaks and resident deaths

Cited by 188 publications

References 33 publications

A rapid systematic review of measures to protect older people in long term care facilities from COVID-19

A rapid systematic review of measures to protect older people in long term care facilities from COVID-19

Association Between Nursing Home Crowding and COVID-19 Infection and Mortality in Ontario, Canada

Non-pharmacological measures implemented in the setting of long-term care facilities to prevent SARS-CoV-2 infections and their consequences: a rapid review

Contact Info

Product

Resources

About