Identifying and Responding to Person and Facility-Level Determinants of COVID-19 Outbreaks, Mortality, and Adverse Quality of Life Outcomes in Long-term Care

The most severe impact of COVID-19 in Canada has been experienced by long-term care home residents. About three quarters of all Canadian deaths to date have been in this population. This has led to forceful calls to action from many quarters, but limited evidence about the underlying causes of outbreaks and deaths has hindered efforts to better protect this vulnerable population. Vaccination is beginning to reduce COVID-19 mortality and outbreaks in Canadian long-term care, but vaccination rates of residents and staff have not (and may not) reached 100 percent levels. More outbreaks and deaths are possible even if most residents are vaccinated. Also, we must learn all we can from this pandemic to better prepare for future events like this. Several factors make it challenging to understand and respond to COVID-19 in long-term care. The magnitude and severity of outbreaks and deaths varied by region and country. Also, COVID-19 has been a protracted pandemic with multiple waves and seasonal variations in outbreak patterns. Finally, there is preliminary evidence about COVID-19 deaths in long-term care, but almost none related to morbidity, disability, and quality of life. We will use 7+ million assessment records for about 1 million unique individuals in long-term care combined with facility records on staffing, absenteeism, infection control, ownership, and local outbreak patterns to identify the factors that led to outbreaks, widespread infections, deaths, and adverse quality of life outcomes. We will partner with international researchers to do comparable studies in other countries. We will also engage Canadian and international experts, long-term care residents, and family members to review evidence from this research to develop recommendations for changes to clinical practice, service delivery, and policy for long-term care that will better equip this sector to protect the well-being of vulnerable persons in future pandemics or localized outbreaks.