COVID-19 has had a devastating impact on vulnerable older adults living in long-term care (LTC) and assisted living (AL) homes. Healthcare reforms have neglected these settings for decades, setting them up for the tragedy that unfolded during COVID-19 – including rates of death and suffering that were disproportionately higher than those in the general older adult population. Several Canadian studies have assessed the impact of COVID-19 on LTC residents, focusing on rates of infection and death, hospitalizations before death, medication prescribing practices, and increased behavioural and mental health issues. Far less attention has been paid to AL, a rapidly expanding residential setting intended for people with similar but generally less advanced needs than in LTC. US research suggests that excess mortality rates in AL during the COVID-19 pandemic were consistent with those in LTC. A study on AL homes in the US and one on retirement homes in Ontario, found that being located in communities with higher rates of COVID-19 infections, larger bed size, and higher proportions of visible minorities among residents in the facility or the surrounding community increased the risk for COVID-19 outbreaks. However, no comprehensive investigation of the impact of the pandemic on Canadian AL residents is available.
Building upon our original work in COVCARES AB/BC this retrospective cohort study will use DSL and LTC resident population-level clinical data (Resident Assessment Instrument, RAI) linked with health administrative data collected 01/2017–12/2021. We will examine and compare the impact of the COVID-19 pandemic on DSL vs LTC residents in Alberta. Further, we will link unique, comprehensive facility-level survey data collected from our 64 randomly sampled DSL homes and from 35 randomly sampled LTC homes participating in the Translating Research in Elder Care (TREC) program. We will assess how facility-reported COVID-19 preparedness, infection prevention/control measures, outbreak status, staffing/care challenges, and communication with family/friend care partners were associated with resident outcomes.
This retrospective cohort study will use DSL and LTC resident population-level clinical data (Resident Assessment Instrument, RAI) linked with health administrative data collected 01/2017–12/2021. We will examine and compare the impact of the COVID-19 pandemic on DSL vs LTC residents in Alberta. Further, we will link unique, comprehensive facility-level survey data collected from our 64 randomly sampled DSL homes and from 35 randomly sampled LTC homes participating in the Translating Research in Elder Care (TREC) program. We will assess how facility-reported COVID-19 preparedness, infection prevention/control measures, outbreak status, staffing/care challenges, and communication with family/friend care partners were associated with resident outcomes. Our objectives are to:
- Assess how DSL residents’ physical and mental health, quality of care indicators, and healthcare use have changed during the course of the pandemic, compared to the 3 years prior to the pandemic
- Explore differences in the outcome trajectories assessed in objective 1, as well as, COVID-19 infections and deaths between DSL and LTC residents
- Evaluate how the novel, potentially modifiable, facility-level measures captured by our DSL and LTC facility surveys are associated with resident’s COVID-19 infections & death, and other resident outcomes
The proposed study builds on the standardized interviews and methods utilized in our Alberta Innovates funded COVID-19 study and an earlier large prospective cohort study (ACCES, 2006-2010) led by Co-PI Maxwell. In the first phase of our COVID-19 study, we randomly selected 64 DSL homes (3,756 spaces), stratified by health zone (North, Edmonton, Central, Calgary, South) and size (small/large, based on zone median bed-size). They accounted for 32% of the 201 DSL homes (11,853 spaces) in Alberta. TREC, led by team member Estabrooks, has done similar work in LTC since 2007. Funded by CIHR and the Alberta government, TREC has collected data on the impact of COVID-19 in a representative cohort of 35 randomly selected urban LTC homes in Alberta (5,180 spaces), stratified by health zone (Edmonton, Central, Calgary), size (small: <80 beds, medium: 80-120 beds, large: >120 beds), and ownership (private for-profit, public or voluntary not-for-profit). For this study we conducted two population-based, retrospective cohort studies using linked clinical (RAI) and health administrative data available for all DSL and LTC residents in Alberta. We will also link our existing unique COVID-19 facility survey data to clinical and health administrative resident data.
i) Facility Characteristics: We examine the following characteristics that are publicly available for all DSL and LTC homes in Alberta: bed number, for-profit vs not ownership, chain affiliation, health zone, urban/rural location, and services provided. Utilizing the comprehensive baseline and follow-up COVID facility surveys completed for the 64 DSL homes participating in our previous study, and the COVID facility survey collected from 35 TREC LTC homes, we also examine the following additional characteristics: staffing levels, COVID-19 testing and outbreak status, extent and timing of infection prevention/control measures, staff education/training, and staffing/care challenges encountered during the pandemic. Both surveys are based on tools used in previous DSL/LTC research in Alberta, designed with input from our stakeholder partners. The research team conducted these surveys via video calls with directors of care. The DSL baseline survey captured the COVID-19 experiences and practices in the 3 months prior to and post March 2020, while the follow-up survey captured changes between wave 1 (March–July 2020) and wave 2 (Oct 2020–Feb 2021). The LTC facility survey (collected in summer/fall 2021) captures facilities’ COVID-19 experiences overall.
ii) Resident COVID-19 Testing, Clinical, and Health Administrative Data: We work with our collaborators to obtain RAI, COVID-19 testing and health administrative data. Specifically, our collaborator Dr. Jeff Bakal, Alberta Health Services Program Director for Provincial Research Data Services, helped facilitate our data access process. We requested the following data covering the period from 01/2017 to 12/2021:
- CDOM. The Communicable Disease and Outbreak Management (CDOM) system will provide information on COVID-19 infections, testing and vaccination for all DSL and LTC residents.
- RAI-HC and RAI-MDS 2.0. The RAI – Home Care (RAI-HC) and the RAI – Minimum Data Set (MDS) 2.0 are standardized, valid, reliable clinical assessment tools. They will provide data on residents’ medical conditions, functional dependence, pain, cognitive impairment, mood, and behavioural problems. These data will also provide risk-adjusted quality of care indicators, based on well-validated algorithms.
- DAD. The hospital Discharge Abstract Database (DAD) will provide information on all resident inpatient hospital stays, including diagnoses, length of stay and treatments received.
- NACRS. The National Ambulatory Care Reporting System (NACRS) will provide data on all resident emergency department visits, diagnoses and treatments received.
- PIN. The Pharmaceutical Information Network (PIN) will provide information on residents’ medications filled through a community pharmacy.
Research Principal Investigators
Dr. Matthias Hoben (Principal Investigator)
Associate Professor & Helen Carswell Chair in Dementia Care
School of Health Policy and Management
Associate Member, YorkU Graduate Program in Nursing
Adjunct Assistant Professor, Faculty of Nursing, University of Alberta
Alzheimer Society of Canada New Investigator (2020-2023) Policy Research
301E Stong College – SC
Keele Campus | Toronto | ON | M3J 1P3
Dr. Colleen Maxwell (Co-Principal Investigator)
Professor
University Research Chair
University of Waterloo, School of Pharmacy
PHR 4013 | Waterloo | ON | N2L 3G1
[Adjunct Professor, Community Health Sciences, University of Calgary, Calgary, AB]
Co-Investigators
Dr. Joseph Amuah
Adjunct Professor
University of Ottawa
Dr. Andrea Gruneir
Assistant Professor
University of Alberta
Dr. David Hogan
Professor
University of Calgary
Dr. Natasha Lane
Resident Physician
University of British Columbia
Dr. Lauren Griffith
Assistant Professor
McMaster University
Dr. Stephanie Chamberlain
Postdoctoral Fellow
University of Alberta
Dr. Jennifer Baumbusch
Associate Professor
University of British Columbia
Dr. Kimberlyn McGrail
Professor
University of British Columbia
Family Caregiver Associations
Sandy Serada
Caregivers Alberta
Barb MacLean
Family Caregivers of British Columbia
Collaborators
Heather Cook
Ministry of Health
British Columbia
Hude Quan
University of Calgary
Alberta
Study Coordinator
Kyle Corbett
Research Coordinator
University of Alberta
ECHA 5-305 | Edmonton | AB | T6G 1C9
corbett@ualberta.ca
Survey Research Centre
The Survey Research Centre (SRC) at the University of Waterloo has been conducting telephone, online, mail and face-to face surveys for academic research purposes since 1999. The SRC has worked with universities and colleges across Canada, and with organizations such as the Centre for Addiction and Mental Health (CAMH), Health Canada and Statistics Canada. The SRC adheres to the standards and protocols developed by the American Association for Public Opinion Research (AAPOR) and employs highly-trained undergraduate and graduate post-secondary students to conduct telephone interviews.