Across Canada and internationally, COVID-19 has had a particularly devastating impact on the quality of care and lives of vulnerable older adults, especially those with complex chronic conditions and frailty who are living in congregate care settings. So far, much research and media attention has been paid to the impacts of COVID-19 and its associated physical distancing restrictions and policies on older clients living in long-term care (LTC) homes. However, far less attention has been paid to older adults living in Designated Supportive Living (DSL) homes or Assisted Living (AL) homes, despite people living in LTC and DSL/AL exhibiting similar vulnerabilities to COVID-19 infection and negative health outcomes.
Similar to LTC, people living in DSL/AL homes are of advanced age (average 84 years), and typically have significant health needs, including high rates of dementia (≥60%), mental health conditions (34% with depression) and multimorbidity (average of 5 conditions), increasing the older adult’ frailty and risk for infection with COVID-19. LTC and DSL/AL homes also have similar structural and operating conditions that unfortunately facilitate widespread transmission of COVID-19, such as heavy reliance on poorly paid part-time staff who provide essential and intimate care across many different facilities.
Although older clients living in LTC and AL/DSL homes exhibit similar vulnerabilities to the negative consequences of COVID-19, DSL/AL homes offer fewer services and have lower staffing levels (including fewer skilled staff members per person in need of care and no onsite 24-hour nursing care). This results in an increased expectation for significant family involvement in care (e.g., assistance with activities of daily living, monitoring of health status, social engagement and support) compared to LTC, increasing stressors experienced by family caregivers. Though the immediate and longer-term effects of COVID-19 on older clients living in DSL/AL homes and their families across Canada are expected to be significant, they remain to be investigated.
Funded by
Our observational study builds directly on the standardized interviews and methods utilized in a large prospective cohort study of 1,089 older clients living in DSL/AL homes and 1,000 older clients living in LTC homes and their family caregivers conducted across 113 DSL/AL and LTC homes in AB during 2006-2010 by Co-Principal Investigator Maxwell and colleagues (termed ACCES). We aim to recruit 1,000 eligible family caregivers of older clients.
Our overall aim of this study is to illuminate and understand the impact of COVID-19 (and associated social distancing restrictions and policies) on the care and oversight provided by family caregivers within a diverse array of DSL/AL homes, and the resulting consequences for the health and psychosocial well-being of these essential (though often invisible) care providers.
COVCARES – AB/BC study objectives are:
- Examine the effects of COVID-19 and related DSL/AL home restrictions, on the types/amount of health and social care provided to older clients living in DSL/AL homes by key family caregivers.
- Explore whether changes in these care patterns differ across characteristics of (a) family caregivers (e.g., age, gender, ethnicity, income, relationship to older clients); (b) older clients living in DSL/AL homes (e.g., age, sex, functional impairment); and (c) DSL/AL homes (e.g., size, region, for-profit status, visiting policies, COVID-19 testing & outbreak status).
Our findings will directly inform the development and conditions for scale-up of policy and practice interventions to (i) ensure timely communication with, and engagement of, family caregivers in DSL/AL homes during emergencies; and, (ii) permit rapid and enhanced emergency preparedness, staffing and services in DSL/AL homes. Interventions targeting both are essential for mitigating the adverse consequences of future outbreaks and restrictions on older clients’ and family caregivers’ health and psychosocial well-being.
The first stage involve a random sample of DSL/AL homes within 10 strata (defined by 5 health zones & large vs. small bed size. These factors were used to define strata given their association with health system factors, urban-rural region, and DSL/AL home characteristics (including staffing, quality of care and pandemic preparedness). The second stage consists of working with identified DSL/A home administrators to have them select eligible older client-caregiver dyads. Eligible family caregivers are those identified as the person most involved in the care and/or informed about the client, and who are primary caregivers of clients who are at least 65+ years of age and who have been in the DSL/AL home for 3 or more months as of March 1, 2020.
For the family/friend caregiver survey (that closed at the end of March 2021) we have a sample size of 690 respondents and for the DSL/AL home [facility] survey (that closed April 6, 2021) we have a sample of 104 respondents. Our baseline surveys had a primary focus on the impact of the first wave of the COVID-19 pandemic covering the period from 3 months prior to and post March 1, 2020. During our baseline data collection, we received significant correspondence from our family/friend caregiver and home [facility] administrator respondents asking us to consider a follow-up version of our surveys to ensure we capture relevant changes associated with the second wave of the pandemic (covering the period from Oct 1, 2020 to Feb 28, 2021). Therefore, we invited the family/friend caregiver participants and DSL/AL home key contacts who completed our initial surveys to complete a follow up survey.
This is a recording of a webinar in which we shared results of the COVCARES-AB/BC study with the general public. COVCARES-AB/BC stands for COVID-19 and Caregivers of Assisted living Residents: their Experiences and Support needs. The study surveyed 673 family/friend caregivers of residents living in assisted living homes in Alberta and British Columbia. We also surveyed directors of care of 104 assisted living homes in these provinces.
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.