Have long-term care systems learned from early pandemic failures?

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Date: Oct. 11, 2022
From: CMAJ: Canadian Medical Association Journal(Vol. 194, Issue 39)
Publisher: CMA Impact Inc.
Document Type: Article
Length: 1,580 words
Lexile Measure: 1430L

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Natalie Stake-Doucet is haunted by deaths she witnessed working as a long-term care nurse in Montreal during the early waves of the pandemic.

"Where I worked, half the residents died in six weeks," says Stake-Doucet, president of the Quebec Nurses' Association. She feels anxious at the thought of returning to a long-term care facility and seeing more death. "I still have nightmares about it," she says.

More than 80% of all COVID-19 deaths in Canada during the first waves of the pandemic occurred in long-term care, mostly in Quebec and Ontario.

The crisis exposed shocking neglect and instances of substandard care, with some residents suffering malnutrition and lying in soiled bedding for days as staff struggled to contain outbreaks.

Better infection-control practices and the rollout of SARS-CoV-2 vaccines to older adults and health care workers helped to stem the tide of deaths. But Stake-Doucet and others worry that many of the problems that contributed to the disaster remain unaddressed--especially now that pandemic precautions are being abandoned and vaccine efficacy is waning.

Lagging vaccine uptake

Widespread vaccination was "probably the single most important thing that happened to protect a lot of homes from the subsequent COVID waves," says Stake-Doucet.

By the end of 2021, more than four in five nursing and seniors' homes reported that at least 95% of staff and residents had received two doses of SARS-CoV-2 vaccines, according to a recent report from Statistics Canada. This strong uptake helped to reduce infections and deaths among long-term care residents by more than 90%.

However, uptake of booster vaccines, which can help maintain that protection, has been weaker. As of mid-August, just over half of Canadians aged 70 and older were fully up to date with four vaccine doses. And the federal government has since dropped that age group from its key updates on vaccination rates.

Pandemic precautions relaxing

Nearly all long-term care facilities reported adopting at least one new infection prevention and control measure in the first year of the pandemic--most commonly, improvements in hand hygiene, personal protective equipment, and screening.

But less than half of nursing and seniors' homes continued improving upon those measures in 2021, according to Statistics Canada. And despite calls for facilities to improve airflow and reduce crowding, less than one-third updated ventilation systems, while fewer than one in five converted multibed rooms to become private or semiprivate --a change that...

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