#VisualAbstract: For-profit long term care homes associated with increased extent of COVID-19 outbreaks and related mortality

1. For-profit status of long term care homes (LTCs) were not associated with the odds of a COVID-19 outbreak.

2. For-profit status was associated with increased extent of outbreak and mortality rate. 

3. Older design standards of LTCs and chain ownership were associated with poorer COVID-19 outbreak outcomes.

Evidence Rating Level: 2 (Good)

In Canada, 80% of deaths from COVID-19 have come from patients living in long-term care homes (LTCs). There are several potential reasons for this, such as the elderly population being at greater risk for COVID-19 mortality, as well as the communal living arrangements. Moreover, there is particular concern over the outbreak risk in for-profit LTCs, since past research has found them to have higher hospital admission rates, more complaints from residents, as well as poorer hand hygiene and infection control. In the province of Ontario, although all LTC residents receive public funding, the homes themselves can be operated by for-profit, non-profit, or municipal parties. The purpose of this retrospective cohort study was to investigate the relationship between for-profit status and COVID-19 related outcomes in Ontario LTCs. Specifically, the primary outcome was risk of COVID-19 outbreak (at least 1 infected individual) extent of outbreak (the number of infected individuals), and death. Covariates analyzed included chain ownership, age of the home’s design standards, and COVID-19 outbreaks in the surrounding region. In total, the study included 623 LTCs in Ontario during the epidemic’s peak (March to May 2020). The results found that for-profit status was not associated with the odds of a COVID-19 outbreak (odds ratio 0.96, 95% CI 0.61-1.49, with non-profit LTCs as the reference). However, for-profit status was associated with the extent of an outbreak (risk ratio 1.96, 95% CI 1.26-3.05) and death (RR 1.78, 95% CI 1.03-3.07). Furthermore, older design standards were associated with the odds of an outbreak, extent of an outbreak, and death (OR 1.55, 95% CI 1.01-2.38; RR 1.88, 95% CI 1.27-2.79; RR 2.08, 95% CI 1.28-3.36 respectively). Chain ownership was also associated with outbreak extent and death (RR 1.84, 95% CI 1.08-3.15; RR 1.89, 95% CI 1.00-3.59 respectively). Overall, this study has implications for policy recommendations to improve for-profit LTCs’ abilities to handle outbreaks, such as by upgrading facilities to modern standards and addressing issues that stem from chain ownership.

Click to read the study in CMAJ

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