A group of Canada-based health researchers investigated why the COVID-19 death rate associated with long-term care (e.g. nursing homes) was higher in Ontario than British Columbia—both Canadian provinces. The answer probably won’t surprise too many but came down to the following elements: 1) generally, the response was faster and more decisive in British Columbia; 2) overall funding was less in Ontario; 3) privatization was higher in that province, which includes Toronto; and 4) effective care coordination between health center/hospital and home appears weaker in Ontario. Overall, it would appear that, statistically speaking, the British Columbia-based long-term care facilities were generally better funded, staffed, organized and led than their Ontario counterparts, Ceteris paribus, leading to lower elderly death rates.
Canada Ranked Worst for the Elderly
Among 16 OECD nations, Canada ranked last for the high number of deaths attributable to SARS-CoV-2 infection in elderly care homes, according to a report from the Canadian Institute for Health Information. Long-term care homes were the location for 81% of COVID-19 deaths in Canada. This compares to an average of 42% for the Organization for Economic Co-Operation and Development.
Overall, Canada ranked well in terms of overall death rates compared to many rich nations the country failed its elderly in long-term care facilities. Here for some perspective are death rates associated with COVID and elderly long term care: Spain (66%), Israel and Norway (58%), Ireland (56%), Belgium (50%), France (48%) and the United States (31%).
The fewest deaths in long-term care as an average included Australia, Austria and Slovenia as they emphasized prevention specifically targeting elderly care facilities.
Comparing Ontario & BC
Ontario is currently home to a total of 14.7 million while British Columbia’s population is at 5.1 million. In Ontario, public sources reveal 5,965 COVID cases by Sept 10 and 1,817 elderly care resident deaths while British Columbia reports 466 cases and only 156 deaths at similar facilities. Within long-term care facilities, COVID-19 infection and death rates were several times higher in Ontario: infection (7.6% v. 1.7%) and morality (2.3% v. 0.6%).
Factors Making Elderly in LTC Facilities Safer in BC
The authors found that the British Columbia system of long-term care exhibited strengths over Ontario due to the following elements:
- Superior care coordination between long-term care, public health & hospitals
- Greater public expenditure in long-term care
- More care hours for residents
- Fewer shared rooms (e.g. less crowding)
- Greater nonprofit facility ownership
- Greater number of comprehensive inspections
The researchers uncovered that, over all, British Columbia was more prepared and responsive during the first wave of the COVID-19 pandemic, implementing efforts to not only bolster public health support and staffing but also greater emphasis on proactive efforts targeting infection prevention and control. Generally, leadership in British Columbia exhibited more of a decisive and coordinated and consistent response, which led to far less loss of life in comparable facilities.
- Michael Liu AB
- Colleen J. Maxwell PhD
- Pat Armstrong PhD
- Michael Schwandt MD MPH
- Andrea Moser MD MSc
- Margaret J. McGregor MD MHSc
- Susan E. Bronskill PhD
- Irfan A. Dhalla MD MS
Call to Action: Those interested in protecting the elderly, an incredibly vulnerable population when factoring in COVID-19, can read the entire study and connect with the authors.