Flowers sit outside the Herron private nursing home in Dorval, west of Montreal on April 16, 2020.ERIC THOMAS/AFP/Getty Images
Canadians living in nursing homes received less medical care for everything from urinary tract infections to lung disease and heart failure during the early days of the pandemic, hastening the deaths of many even in provinces barely affected by the coronavirus, a new report says.
The number of residents transferred to hospital for chronic medical conditions fell 27 per cent between March 1 and Aug. 31, 2020, compared with the same period in 2019, according to the analysis from Canada’s health care statistics agency. Doctors visited 16 per cent fewer residents in the homes.
Nursing homes were all but forgotten during the health system’s push to ensure that hospitals were not overwhelmed. The pandemic also altered the practice of medicine across the country, as some provinces discouraged transferring the frail elderly to hospitals and online and telephone appointments between doctors and patients became common.
Number of long-term care (LTC) residents transferred to hospital for chronic medical conditions during the first wave compared with the same period in 2019, Canada
2019
2020
3,000
2,500
2,000
1,500
1,000
Jan.
Feb.
March
April
May
June
July
Aug.
Note: First wave is March 1 to Aug. 31, 2020.
Quebec data are not included.
THE GLOBE AND MAIL, SOURCE: CANADIAN
INSTITUTE FOR HEALTH INFORMATION
Number of long-term care (LTC) residents transferred to hospital for chronic medical conditions during the first wave compared with the same period in 2019, Canada
2019
2020
3,000
2,500
2,000
1,500
1,000
Jan.
Feb.
March
April
May
June
July
Aug.
Note: First wave is March 1 to Aug. 31, 2020.
Quebec data are not included.
THE GLOBE AND MAIL, SOURCE: CANADIAN
INSTITUTE FOR HEALTH INFORMATION
Number of long-term care (LTC) residents transferred to hospital for chronic medical conditions during the first wave compared with the same period in 2019, Canada
2019
2020
3,000
2,500
2,000
1,500
1,000
Jan.
Feb.
March
April
May
June
July
Aug.
Note: First wave is March 1 to Aug. 31, 2020. Quebec data are not included.
THE GLOBE AND MAIL, SOURCE: CANADIAN INSTITUTE FOR HEALTH INFORMATION
The Canadian Institute for Health Information (CIHI) report, published Tuesday, marks the first official attempt to measure the toll these practices took on nursing home residents – those who faced both the highest needs for medical care and the highest risk from COVID-19 infections.
However, the national snapshot is far from complete. Hospital transfers do not include Quebec, the province hardest hit by COVID-19 during the first wave. And only five provinces – British Columbia, Alberta, Manitoba, Ontario and Newfoundland and Labrador – are included in the statistics on doctor visits and the higher than usual number of deaths.
Samir Sinha, the director of geriatrics at the University Health Network and Sinai Health System and expert adviser to CIHI, said residents sickened with non COVID-19 conditions were not sent to hospital because of physician absences at the homes and a lack of medical care. For those residents afflicted with COVID-19, he said, “blatant discrimination” was behind the decision not to transfer many of them to hospital.
Top 10 reasons LTC residents are admitted to hospital
Peak of first wave compared with same period in 2019
2019
2020
0
200
400
600
+0.4%
Hip fracture
COVID-19
-17%
Palliative care
-36%
Urinary tract infection
-34%
Bloodstream infection
Pneumonitis due to
food and vomit
-45%
-50%
Pneumonia, organism
unspecified
-51%
Heart failure
-58%
COPD
-36%
Delirium
Note: Peak of first wave is March 1 to June 30, 2020.
Quebec data are not included.
THE GLOBE AND MAIL, SOURCE: CANADIAN
INSTITUTE FOR HEALTH INFORMATION
Top 10 reasons LTC residents are admitted to hospital
Peak of first wave compared with same period in 2019
2019
2020
0
200
400
600
+0.4%
Hip fracture
COVID-19
-17%
Palliative care
-36%
Urinary tract infection
-34%
Bloodstream infection
Pneumonitis due to
food and vomit
-45%
-50%
Pneumonia, organism
unspecified
-51%
Heart failure
-58%
COPD
-36%
Delirium
Note: Peak of first wave is March 1 to June 30, 2020.
Quebec data are not included.
THE GLOBE AND MAIL, SOURCE: CANADIAN
INSTITUTE FOR HEALTH INFORMATION
Top 10 reasons LTC residents are admitted to hospital
Peak of first wave compared with same period in 2019
2019
2020
0
200
400
600
+0.4%
Hip fracture
COVID-19
-17%
Palliative care
-36%
Urinary tract infection
-34%
Bloodstream infection
Pneumonitis due to
food and vomit
-45%
-50%
Pneumonia, organism
unspecified
-51%
Heart failure
-58%
COPD
-36%
Delirium
Note: Peak of first wave is March 1 to June 30, 2020. Quebec data are not included.
THE GLOBE AND MAIL, SOURCE: CANADIAN INSTITUTE FOR HEALTH INFORMATION
“The overwhelming narrative was if patients [in nursing homes] get COVID, don’t send them to hospital,” Dr. Sinha said. “That narrative really shortchanged the situation for many of these residents.”
During the peak period of the first wave – March 1 to June, 30, 2020 – 13,959 residents in nursing homes died from all causes, including COVID-19, in the five provinces where data were available, the CIHI report says. By comparison, an average of 11,686 residents died during the same period over the previous five years.
Ontario experienced the largest increase in excess deaths, while British Columbia’s was the smallest.
Most of the 6,080 long-term care residents in Canada who succumbed to COVID-19 during the first wave died inside the virus-stricken understaffed facilities while many hospital beds sat empty.
At the onset of the pandemic, government leaders and health officials across Canada worried about averting a catastrophe in this country’s hospitals, similar to what had happened in Italy and New York. They focused most of their attention on expanding the number of available hospital beds in anticipation of an influx of patients with COVID-19.
Rhonda Collins, chief medical officer of nursing home operator Revera Inc., testified last fall at the independent commission examining the devastating impact of the coronavirus on Ontario’s long-term homes, about the push to increase capacity in the acute-care sector in preparation for a surge of COVID-19 patients. “Many homes were directed to keep residents out of hospital to the best of their abilities,” she said.
As well, Dr. Collins said, provincial colleges governing physicians recommended that primary care practitioners deliver virtual care as much as possible to minimize the risk of spreading the virus.
COVID-19 cases, deaths and fatality rates in Canada’s LTC and retirement homes, by pandemic wave
First wave
Second wave
21,140
Resident cases
34,270
7,260
Resident deaths
7,479
34%
Resident
fatality rate
22%
Resident deaths as
percentage of all
COVID-19 deaths
79%
60%
Note: Includes LTC and retirement homes with at least one COVID-19 case, in all provinces and territories. First wave is March 1 to Aug. 31, 2020. Second wave is Sept. 1, 2020, to Feb. 15, 2021.
THE GLOBE AND MAIL, SOURCE: CANADIAN
INSTITUTE FOR HEALTH INFORMATION
COVID-19 cases, deaths and fatality rates in Canada’s LTC and retirement homes, by pandemic wave
First wave
Second wave
21,140
Resident cases
34,270
7,260
Resident deaths
7,479
34%
Resident
fatality rate
22%
Resident deaths as
percentage of all
COVID-19 deaths
79%
60%
Note: Includes LTC and retirement homes with at least one COVID-19 case, in all provinces and territories. First wave is March 1 to Aug. 31, 2020. Second wave is Sept. 1, 2020, to Feb. 15, 2021.
THE GLOBE AND MAIL, SOURCE: CANADIAN
INSTITUTE FOR HEALTH INFORMATION
COVID-19 cases, deaths and fatality rates in Canada’s LTC and retirement homes, by pandemic wave
First wave
Second wave
21,140
Resident cases
34,270
7,260
Resident deaths
7,479
34%
Resident
fatality rate
22%
Resident deaths as
percentage of all
COVID-19 deaths
79%
60%
Note: Includes LTC and retirement homes with at least one COVID-19 case, in all provinces and territories. First wave is March 1 to Aug. 31, 2020. Second wave is Sept. 1, 2020, to Feb. 15, 2021.
THE GLOBE AND MAIL, SOURCE: CANADIAN INSTITUTE FOR HEALTH INFORMATION
Many doctors followed that advice, which had a profound effect in limiting the availability of their in-person visits at long-term care homes, the CIHI report shows.
Residents with lung disease and heart failure bore the brunt of physician absences, with transfers to hospital falling 58 per cent and 51 per cent, respectively, the report says. Chronic health conditions are typically diagnosed by a doctor, who makes the decision on whether a patient requires hospital care.
The decreases for all chronic conditions were highest in Ontario and New Brunswick. Alberta had the lowest decreases.
Prince Edward Island and Newfoundland and Labrador – two provinces with no COVID-19 fatalities in nursing homes – also transferred fewer residents with chronic health conditions to hospital. Visits by doctors to homes in Newfoundland dropped by 19 per cent, the report says.
Just over 14,700 residents and 30 staff died in long-term care and retirement homes across Canada between March 1, 2020, and Feb. 15, the report says.
The deaths account for more than two-thirds of overall fatalities in Canada from COVID-19, significantly higher than the international average of 41 per cent.
The second wave was more punishing, reaching broader swaths of the country and resulting in a larger number of infections and deaths. But fewer residents in long-term care and retirement homes sickened with COVID-19 succumbed to the virus. One in five residents who tested positive died between Sept. 1 and Feb. 15, the report says. During the first wave, the fatality rate was 34 per cent.
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Karen Howlett