Out of date design of long-term care homes left residents more vulnerable to COVID-19: study

A new study shows that aging facilities with designs dating back to the 70s are partially to blame for why the virus spread in long-term care homes.

Rate of cases almost double at for-profit facilities that typically had an older design

A new report says that outdated buildings are partially to blame for how the virus affected residents in long-term care homes, including the number of cases and deaths at for-profit locations.

A study of long-term care homes across Ontario during the pandemic shows that aging facilities, whose designs date back to 1972 standards, were a significant factor in determining the likelihood of an outbreak. 

The authors found the odds were higher with older homes — many of which are for-profit — and were also linked to the infection rate in the local health unit and number of people inside the building. 

Dr. Andrew Costa, senior author and McMaster University professor, said he was surprised at how crucial the facilities' design was when it came to managing an outbreak. 

"We were frankly disappointed... at how many facilities still maintained essentially 1972 designs," he said. "That's a long time ago. And the philosophy of care has changed so much." 

The report, published in the Canadian Medical Association Journal, looked at all 623 long-term care (LTC) homes in Ontario — home to 75,676 residents — from March 29 to May 20, 2020.

Around 30 per cent of homes in the province experienced outbreaks during this peak period, with 110 occurring in for-profit homes, 55 in nonprofit homes and 25 in municipal homes.

There were 190 outbreaks of COVID-19 in LTC homes, which at this point killed 1,452 people. Their lives account for more than 80 per cent of Canada's deaths. 

Deaths up 178 per cent at for-profit homes

At for-profit homes, the report said the rate of cases was almost double compared to those with non-profit status. These homes also had a 178 per cent increase in the number of resident deaths. 

For-profit homes, were "usually smaller, housed fewer residents, and had older design standards from before 1972 with multiple-occupancy rooms and chain ownership." Costa said this was the case for around half of the for-profit places. 

Newer designs, the authors said, allow for larger and more private rooms, and less crowded and self-contained common space. This limits infection.

But older designs use ward-style accommodations and centralized common spaces where people can interact with each other, allowing the virus to spread. 

One in five of the nonprofits and very few municipal ones had old designs.

And it made a difference. If you factor in age and whether or not the home is a chain, Costa said, then "essentially there was no difference" between each type of residence. 

"It's only now that we've seen the infection control issue as cleanly and plainly, where we can't disregard it, that it's gotten attention. But it's always been bad for the people living there," he said. 

The findings echo those in a CBC Marketplace investigation in June. 

Dr. Andrew Costa, senior author, says some buildings' designs date back to 1972 and that "it's time" for people to take this issue seriously. (McMaster University)

Of the 10 homes with the highest death rates, seven were for-profit homes with older design standards and chain ownership. Of the 15 homes with the highest rate of cases, 12 fell into this same category.

"From a Hamilton perspective, we have some old facilities in our midst...but it's something that local public health units have to pay particular attention to," he said and added that units and municipal government should identify these vulnerable facilities to create plans for evacuations and handling staff crises. 

About 23.8 per cent of residents in for-profit homes had the virus, which is higher than the average for nonprofit and municipal homes (17.1 per cent and 7.1 per cent respectively.) Around 6.5 per cent of all non-profit residents died of COVID-19. 

"It was clear that across the board, for all of our planning for covid, the long-term care sector was left neglected," he said. "We were planning for a crisis in hospitals...that instead fell to long-term care. And we were on our back heels. And so now we have evidence, clear evidence [on] what the priorities are for prevention and we have to act." 

The authors write that with government commitment to independent commissions and inquiries into the long-term care systems, "it is important that policy recommendations and changes consider all root causes of the present crisis, including supporting capital projects to retrofit or rebuild older LTC homes." 

In May, the province announced an independent commission into long-term care. 

The authors did not look at retirement residences since they are privately funded and not administered by the Ministry of Long-term Care.