Care Aides Working Multiple Jobs: Considerations for Staffing Policies in Long-Term Care Homes During and After the COVID-19 Pandemic

Duan, Yinfei; Iaconi, Alba; Song, Yuting; Norton, Peter; Squires, Janet E.; Keefe, Janice; Cummings, Greta G.; Estabrooks, Carole A.

doi:10.1016/j.jamda.2020.07.036

Cited by 48 publications

(68 citation statements)

References 2 publications

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“…† † † Specifically among LTCF staff members, a November 2020 survey found that only 45% of respondents were willing to receive a COVID-19 vaccine immediately once available, and an additional 24% would consider it in the future; the most frequently identified reason for vaccine hesitancy was concern about side effects (8). High staff member turnover, staff members working in multiple facilities (9), and limited resources for staff member outreach and education (10) staff members might have additional benefits for promoting vaccination among residents. Because coverage varied among jurisdictions, lessons learned from jurisdictions or individual facilities with high coverage might provide insight into strategies that could be applied more broadly.…”

Section: Discussionmentioning

confidence: 99%

Early COVID-19 First-Dose Vaccination Coverage Among Residents and Staff Members of Skilled Nursing Facilities Participating in the Pharmacy Partnership for Long-Term Care Program — United States, December 2020–January 2021

Gharpure¹,

Guo²,

Bishnoi³

et al. 2021

MMWR Morb. Mortal. Wkly. Rep.

108

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Section: Discussionmentioning

confidence: 99%

Early COVID-19 First-Dose Vaccination Coverage Among Residents and Staff Members of Skilled Nursing Facilities Participating in the Pharmacy Partnership for Long-Term Care Program — United States, December 2020–January 2021

Gharpure¹,

Guo²,

Bishnoi³

et al. 2021

MMWR Morb. Mortal. Wkly. Rep.

108

View full text Add to dashboard Cite

“…3 As a result, many PSWs need to work multiple parttime jobs to earn a living wage. 3,70,71 The conditions of work within LTC homes and the difficulties in both promoting and retaining worker in the sector have been severely exacerbated by the COVID-19 pandemic. 3 Many LTC home workers contracted SARS-CoV-2 infections themselves, with eight staff members dying of COVID-19 in the first wave and two staff members dying in the second wave to date.…”

Section: Promote Staff Entry and Retention In The Sector By Improvingmentioning

confidence: 99%

COVID-19 and Ontario’s Long-Term Care Homes

Stall¹,

Brown²,

Maltsev³

et al. 2021

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Key Message Ontario long-term care (LTC) home residents have experienced disproportionately high morbidity and mortality, both from COVID-19 and from the conditions associated with the COVID-19 pandemic. There are several measures that could be effective in preventing COVID-19 outbreaks, hospitalizations, and deaths in Ontario’s LTC homes, if implemented. First, temporary staffing could be minimized by improving staff working conditions. Second, homes could be further decrowded by a continued disallowance of three- and four-resident rooms and additional temporary housing for the most crowded homes. Third, the risk of SARS-CoV-2 infection in staff could be minimized by approaches that reduce the risk of transmission in communities with a high burden of COVID-19. Summary Background The Province of Ontario has 626 licensed LTC homes and 77,257 long-stay beds; 58% of homes are privately owned, 24% are non-profit/charitable, 16% are municipal. LTC homes were strongly affected during Ontario’s first and second waves of the COVID-19 pandemic. Questions What do we know about the first and second waves of COVID-19 in Ontario LTC homes? Which risk factors are associated with COVID-19 outbreaks in Ontario LTC homes and the extent and death rates associated with outbreaks? What has been the impact of the COVID-19 pandemic on the general health and wellbeing of LTC residents? How has the existing Ontario evidence on COVID-19 in LTC settings been used to support public health interventions and policy changes in these settings? What are the further measures that could be effective in preventing COVID-19 outbreaks, hospitalizations, and deaths in Ontario’s LTC homes? Findings As of January 14, 2021, a total of 3,211 Ontario LTC home residents have died of COVID-19, totaling 60.7% of all 5,289 COVID-19 deaths in Ontario to date. There have now been more cumulative LTC home outbreaks during the second wave as compared with the first wave. The infection and death rates among LTC residents have been lower during the second wave, as compared with the first wave, and a greater number of LTC outbreaks have involved only staff infections. The growth rate of SARS-CoV-2 infections among LTC residents was slower during the first two months of the second wave in September and October 2020, as compared with the first wave. However, the growth rate after the two-month mark is comparatively faster during the second wave. The majority of second wave infections and deaths in LTC homes have occurred between December 1, 2020, and January 14, 2021 (most recent date of data extraction prior to publication). This highlights the recent intensification of the COVID-19 pandemic in LTC homes that has mirrored the recent increase in community transmission of SARS-CoV-2 across Ontario. Evidence from Ontario demonstrates that the risk factors for SARS-CoV-2 outbreaks and subsequent deaths in LTC are distinct from the risk factors for outbreaks and deaths in the community (Figure 1). The most important risk factors for whether a LTC home will experience an outbreak is the daily incidence of SARS-CoV-2 infections in the communities surrounding the home and the occurrence of staff infections. The most important risk factors for the magnitude of an outbreak and the number of resulting resident deaths are older design, chain ownership, and crowding. Figure 1. Anatomy of Outbreaks and Spread of COVID-19 in LTC Homes and Among Residents Figure from Peter Hamilton, personal communication. Many Ontario LTC home residents have experienced severe and potentially irreversible physical, cognitive, psychological, and functional declines as a result of precautionary public health interventions imposed on homes, such as limiting access to general visitors and essential caregivers, resident absences, and group activities. There has also been an increase in the prescribing of psychoactive drugs to Ontario LTC residents. The accumulating evidence on COVID-19 in Ontario’s LTC homes has been leveraged in several ways to support public health interventions and policy during the pandemic. Ontario evidence showed that SARS-CoV-2 infections among LTC staff was associated with subsequent COVID-19 deaths among LTC residents, which motivated a public order to restrict LTC staff from working in more than one LTC home in the first wave. Emerging Ontario evidence on risk factors for LTC home outbreaks and deaths has been incorporated into provincial pandemic surveillance tools. Public health directives now attempt to limit crowding in LTC homes by restricting occupancy to two residents per room. The LTC visitor policy was also revised to designate a maximum of two essential caregivers who can visit residents without time limits, including when a home is experiencing an outbreak. Several further measures could be effective in preventing COVID-19 outbreaks, hospitalizations, and deaths in Ontario’s LTC homes. First, temporary staffing could be minimized by improving staff working conditions. Second, the risk of SARS-CoV-2 infection in staff could be minimized by measures that reduce the risk of transmission in communities with a high burden of COVID-19. Third, LTC homes could be further decrowded by a continued disallowance of three- and four-resident rooms and additional temporary housing for the most crowded homes. Other important issues include improved prevention and detection of SARS-CoV-2 infection in LTC staff, enhanced infection prevention and control (IPAC) capacity within the LTC homes, a more balanced and nuanced approach to public health measures and IPAC strategies in LTC homes, strategies to promote vaccine acceptance amongst residents and staff, and further improving data collection on LTC homes, residents, staff, visitors and essential caregivers for the duration of the COVID-19 pandemic. Interpretation Comparisons of the first and second waves of the COVID-19 pandemic in the LTC setting reveal improvement in some but not all epidemiological indicators. Despite this, the second wave is now intensifying within LTC homes and without action we will likely experience a substantial additional loss of life before the widespread administration and time-dependent maximal effectiveness of COVID-19 vaccines. The predictors of outbreaks, the spread of infection, and deaths in Ontario’s LTC homes are well documented and have remained unchanged between the first and the second wave. Some of the evidence on COVID-19 in Ontario’s LTC homes has been effectively leveraged to support public health interventions and policies. Several further measures, if implemented, have the potential to prevent additional LTC home COVID-19 outbreaks and deaths.

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“…The single-site work order decreased work hours for health-care aides by an average of sixteen hours (Duan et al 2020). To offset the financial impacts of reduced jobs, British Columbia and Alberta mandated that employers therefore increase employee hours (Possamai 2020).…”

Section: Introductionmentioning

confidence: 99%

“…The Alternative: Centralizing the Nursing and Support Staff Workforce It is estimated that 30 percent of health-care aides in Alberta work in multiple long-term care centres. However, Minister Shandro's single-site order does not exclude healthcare aides from working outside of long-term care facilities, which 15 percent of aides reportedly do at an average of 18 hours a week (Duan et al 2020). For example, a long-term care worker in Alberta could also work in acute care, homecare, or even a grocery store, which does little to suppress COVID-19 transmission but may be necessary for financial stability (AHS 2020a).…”

Section: Introductionmentioning

confidence: 99%

Alberta COVID-19 Response: Critical Considerations for Health Care Worker Single-Site Exclusion Policies and Wage Supplements

Dhunnoo

2021

PSUR

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Abstract: On April 20, 2020, Alberta Minister of Health Tyler Shandro issued a single-site exclusion order and wage supplement for health care aid workers at long term care centres in an effort to reduce the transmission of COVID-19 between and within high-risk populations. Adequate staffing and diligent infection prevention measures in long term care centres are necessary to maintaining a medically secure environment and alleviating the pressures that are being faced by acute and intensive care units in-hospital, which have reached capacity as of December 2020. This paper argues that the April 20th order was an insufficient and inefficiently executed iteration of a policy intended to protect both the lives of residents and livelihoods of employees in long-term care throughout the pandemic. I propose instead that centralized regulation of all health care aid and nursing support staff would have better addressed the financial and health concerns that this policy aimed to target. I will also point out systemic issues in Canadian long-term care provision that have been aggravated by COVID-19, as well as reiterate the need for general infection prevention measures outside of the long-term care setting.

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Care Aides Working Multiple Jobs: Considerations for Staffing Policies in Long-Term Care Homes During and After the COVID-19 Pandemic

Cited by 48 publications

References 2 publications

Early COVID-19 First-Dose Vaccination Coverage Among Residents and Staff Members of Skilled Nursing Facilities Participating in the Pharmacy Partnership for Long-Term Care Program — United States, December 2020–January 2021

Early COVID-19 First-Dose Vaccination Coverage Among Residents and Staff Members of Skilled Nursing Facilities Participating in the Pharmacy Partnership for Long-Term Care Program — United States, December 2020–January 2021

COVID-19 and Ontario’s Long-Term Care Homes

Alberta COVID-19 Response: Critical Considerations for Health Care Worker Single-Site Exclusion Policies and Wage Supplements

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