The Impact of the COVID-19 Pandemic on Long-Term Care in Canada.

The COVID-19 pandemic has disproportionately affected Canada's long-term care (LTC) sector, with residents of LTC and retirement homes accounting for 67% of all COVID-19-related deaths as of February 15, 2021. This study investigated the impact of the COVID-19 pandemic on LTC residents across Canada during the first six months of the pandemic, including how care changed for residents, using data from the Canadian Institute for Health Information's LTC and acute care databases. The results suggest that LTC residents received less medical care, with fewer physician visits and hospital transfers compared with the same period in 2019. They also had less contact with family/friends compared with the same period in 2019, which was associated with higher levels of depression. In provinces where it could be measured, the number of LTC resident deaths from all causes was higher than pre-pandemic years during the peak of the first wave, even in jurisdictions with few COVID-19-related deaths in LTC.

Measuring Access to Home and Community Care and to Mental Health and Addictions Services in Canada.

Federal, provincial and territorial governments endorsed agreements in August of 2017 to focus on the shared health priorities of home, community, mental health and addictions care (Government of Canada 2017). The related $11 billion federal investment over a 10-year period aims to improve access for Canadians to effective and appropriate services in these areas (Government of Canada 2019).

Access to Palliative Care in Canada.

Palliative care enables a better end of life, but not all Canadians have access to it. Access to community-based palliative care has become a priority for federal, provincial and territorial governments, with an emphasis on services that can help people remain in the community even at the end of life. The Canadian Institute for Health Information (CIHI) investigated the current state of access to publicly funded palliative care across the country. The purpose of the research is to help health system planners to identify service gaps and develop strategies for improving care. Using linked administrative data, the analysis found that while many people could benefit from palliative care at the end of life, only a few (15%) received palliative home care in Alberta and Ontario in 2016-2017. The analysis also found that early palliative care in the community was associated with better end-of-life outcomes and that access to palliative care varied by age and whether a patient had cancer or not.

A Snapshot of Advance Directives in Long-Term Care: How Often Is "Do Not" Done?

Advance directives allow individuals and their families or legal guardians to communicate preferences for interventions and treatments in the event that these individuals are no longer able to make decisions for themselves. This study examines how often do-not-hospitalize (DNH) and do-not-resuscitate (DNR) directives were recorded for residents in 982 reporting Canadian long-term care facilities between 2009-2010 and 2011-2012 and, to the extent possible, whether these directives were followed in acute care settings. It found that three-quarters of long-term care residents had a directive not to resuscitate and that these directives appeared to be well followed across the continuum; only 1 in 2,500 residents with a DNR received resuscitation in hospital. Fewer residents - 1 in 5 - had a directive not to hospitalize, and about 1 in 14 (7%) of these residents was admitted to hospital. The data are unable to determine whether patients or their families provided consent for these hospitalizations at the time of a decision to transfer. Close to half of hospitalizations among residents with a DNH directive were from potentially preventable causes, such as injuries or infections. Although hospital transfers from long-term care decreased over the study period, hospitalizations could be further reduced with the enhancement of palliative care services in long-term care settings.

Care for Patients with Complex Needs: Canadian Results from the Commonwealth Fund 2015 International Health Policy Survey of Primary Care Physicians.

Good primary care is essential for the effective management of patients with chronic conditions in the community and to ensure their care is well coordinated with other parts of the system. The Commonwealth Fund 2015 International Health Policy Survey compares the views and experiences of primary care physicians in 11 countries including Canada. The survey found nearly all (98%) primary care doctors across countries treat patients with complex needs in their practice. However, when examining questions on chronic disease management and coordination of care with other providers, Canadian results are mixed compared to the international average, and show variation at the provincial level. Opportunities likely exist to learn from other countries that have a more systematic approach to primary care delivery.

Compromised wounds in Canada.

Wounds are a serious healthcare issue with profound personal, clinical and economic implications. Using a working definition of compromised wounds, this study examines the prevalence of wounds by type and by healthcare setting using data from hospitals, home care, hospital-based continuing care and long-term care facilities within fiscal year 2011-2012 in Canada. It also evaluates several risk factors associated with wounds, such as diabetes, circulatory disease and age. Compromised wounds were reported in almost 4% of in-patient acute hospitalizations and in more than 7% of home care clients, almost 10% of long-term care clients and almost 30% of hospital-based continuing care clients. Patients with diabetes were much more likely to have a compromised wound than were patients without the disease.

Medication reconciliation: a prescription for safer care.

Four national healthcare organizations - Accreditation Canada, the Canadian Institute for Health Information, the Canadian Patient Safety Institute and the Institute for Safe Medication Practices Canada - recently collaborated to better understand and share comprehensive information about medication reconciliation in Canada. This article summarizes the key findings of their joint report titled Medication Reconciliation in Canada: Raising the Bar and profiles innovative approaches and tools for healthcare organizations across Canada.