Study explores best practices in long-term care homes during the COVID-19 pandemic

Even the best-managed long-term care homes will need to step up to get through the second wave of the pandemic, suggests a new study by researchers at the UBC school of nursing.

The team, led by Professor Farinaz Havaei, evaluated the management practices of a large B.C. long-term care facility that successfully kept COVID-19 at bay at the start of the pandemic. It did not experience a single outbreak until much later in the year--when the B.C. health care system was much better prepared to fight the virus.

The study showed that a combination of good planning, strong leadership and a focus on safety above everything else contributed to this outcome.

"The facility leaders were monitoring COVID news as early as December," said Havaei, a researcher who studies workplace safety and patient care. "They created a crisis operations center quickly so they had a plan in place when the magnitude of the crisis became clear."

Early preparation

In March, the care home started implementing many of the infection control practices that would be recommended by the BC Centre for Disease Control a few months later. These include keeping an up-to-date list of people entering the facility, enforcing staff members' hand hygiene, monitoring supplies of PPE and launching one-on-one support programs for residents.

The facility also paid full-time wages to all quarantined staff and provided them with laptops and access to fast internet so they could continue to work from home.

Like similar facilities, the care home had to restrict family visits during the pandemic but made sure that residents stayed socially connected through email and regular updates from the care home leaders.

To keep communication lines open, staff, residents and family members were also encouraged to e-mail their concerns directly to the chief executive officer and other executive leaders.

Staff stress

These practices, as well as adherence to measures mandated by the health authority, worked well to prevent outbreaks in the care home and inspire staff confidence. A UBC survey, conducted in September, saw the care staff expressing approval of the pandemic response by management.

However, the same survey also found growing levels of stress among the staff members, suggesting there is room for improvement. Thirty-eight per cent said they were dissatisfied with general staffing levels, and 48 per cent wanted more flexible sick time policies.

The practices and policies put in place to prevent the spread of the virus also negatively affected staff workloadWith family visits restricted, they often had to provide the care and emotional connection that would otherwise come from the residents' family. Isolation measures were time-consuming. And despite the increased workload, staffing levels did not change--if anything they decreased as staff now couldn't work at multiple sites."

Farinaz Havaei, Professor and Researcher

The pandemic merely exacerbated staffing issues that have long plagued Canada's long-term care sector, she said, noting that while adding staff is a goal, it's not the only answer.

"In the short term, we can look at better matching staff competencies to patient needs. We can build stronger teams through team building activities, and we can implement workplace policies and practices that better support the health and well-being of staff. Ultimately, these translate to better patient outcomes--and in the time of COVID, ensuring this is more essential than ever."