The Ontario government is keeping a dynamic list of which long-term care homes in the province are considered high-risk for COVID-19 and is modelling how many outbreaks might occur and how severe they might be, based on how the pandemic is evolving.
Details of how the government is tracking that information were put online by the independent commission into long-term care, part of a series of slide decks the commissioners received along with briefings by government officials.
One deck says the province uses a three-step process to model COVID-19 cases and deaths in long-term care: predicting how many homes will have outbreaks based on rates of community COVID-19 infection; predicting which homes will have outbreaks; and finally modelling the number of cases and deaths within each home that is predicted to have an outbreak.
The ministry determines each home's risk level based on a variety of factors, starting with the incidence of COVID-19 in the surrounding community — if a home is in a municipality with more than 10 active cases per 100,000 people, the home is considered high risk.
Ontario's hardest-hit regions currently have rates well above that threshold — there are 53 active cases per 100,000 people in Ottawa, 47 in Peel, 37 in Toronto and 25 in York Region, according to calculations by QP Briefing.
There are four other criteria: being an older home owned by a chain; having had previous outbreaks of COVID-19; having previously been in "red" status for more than five days; and being crowded, with a high proportion of residents living in ward rooms with three or four beds. Red status refers to the ministry's label for a home in the midst of an outbreak that is not under control.
Based on that, there are four categories of high-risk homes, according to the document. At the time of the briefing earlier this month, 149 homes were considered high risk, with six of them at the highest level, meeting three or more of the criteria and being located in an area with a high rate of COVID-19 cases.
However, the number of active cases in Ontario has risen steadily all month, which would impact those figures.
The factors that determine a home's risk status stem from research by a team led by geriatrician Dr. Nathan Stall. It found that the rate of COVID-19 in the area around the home influences the likelihood outbreak will occur, and identified chain ownership, the crowdedness of a home and its age as factors in how severe — in terms of increased cases and deaths — the outbreaks are when they occur.
His research also found that those risk factors are more prevalent in for-profit, rather than non-profit and municipal homes.
Stall said it's a "good news story" that the government is using data analytics to help guide its risk assessments and management responses, but he has been calling on the government to do more to protect long-term care residents from the second wave.
He said the number of active cases has been rising steadily and in many areas is passing the threshold the government considers a risk for causing outbreaks in long-term care homes. He noted that in the meantime long-term care owners along with groups representing residents and their families wrote to the Ford government to warn that the sector isn't ready for the second wave and needs support for staffing and infection prevention and control.
Stall also said that one of the risk factors could be controversial. Most chain homes, and all of the largest chains, have for-profit ownership and the government hasn't previously acknowledged any connection between ownership and COVID-19 outcomes. Stall said his research suggested two potential weaknesses with the chain model: lower staffing levels overall and breakdowns in processes or communication when long-term care companies' COVID-19 response policies are centrally determined rather than locally at each home.
He noted the deputy minister of long-term care recently sent a memo to LTC homes to warn them that they could not depend on local hospitals for staffing support, as some did in the first wave, and called on chain-owned homes to look within their companies for staffing support.
Stall said the list of high-risk homes should be made public, "not to strike fear into the hearts of residents and families and caregivers" but to inform residents' family caregivers of the risk so that they can be of help as extra sets of eyes and hands for homes at risk, keeping them safer.
"And so if my loved one was in a home, where there was higher risk, I would certainly want to know that," he said. "And that might change my own behaviour, which could actually impact the outcomes of my loved one who was in that home."
However, he said he is leerier about releasing modelling information, saying that while it can help alert policy-makers and the public to the risk of COVID-19, modelling is not exact and can be flawed, so it could have the potential to do harm.
QP Briefing asked the minister's office if it will make the list of high-risk homes and modelling information public, but it declined.
"As the inspections at our highest risk homes are unannounced, we are unable to confirm the list you requested," a spokesperson said. "The Ministry of Long-Term Care, along with Ontario Health and our other partners, is in constant contact with long-term care homes across the province, and assesses their status and needs on an ongoing basis."
The spokesperson also noted that the Canadian Armed Forces were deployed to homes that had the most acute staffing challenges in the first wave.
The slide deck also shows the ministry is keeping tabs on excess mortality in long-term care — how many deaths there have been in long-term care, over the five-year average, and how many have been confirmed as COVID-19 related. The figures in the slide deck aren't current but identified 160 excess non-COVID deaths compared to the five-year average as of June. As of Tuesday morning, the ministry had counted 1,828 COVID-19 deaths in long-term care.
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