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Long-term care infrastructure must be re-imagined in a post-pandemic world
Protecting long-term care residents from outbreaks requires different infrastructure, proper staffing conditions and a culture of quality assurance, researchers have found.
The experts further determined that designing smaller, more homelike spaces would minimize the spread of viruses while promoting better health and quality of life for residents.
“Community outbreaks and lack of personal protective equipment were the primary drivers of outbreak occurrence in long-term care homes, and the built environment was the major determinant of outbreak severity,” said George Heckman, a professor in Waterloo’s School of Public Health and Health Systems and Schlegel Research Chair in Geriatric Medicine with the Research Institute for Aging.
“We need to distinguish between small-scale living and small-scale housing, using architectural features to create uncrowded and home-like spaces – but within a sufficiently resilient infrastructure to avoid critical staff shortages such as those experienced by some very small homes in Italy and the United States.”
In the U.S., data from geospatial analysis and cellphone tracking showed that outbreaks were more likely when staff commuted from neighbourhoods with high viral circulation, and in large homes with more staff traffic.
The researchers said that in the case of Ontario, simulations found that 31 per cent of infections and 31 per cent of deaths could have been prevented if all Ontario long-term care residents had had single rooms. However, 30,000 new private rooms would have been needed.
“Policymakers need to reimagine long-term care infrastructure in a post-pandemic world, keeping in mind that smaller homes support better resident outcomes and are more resilient against infectious outbreaks,” Heckman said. “New large-scale long-term care home developments should be strongly discouraged.”
Other factors that would improve resident well-being and curb the spread of viral infections include a dedicated infection control officer in all long-term care homes, proper staffing conditions and high-quality assurance frameworks.
Hong Kong, for example, learned from the 2003 SARS outbreak and implemented several policies that led to success when it came to COVID-19. They developed guidelines for the prevention of communicable diseases in long-term care, including that all homes have an infection control officer, conduct annual outbreak drills and have a permanent stockpile of personal protective equipment and establish visitation rules that address hygiene and PPE use.
In addition to robust infection control and communication technologies used in Hong Kong, Heckman believes full-time positions, paid sick leave and mental health and well-being supports for staff would make a big difference.
The Hong Kong experience underscores the critical importance of learning health systems, of which a culture of quality assurance is an intrinsic component. Ontario, and most Canadian provinces, already have the required information infrastructure to achieve a learning health system. Based on standardized international Resident Assessment Instrument systems, developed by an international consortium of which Waterloo is a principal leader, their use by communities of practice has led to reductions in inappropriate antipsychotic use and better health outcomes for long-term care residents.
“Reflecting on the COVID-19 Themes from Long Term Care” was published in the Journal of the American Medical Directors Association. The co-authors are Heckman, Kelly Kay, Adam Morris, David Grabowski, John Hirdes, Vincent Mor, Greg Shaw, Sophiya Benjamin, Veronique Boscart, Andrew Costa, Anja Declercq, Leon Geffen, Terry Yat Sang Lum, Andrea Moser, Graziano Onder and Hein van Hout.
Map the System takes Waterloo students around the world
This article was originally featured on the Kindred Credit Union for Peace Advancement website.
Many of Map the System’s 2021 competitors are participating from their homes this year, however that did not prevent the University of Waterloo’s campus finalists from tackling systemic issues on local, national, and global scales. Over 200 students applied to participate this year through the University of Waterloo, representing nearly one fifth of Canadian registrations! On Thursday, April 15, UWaterloo’s top six teams competed for the chance to move on to the Canadian finals. For their research on foreign labour conditions in Malaysian palm oil plantations, Muhammed Ahsanur Rahim, Ewomazino IyanuOluwa Odhigbo and Leah Feor received first prize and the opportunity to progress in the competition.
The virtual setting of Waterloo’s third annual Map the System competition did not dampen the enthusiasm of participating students, faculty and staff. Over 200 students comprising 52 teams of graduate and undergraduate students entered the competition this year, mapping societal problems with guidance from their professors, the Kindred Credit Union Centre for Peace Advancement, and Waterloo’s 2021 Map the System Campus Lead, Thomas Fraser. Under the 2021 theme of “Systems Reset”, students tackled systemic issues in health, climate, economic and social spheres.
Based on the strength of their written submissions, six teams were invited to showcase their work at the live campus finals on Thursday, April 15th, to an audience of Waterloo students, staff, and faculty, as well as their family and friends and this year's sponsors. Local topics included COVID-19 and the Opioid epidemic in Ontario and Student food insecurity at the University of Waterloo. On a national level, teams explored the causes and connections behind Vaccine hesitancy and Work-life conflict in Canada. Finally, two teams focused on systems around the world, reflecting on the incidence of Girl-child marriages in Kenya and Foreign labour conditions in Malaysian palm oil plantations.
Many judges pitched in for this year’s competition, dedicating their time and expertise to determine Waterloo’s top teams. The quick wits of Erin Alexiuk (Waterloo Institute for Social Innovation and Resilience), Brian Doucet (UWaterloo School of Planning), Jennifer King (Mennonite Economic Development Associates) and Roopa Reddy (Conrad School of Entrepreneurship and Business) ensured that participating teams received meaningful opportunities to expand on their presentations during the question and answer period, which supported the selection of this year’s finalists. In addition, this year’s evaluators, Karen Schmidlin, Jonathan Baltrusaitis, Jason Lajoie, Tobias Thielen, Simron Singh, and Paul Heidebrecht dedicated many hours reviewing written submissions leading up to the finals.
Behind the scenes, the judges deliberated with spirit and enthusiasm. With such a vast range of topics and scales, choosing just one team to advance to the Canadian Nationals in May was quite the challenge. Fortunately, multiple awards were announced during the campus final showcase.
Delia Lin, Josée Maurice and Lauren Forrest took home the third-place prize of $500 sponsored by the Waterloo Institute for Complexity and Innovation (WICI) for their research into the causes of Vaccine hesitancy in Canada and possible ways to address it in a culturally-sensitive manner. This team joined the 2021 competition through Professor Simron Singh’s International Development course Methods for sustainable development practice: A systems approach.
The second-place award of $1,000 from the University of Waterloo Council for Responsible Innovation and Technology (CRIT) went to Peace and Conflict Studies (PACS) students Victoria Lumax, Blair Ashford and Jen Collins from Professor Paul Heidebrecht’s Map the System seminar. While exploring Food insecurity at the University of Waterloo, this team identified a gap between student needs and their eligibility for community support. As the highest scoring team with a PACS student, this group also received a prize that is new to the competition this year, leaving with an additional $1,000 sponsored by Owl Practice.
Finally, congratulations to Muhammed Ahsanur Rahim, Ewomazino IyanuOluwa Odhigbo and Leah Feor for their outstanding work learning about the systems perpetuating Precarious conditions for foreign labour in Malaysian palm oil plantations. This team, brought together by Professor Singh's International Development course, received a grand prize of $2,000 donated by the Kindred Credit Union, and will be moving forward in the competition to represent the University of Waterloo in the Canadian finals.
From May 3 to 7, teams from across Canada will be participating in a series of online events as part of the online Finals week. Campus finals may be over, but the Map the System journey has only just begun for Rahim, Odhigbo and Feor. On Tuesday, May 4 they will compete against winning teams from institutions across Canada for the chance to move on to the global Map the System finals in June. Stay tuned in the coming weeks for more updates on this team of University of Waterloo students, and consider cheering them on by attending the Canadian finals.
The Map the System Canada National Finals will take place on May 7 at 3:00 p.m. Here is the link to register to attend this event.
HREI launches spring workshops
Human Rights, Equity and Inclusion has released its spring schedule of workshops, which are available to all current students, faculty and staff. This spring, new, renewed, or refreshed workshops include:
- Listening, Acting and Taking Responsibility in the Anti-Racist Movement
- Responding to Disclosures: How to support a friend who experiences trauma
- How masculine-identifying folks can engage in bystander intervention
- 2SLGBTQ+ Fundamentals
- Radical Solidarity for a Collective Future
Equity-related workshops now include information to help guide participants to the workshop that is right for them by including whether the workshop is considered introductory, intermediate, or advanced.