Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Aug 17;192(33):E946-E955.
doi: 10.1503/cmaj.201197. Epub 2020 Jul 22.

For-profit long-term care homes and the risk of COVID-19 outbreaks and resident deaths

Nathan M Stall  1 , Aaron Jones  2 , Kevin A Brown  2 , Paula A Rochon  2 , Andrew P Costa  2
Affiliations

For-profit long-term care homes and the risk of COVID-19 outbreaks and resident deaths

Nathan M Stall et al. CMAJ. .

Abstract

Background: Long-term care (LTC) homes have been the epicentre of the coronavirus disease 2019 (COVID-19) pandemic in Canada to date. Previous research shows that for-profit LTC homes deliver inferior care across a variety of outcome and process measures, raising the question of whether for-profit homes have had worse COVID-19 outcomes than nonprofit homes.

Methods: We conducted a retrospective cohort study of all LTC homes in Ontario, Canada, from Mar. 29 to May 20, 2020, using a COVID-19 outbreak database maintained by the Ontario Ministry of Long-Term Care. We used hierarchical logistic and count-based methods to model the associations between profit status of LTC homes (for-profit, nonprofit or municipal) and COVID-19 outbreaks in LTC homes, the extent of COVID-19 outbreaks (number of residents infected), and deaths of residents from COVID-19.

Results: The analysis included all 623 Ontario LTC homes, comprising 75 676 residents; 360 LTC homes (57.7%) were for profit, 162 (26.0%) were nonprofit, and 101 (16.2%) were municipal homes. There were 190 (30.5%) outbreaks of COVID-19 in LTC homes, involving 5218 residents and resulting in 1452 deaths, with an overall case fatality rate of 27.8%. The odds of a COVID-19 outbreak were associated with the incidence of COVID-19 in the public health unit region surrounding an LTC home (adjusted odds ratio [OR] 1.91, 95% confidence interval [CI] 1.19-3.05), the number of residents (adjusted OR 1.38, 95% CI 1.18-1.61), and older design standards of the home (adjusted OR 1.55, 95% CI 1.01-2.38), but not profit status. For-profit status was associated with both the extent of an outbreak in an LTC home (adjusted risk ratio [RR] 1.96, 95% CI 1.26-3.05) and the number of resident deaths (adjusted RR 1.78, 95% CI 1.03-3.07), compared with nonprofit homes. These associations were mediated by a higher prevalence of older design standards in for-profit LTC homes and chain ownership.

Interpretation: For-profit status is associated with the extent of an outbreak of COVID-19 in LTC homes and the number of resident deaths, but not the likelihood of outbreaks. Differences between for-profit and nonprofit homes are largely explained by older design standards and chain ownership, which should be a focus of infection control efforts and future policy.

PubMed Disclaimer

Conflict of interest statement

Competing interests: Andrew Costa reports that he holds the position of Schlegel Chair at McMaster University, which was given as a gift by the Schlegel family (who own Schlegel Villages [a for-profit chain of long-term care and retirement homes] as well as other unrelated businesses). No other competing interests were declared.

Figures

Figure 1:
Figure 1:
Distribution of the extent of outbreaks of coronavirus disease 2019 (COVID-19) in long-term care homes, by profit status.
Figure 2:
Figure 2:
Distribution of the number of deaths from coronavirus disease 2019 (COVID-19) among residents in a long-term care home, by profit status.
See this image and copyright information in PMC

Comment in

References

    1. Barnett ML, Grabowski DC. Nursing homes are ground zero for COVID-19 pandemic JAMA Health Forum 2020. Mar. 24 Available: https://jamanetwork.com/channels/health-forum/fullarticle/2763666 (accessed 2020 May 1). - PubMed
    1. Hsu AT, Lane N, Sinha SK, et al. Understanding the impact of COVID-19 on residents of Canada’s long-term care homes — ongoing challenges and policy responses. London (UK): International Long-Term Care Policy Network; updated 2020 June 4. Available: https://ltccovid.org/wp-content/uploads/2020/06/LTCcovid-country-reports... (accessed 2020 July 1).
    1. Pandemic experience in the long-term care sector: How does Canada compare with other countries? Ottawa: Canadian Institute for Health Information; 2020. Available: www.cihi.ca/sites/default/files/document/covid-19-rapid-response-long-te... (accessed 2020 July 1).
    1. D’Adamo H, Yoshikawa T, Ouslander JG. Coronavirus disease 2019 in geriatrics and long-term care: the ABCDs of COVID-19. J Am Geriatr Soc 2020;68:912–7. - PubMed
    1. McMichael TM, Currie DW, Clark S, et al. Epidemiology of COVID-19 in a long-term care facility in King County, Washington. N Engl J Med 2020;382: 2005–11. - PMC - PubMed